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After completing this case study, the reader should be able to:
Distinguish Candida vaginitis (vulvovaginal candidiasis, VVC) from other types of vaginitis.
Know when to refer a patient with symptoms of vaginitis to a physician for further evaluation and treatment.
Choose an appropriate treatment regimen for a patient with VVC.
Choose appropriate alternatives for a patient with recurrent VVC, while considering issues relating to non-albicans VVC.
Educate patients with vaginitis about proper use of pharmacotherapeutic treatments and nonpharmacologic management strategies.
“I’m having the same problem I had 2 weeks ago, and my doctor is away until next Monday. Can you give me some more of these suppositories?”
Sophie Kim is a 32-year-old woman who presents to your pharmacy with the above complaint. Upon further questioning, you find that she was diagnosed 3 weeks ago by her physician as having another vaginal Candida infection. She was prescribed nystatin suppositories 100,000 units intravaginally for 14 nights, which was the same as what she had been prescribed for her previous episode of vaginal candidiasis 2 months earlier. She stated that she finished the prescription 1 week ago and felt better then. However, 3 days ago she began to notice mild vaginal itching again. She thought it was her new control-top panty hose and stopped wearing them, but the itching got worse and became fairly severe with a burning sensation. There was also a white, dry, curd-like vaginal discharge that was nonodorous. This seemed to be identical to what she had experienced 3 weeks ago. Her physician is away until next week, and she wondered if the pharmacy can give her some more suppositories. Last month, she began using tights (with an adjustable waist) to help prevent varicose veins.
Diabetes type 1 since age 11. Her blood glucose is well controlled, and her physician is keeping a close eye due to her pregnancy.
Recurrent leg ulcers and foot infections for which she has been prescribed antibiotics on a frequent basis. Currently, there are no ulcers or infections, and she is not on antibiotics.
Nonsmoker; drinks alcohol in moderate amounts (one to two drinks maximum) at social functions. She is married and is 7½ months pregnant.
Insulin glargine 15 units SC Q AM for past year
Insulin lispro 6 units SC 15 minutes prior to breakfast, 8 units 15 minutes prior to lunch, and 10 units 15 minutes prior to dinner, for past 4 months