The widespread availability of OTC azole antifungals does not appear to have increased the incidence of resistant candida species, according to a study from the North of England.

A retrospective review was performed of all vaginal yeast cultures collected from women with symptoms attending a sexual health clinic in Leeds between 2004 and 2008. Positive cultures were quantified and further tests were used to identify species. Women prescribed amphotericin and flucytosine vaginal cream nightly for a fortnight had their records reviewed for the outcome of treatment.

The number of all candida isolates increased with workload but the prevalence of non-albicans yeasts remained stable at 0.87-1.06%.

A total of 18 patients with non-albicans vaginal candidiasis were prescribed amphotericin and flucytosine vaginal cream; all were clear of their initial yeast isolate but two had persistent symptoms and had positive cultures for C. albicans which cleared with azoles.

In practice, we may see women with recurrent thrush or thrush resistant to treatment. We may treat syndromically (without any investigations) for simple cases. However, with recurrent or resistant cases, getting at least one swab that demonstrates candida and possibly another swab requesting testing specifically for Candida glabrata may help to support treatment with non-azole antifungals.

Dr Richard Ma