The best anti-thrush pills for women: rating of the top 5 inexpensive and effective remedies according to KP

Rectal candidiasis, like intestinal candidiasis, is provoked by the uncontrolled growth of fungi of the genus Candida. These organisms, under normal conditions, are a permanent component of the intestinal microflora and do not cause any harm to the human body: Candida fungi can be found in almost half of the healthy population. The rectum is the main habitat of most of the various Candida fungi.

Their number is carefully regulated by the work of the immune system and the percentage of these organisms, compared to other representatives of the intestinal microflora, is negligible. But with a general deterioration of the body’s defense system, fungi multiply, a large number of which cause the development of a disease such as rectal candidiasis.

Candidiasis - what is it

Candidiasis is a disease caused by a fungus of the genus Candida. This fungus is present in the vagina of the vast majority of women. In developed countries, Candida spores are recognized as a conditionally pathogenic flora. That is, the presence of traces of this fungus in tests is not an indication for treatment if there are no accompanying symptoms. The female vagina contains countless microorganisms. In each specific case, this is the individual composition of the flora.

When a person’s immunity is not weakened, pathogenic bacteria and fungi only provide balance to the constant environment. But as soon as the immunity weakens or an infectious infection occurs, allowing opportunistic microorganisms to gain numerical superiority over other representatives of the microflora, signs of the disease appear.

Candidiasis occurs in the following cases:

weakened immunity, for example, as a result of pregnancy;
the balance of the intestinal and vaginal microflora is disturbed, for example, as a result of poisoning or abuse of sweets, as well as after long-term use of large doses of antibiotics;
infection occurs after unprotected sexual intercourse with a partner who is a carrier of candidiasis;

Regardless of what caused the thrush, drugs from the group of fungicides are prescribed.

Intestinal candidiasis

Ph.D. Yu.O. Shulpekova

MMA named after I.M. Sechenov

In recent decades, opportunistic infections caused by opportunistic fungi have occupied a special place in the practice of clinicians of various specialties.

Paradoxically, this is partly due to the successes that modern medicine has achieved in the treatment of cancer and in the fight against pathogens of serious infections. In addition, it is obvious that in recent decades there has been an increase in the intensity of the impact on the human body of external factors that cause the development of immunosuppressive conditions. In addition, the end of the 20th century was marked by a significant spread of the fatal disease HIV infection.

Pathological conditions caused by the influence of fungi of the genus Candida on the human body also belong to the category of opportunistic mycoses.

Characteristics of the pathogen

Members of the genus Candida are yeasts related to Ascomycetes.

The genus Candida includes various species (Candida spp.), among which the main ones as causative agents of candidiasis are: Candida albicans, Candida tropicalis, Candida parapsilosis, Candida glabrata, Candida dubliniensis, Candida lusitaniae, Candida krusei.

Candida spp. They are a component of microflora that is symbiont for humans. In 10-25% of the population who do not have clinical signs of fungal infection, Candida spp. are inconsistently detected in the oral cavity, in 65-80% in the intestinal contents. Candida spp. are found in the detritus of gastroduodenal ulcers in approximately 17% of cases.

According to modern ideas, under normal conditions the main “habitat” of Candida spp. in the human body is the intestines. The proportion of these fungi in the intestinal microbial population is negligible. Growth of colonies of Candida spp. in the human body it is partly regulated due to the work of the immune system. The main place in this process is occupied by the links of nonspecific immunity: mononuclear phagocytes (monocytes/macrophages) and polymorphonuclear leukocytes [1,3].

Intestinal symbiont bacteria also play a very important role in limiting the growth of the Candida population. The normal microflora inhabiting the lumen of the gastrointestinal tract produces substances with antibacterial activity (in particular, bacteriokines and short-chain fatty acids), which prevent the introduction of pathogenic microorganisms and excessive growth, the development of opportunistic flora. Escherichia coli, enterococci, bifidobacteria and lactobacilli have the most pronounced antagonistic properties.

The term candidiasis implies a pathological process, the basis of which is the excessive growth of Candida primarily in the gastrointestinal tract and secondarily in other areas (on the mucous membrane of the genitals, bronchi, in parenchymal organs) [1,3,5].

Candida virulence factors

Fungi of the genus Candida are adhesive to epithelial cells. Attachment to the mucous membrane is one of the conditions for further invasion of the microorganism into the underlying tissue. The adhesion capacity of different Candida species varies considerably; this ability is highest in C. albicans, C. tropicalis, C. dubliniensis; the smallest in Candida glabrata, Candida krusei. Mucin, a glycoprotein of the cell wall of epithelial cells, plays an important role as a protective barrier that prevents the microbe from attaching to the mucous membrane.

Factors of aggression of these microorganisms include proteases and glycosidases that can intensively break down mucin.

The ability to rapidly form filaments of pseudomycelium is also considered as a virulence factor; this feature is most pronounced in C. albicans.

The virulence of microorganisms is subject to intraspecific variability, depending on the genotype [1,3].

Risk factors for developing candidiasis

As general factors predisposing to the development of candidiasis of the digestive organs and subsequent lymphohematogenous dissemination of fungi, as in the cases of other opportunistic infections, are conditions in which there is a lack of immune defense of the body. These include:

1) Physiological immunodeficiencies (newborn period and early childhood, senile immunodeficiency, pregnancy, stress conditions).

2) Congenital immunodeficiencies (DiGeorge, Nezelof, Shediac-Higashi syndrome, etc.).

3) Infection with the human immunodeficiency virus in the terminal stage (acquired immunodeficiency syndrome). Mycoses make up 70% of the clinical manifestations of HIV infection.

4) Oncological diseases (including hematological malignancies); chemotherapy of malignant tumors, accompanied by severe granulocytopenia (<1x109 granulocytes per l). The development of candidiasis during antitumor therapy is usually associated with suppression of the functions of the immune system, observed as an undesirable effect of treatment. At the same time, there are suggestions that cytostatics and radiation therapy inhibit the protective functions of the intestinal epithelium and promote the translocation of Candida to other organs. During chemotherapy, the percentage of fungal microorganisms adhering to enterocytes increases.

5) Autoimmune and allergic diseases, especially when prescribing glucocorticosteroids.

6) Organ transplantation (use of immunosuppressants in the post-transplant period). More than half of patients scheduled for bone marrow transplantation have a picture of systemic candidiasis even before transplantation.

7) Endocrinopathies (decompensated diabetes mellitus, autoimmune polyglandular syndrome).

Other diseases and conditions (shock conditions, anemia, hepatitis, cirrhosis of the liver, chronic infections, malabsorption syndrome, etc.). In pathological conditions accompanied by a decrease in blood supply to the intestine, the translocation of fungi into other tissues increases. Digestion and absorption disorders are accompanied by excessive growth of microorganisms in the intestinal lumen.

9) Antibiotic therapy (usually long-term use of broad-spectrum drugs). The introduction of antibacterial drugs can lead to an imbalance in the microbial biocenosis of the intestine, as a result of which excessive development of the candidal population in the intestine is possible. Prescription of tuberculostatic drugs for 3-4 months. accompanied by the development of intestinal candidiasis in 58-62% of cases. The risk of developing idiopathic antibiotic-associated diarrhea depends on the dose of antibiotic administered; this disease usually occurs without fever and leukocytosis in the blood and in the absence of laboratory signs of Clostridium difficile infection. It is believed that in about a third of cases, the development of idiopathic antibiotic-associated diarrhea is caused by intestinal candidiasis.

10) Unbalanced nutrition (deficiency in the diet of proteins, vitamins). Animal experiments have shown that insufficient protein intake into the body is accompanied by a decrease in the phagocytic and bactericidal activity of the macrophage component, incomplete phagocytosis and an increase in the permeability of the intestinal barrier to Candida albicans [1,3,4,5].

According to autopsy data, candidiasis of the duodenum, small and large intestine is found in approximately 3% of dead patients (only macroscopic changes were taken into account). Moreover, half of the cases occur in patients receiving chemotherapy for malignant neoplasms [1].

Pathogenesis of the development of intestinal candidiasis

Research in recent years has largely clarified the patterns of interaction between Candida fungi and the host organism. According to modern concepts, two fundamentally different mechanisms of the pathogenesis of candidiasis of the digestive organs can be distinguished: invasive and non-invasive candidiasis [3].

Invasive candidiasis is caused by the introduction of a filamentous form of the Candida fungus into tissues. The first stage of candidiasis, as an infectious process, is adhesion to epithelial cells, then invasion occurs into the epithelial layer, penetration beyond the basement membrane. These manifestations of microbial aggression macroscopically correspond to erosive and ulcerative defects of the intestinal wall of various sizes and shapes, cracks, membrane deposits (similar to those in pseudomembranous colitis), polypoid or segmental circular formations.

With progressive invasion, the development of lymphohematogenous dissemination of fungi is possible (systemic candidiasis with damage to the mucous membranes of other organs; generalized candidiasis with damage to visceral organs). An experimental model of animals orally infected with C. albicans under conditions of immunosuppression showed the initial occurrence of erosions and ulcers of the mucous membrane in the ileum, colonization of intestinal lymphoid formations, their necrosis and further dissemination. The absence of macroscopic changes should probably not be considered as evidence against invasive candidiasis.

In disseminated forms of candidiasis, multinucleated giant cells containing fungi are found in the lymph nodes and ducts, which probably reflects the phenomenon of incomplete phagocytosis.

Invasive candidiasis is more often observed in organs lined with stratified squamous epithelium (oral cavity, esophagus), and less often with columnar epithelium (stomach, intestines), which is probably due to the peculiarities of local immune defense.

Non-invasive candidiasis is not accompanied by the transformation of the fungus into a filamentous form; There is an excessive growth of its colonies in the lumen of the hollow intestinal organ. It is assumed that the disruption of cavity and parietal digestion, the penetration of microbial components and metabolites into the systemic bloodstream, and the development of a more or less pronounced systemic immune-inflammatory reaction are of important pathogenetic significance.

Based on all of the above, it should be emphasized once again that mucosal candidiasis of extraintestinal localization or generalized candidiasis with damage to parenchymal organs is a manifestation of the translocation of fungi from the intestinal lumen, where the bulk of these saprophytic fungi are represented. Candidiasis of extraintestinal localization (for example, the oral cavity or genitals) is a manifestation of systemic candidiasis, originating from the intestines.

The following is the classification of candidiasis of the digestive organs:

1. Oropharyngeal candidiasis (cheilitis, gingivitis, seizures, glossitis, stomatitis, pharyngitis).

2. Esophageal candidiasis (complications: bleeding, stricture).

3. Gastric candidiasis:

diffuse (specific erosive-fibrinous gastritis);

focal (secondary to gastric ulcer).

4. Intestinal candidiasis:

invasive diffuse;

focal (secondary to duodenal ulcer, with nonspecific ulcerative colitis);

non-invasive (overgrowth of Candida in the intestinal lumen).

5. Anorectal candidiasis:

invasive candidiasis of the rectum,

perianal candidal dermatitis.

Below we describe the main manifestations of candidiasis of the intestine, which, as mentioned above, is the basis for the development of systemic manifestations.

Clinical picture of intestinal candidiasis

The features of the course of intestinal candidiasis are not clearly defined, not well studied and little known to most practicing doctors. It is characteristic that in patients who died from various causes and whose autopsy revealed macroscopic changes in the intestine corresponding to invasive candidiasis, during their lifetime, as a rule, very scanty symptoms from the gastrointestinal tract were noted, and the endoscopic diagnosis was often erroneous. Often, when single ulcerations of the intestinal wall are detected, the doctor finds it difficult to interpret them, and based on the results of a morphological study, a conclusion is given about nonspecific inflammatory changes in the edges of ulcerative defects, while a targeted mycological study is not carried out.

Clinical manifestations of intestinal candidiasis may vary depending on the level of damage.

With diffuse invasive intestinal candidiasis, there are manifestations of enterocolitis: complaints of spastic abdominal pain, flatulence, the presence of pathological impurities in the stool (blood and mucus), there are usually signs of systemic candidiasis (damage to the mucous membranes of the oral cavity, genitals). Endoscopic examination reveals changes similar to fibrinous ulcerative colitis.

With invasive focal intestinal candidiasis, the manifestations of the disease may resemble a persistent course of duodenal ulcer or nonspecific ulcerative colitis, resistant to traditional therapy.

With non-invasive intestinal candidiasis, patients complain of loose stools, flatulence, abdominal discomfort, with positive clinical and laboratory dynamics when treated with antifungal drugs.

With invasive candidiasis of the rectum, symptoms of proctitis (pain, tenesmus, pathological impurities in the stool) may be observed. In some cases, this is accompanied by the phenomenon of perianal candidodermatitis.

Intestinal candidiasis is often accompanied by low-grade fever [1,3,5].

Complications

As complications of intestinal candidiasis, it is possible to develop intestinal perforation, penetration of ulcers into surrounding organs, bleeding, generalization with damage to parenchymal organs, and the development of fungal sepsis.

Damage to parenchymal organs (liver, gallbladder, pancreas, etc.) very often accompanies deep neutropenia (less than 500 neutrophils per mm3 of blood) and is observed in the terminal phase of AIDS [1,3,5].

The mortality rate for invasive candidiasis reaches 25-55%. For some categories of patients (transplant recipients, patients with acute leukemia), invasive mycoses are the main cause of death.

Diagnostics

The issue of diagnosing intestinal candidiasis and determining indications for antifungal therapy is extremely important.

In recognizing mucosal candidiasis, it is necessary to distinguish between physiological “candidiasis” and the infectious process caused by this fungus.

For the diagnosis of candidiasis, the detection of Candida in sterile fluids (cerebrospinal fluid, lavage fluid, peritoneal fluid, etc.) or the detection of fungi in tissues (changes such as granulomas with necrosis are often found) are absolutely informative.

To increase the sensitivity of cultural and morphological methods for diagnosing candidiasis, it is recommended to examine several biopsies of the mucous membrane.

The biopsied tissue is collected in 2 sterile Petri dishes or sterile jars with a screw cap; one sample is filled with a 10% formaldehyde solution and sent for histological examination, the second is used for mycological examination. The material is transported to the microbiological laboratory, protected from direct sunlight. It is necessary that the material be delivered for mycological examination no later than 1 hour after collection when stored at room temperature or no more than 3 hours when stored at +4ｰC.

Microscopic examination must be carried out in native and stained preparations.

The CHIC reaction (treatment with chromic acid) or its modification, Gridley staining, makes it possible to identify the pathogen in a tissue or smear by staining the polysaccharide components of the cell wall; To suppress the color of surrounding tissues, a “counter-paint” with light green, methanil yellow, etc. is used. In this case, only invading fungal cells are detected, while at the same time it is impossible to judge the reaction of the surrounding tissues. Therefore, it is also necessary to evaluate preparations “counter-stained” with hematoxylin and eosin.

Pseudomycelium of Candida can also be detected in a smear of the mucous membrane or a smear of the bottom of the ulcer (Romanovsky Giemsa stain).

An imprint is made on the surface of a dense nutrient medium in a Petri dish with a piece of tissue being examined, then sieving is carried out with a loop. The same piece of tissue is placed in 50 ml of liquid nutrient medium (Sabouraud medium, wort) and incubated at +37ｰC for 5 days.

Methods for rapid identification of C. albicans are widely used. This species of Candida is capable of forming germ tubes and short filaments of pseudomycelium within 2-4 hours at +37ｰC on blood serum, egg white and other similar media. For the species C.albicans, this phenomenon is typical in 90% of cases.

For effective treatment, it is necessary to strive to determine the species of Candida fungi and determine the individual sensitivity of the strain to antimycotic agents; some strains of Candida lusitanlae are resistant to amphotericin, and Candida krusei and Candida glabrata are resistant to fluconazole.

Detection of Candida in the blood allows a diagnosis of generalized candidiasis to be made only in combination with appropriate clinical symptoms (repeated detection of Candida in the blood is especially informative). It should be remembered that in 70-80% of patients who actually suffer from generalized candidiasis, fungi cannot be detected by blood culture.

The value of serological methods consists mainly in identifying patients with probable invasive mycoses. False-positive results of serological tests are possible with mycocarriage and in healthy people sensitized by fungal antigens; false-negative tests can occur in immunodeficiency.

Original procedures for the detection of antigens and antibodies of some metabolites of fungal cells are proposed; special diagnostic kits have been created. An example is Pastorex Candida, for the determination in the latexagglutination reaction of repeating oligomannose epitopes of antigenic structures expressed on a large number of fungal macromolecules. The Platelia Candida kit can be used to detect Candida antigen-mannan, for example, in the blood serum of a patient with the organism circulating. Using the first kit, the threshold for determining antigenic structures is 2.5 ng/ml; using the second in conjunction with the method, the threshold for determining antigenic structures is 0.5 ng/ml.

In the diagnosis of non-invasive intestinal candidiasis, in which there is no tissue biopsy material for mycological examination, it is proposed to use the following criteria as a diagnostic standard: growth over 1000 CFU/g Candida spp. when inoculating intestinal contents taken under sterile conditions, in combination with symptoms of intestinal dyspepsia and positive clinical and laboratory dynamics during treatment with antimycotic drugs [1]. Unfortunately, proper collection of intestinal contents for culture is technically challenging; The widespread method of stool culture for dysbacteriosis in our country cannot serve as a basis for assessing the actual composition of the intestinal microflora [1,3,5].

In diagnosing any form of candidiasis of the digestive organs, it is important to take into account the presence of predisposing risk factors in the patient. The incidental detection of candidiasis should serve as an incentive to search for such a background factor. It is important to remember that candidiasis can act as an early manifestation of common diseases accompanied by the development of immunodeficiency.

Considering the above, it would probably not be entirely correct to formulate the diagnosis briefly as “Candida” without indicating the underlying condition.

The differential diagnosis of invasive intestinal candidiasis (if macroscopic changes in the intestine are detected) must be made with chronic inflammatory bowel diseases, antibiotic-associated diarrhea due to C. difficile infection, malignant lesions, and ischemic colitis. The non-invasive form of candidiasis should be differentiated from a wide range of enteritis and colitis of other etiologies. Indirect evidence in favor of the presence of intestinal candidiasis may be extraintestinal systemic manifestations of candidiasis.

Treatment

It should be emphasized once again that the mere detection of fungi of the genus Candida during bacteriological analysis of feces (according to the accepted method in Russia), regardless of the presence or absence of symptoms of intestinal dyspepsia, cannot serve as an indication for prescribing antifungal drugs to the patient.

To treat intestinal candidiasis, it is necessary to prescribe drugs that are not absorbed from the intestinal lumen.

Today there are a variety of antimycotic agents. Drugs such as amphotericin B, itraconazole, ketoconazole, fluconazole have a systemic effect and can be used topically, orally and intravenously. When administered orally, these drugs are almost completely adsorbed from the upper gastrointestinal tract and do not reach the level of the ileum, where the main population of fungi is concentrated. In addition, the use of systemic antifungal drugs is often accompanied by side effects, in particular, the development of toxic hepatitis.

Practically non-absorbable antimycotic agents include levorin, nystatin and natamycin (Pimafucin). The prescription of levorin and nystatin with a fairly high frequency is accompanied by the development of side effects (dyspeptic symptoms, allergies, toxic hepatitis).

Pimafucin (natamycin) is a broad-spectrum antifungal polyene antibiotic. Has fungicidal potential. Pimafucin binds sterols of cell membranes, disrupting their integrity and functions, which leads to the death of microorganisms. Most pathogenic yeasts are sensitive to natamycin, most notably Candida albicans. Pimafucin is more effective than nystatin. There have been no cases of natamycin resistance in clinical practice; with repeated use of this drug, its minimum inhibitory concentration against C. albicans does not change. Pimafucin tablets act only in the intestinal lumen and are practically not absorbed from the gastrointestinal tract.

When using tablets in the first days of treatment, dyspeptic symptoms such as nausea and diarrhea are possible, which do not require discontinuation of the drug and resolve independently during treatment. The only contraindication to the use of Pimafucin is hypersensitivity to the components of the drug. Pimafucin can be prescribed during pregnancy and lactation, as well as newborns.

To treat intestinal candidiasis, a course of treatment with non-absorbable antifungal drugs is required for 710 days. Nystatin is prescribed 250,000 units 68 times a day (daily dose up to 3 million units) for 14 days. It is prescribed 100 mg (1 tablet) 2-4 times a day for 710 days [1].

Based on the above provisions and clinical experience, we have to admit that the tactics of treating candidiasis of the mucous membranes of extraintestinal localization only with local antifungal agents or systemic drugs absorbed from the gastrointestinal tract are inherently erroneous. Since the source of lymphohematogenous spread of virulent Candida strains that cause systemic candidiasis is the intestine, without suppressing the growth of fungi in its lumen, antifungal therapy is ineffective or only a short-term unstable effect is observed. For systemic candidiasis, the dose of nystatin can be increased to 46 million units/day, while a locally active antifungal agent is prescribed. For systemic candidiasis, Pimafucin is used in the same dose while simultaneously prescribing a locally active antifungal agent. In severe cases, drugs with systemic action are added to complex therapy [1,5].

Timely recognition and treatment of intestinal candidiasis is especially important as a prevention of systemic and generalized candidiasis in patients at risk, which primarily include patients receiving antitumor radiation and/or chemotherapy, anti-tuberculosis drugs, and patients preparing for planned operations on the abdominal organs. In these situations, it is most preferable to prescribe non-absorbable antifungal drugs, since their long-term and repeated use does not significantly affect the pharmacodynamics of other drugs.

The main criterion for the effectiveness of therapy is not obtaining a negative culture result for fungi, but, first of all, the disappearance of the main manifestations of the disease, normalization of the number of fungi according to mycological research (if adequate culture of intestinal contents is possible). To achieve an effect, it is often necessary to resort to repeated courses of treatment [1].

This article aimed to expand the understanding of practitioners about the flexibility of interaction between the human body and symbiont microflora, and about the pathogenic potential that the harmless intestinal commensal Candida has. Internists and specialists in medical mycology are faced with the urgent tasks of clearly determining the prevalence and clinical significance of fungal infections in clinical practice, developing a diagnostic algorithm and indications for treatment of intestinal candidiasis.

Literature:

1. Zlatkina A.R., Isakov V.A., Ivanikov I.O. Intestinal candidiasis as a new problem in gastroenterology. // Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2001. No. 6. P.3338.

2. Danna PL, Urban C., Bellin E., Rahal JJ Role of Candida in the pathogenesis of antibiotic-associated diarrhoea in elderly patients.//Lancet/1991.Vol.337.P.511514.

3. Prescott RJ, Harris M., Banerjee SS Fungal infections of small and large intestine.//J.clin.Path.1992.Vol.45.P.806811.

4. Redmond HP, Shou J, Kelly CJ et al. Proteincalorie malnutrition impairs host defense against Candida albicans.//J.Surg.Res.1991.Vol.50.P.552559.

Published with permission from the administration of the Russian Medical Journal.

Symptoms of thrush

One of the most striking and recognizable symptoms is copious curdled vaginal discharge. They do not always have a characteristic smell. However, thrush may initially present itself differently, before heavy discharge becomes noticeable:

redness of the mucous membrane of the labia minora, a feeling of sticking together;
burning sensation spreading to the inner surface of the labia minora during contact with water or during urination;
itching at the entrance to the vagina;
peeling, spreading not only to the genital area, but also to the anus.

In men, thrush appears as a white coating and rash that covers the head of the penis. If candidiasis in a man was caused by a malnutrition (poisoning or excessive consumption of sweets), then the disease will manifest itself as itching around the anal ring.

Candidiasis can affect not only the mucous membranes of the genital organs. In infants, thrush often occurs in the mouth when the body experiences a lack of fluid. In adults, oral thrush may appear after taking large doses of antibiotics. It manifests itself as redness of the inner surface of the cheeks, tongue and gums. An astringent sensation is created in the mouth, accompanied by a white coating.

Drugs for candidiasis

For women, the most effective medications are those available in the form of vaginal suppositories. They act locally and, as a rule, allow you to get rid of unpleasant symptoms after a couple of uses. Modern pharmacology offers drugs, including for pregnant women.

Men are prescribed antifungal medications in the form of creams that work when applied to the infected area of the genitals or anus. In special cases, including relapses, tablets are prescribed for the systemic treatment of thrush.

Each product contains an active substance that does not allow Candida fungi to multiply.

Rating of the top 5 inexpensive and effective tablets for thrush according to KP

Among all the drugs against thrush, tablet forms stand out. They can be used either orally, having a systemic effect, or locally, inserted into the vagina and fight the growth of fungus in the affected area. It is important not to confuse the forms of the medicine when purchasing drugs, otherwise the effect will not be what you expect. Let's look at both tablets and capsules for thrush.

Diflucan

Diflucan.
Photo: market.yandex.ru Available in the form of capsules of different dosages, as well as solutions for intravenous administration. Available without a prescription (except for solution). The main active ingredient is fluconazole. It is active against most fungi of the genus Candida and cryptococci, therefore it is effective both in acute thrush and in recurrent forms of infection, chronic bacterial vaginosis. It can also be used in a partner to prevent recurrence of the fungus after treatment in a woman.

In case of acute uncomplicated candidiasis, one tablet in a high dose is often sufficient to completely suppress the infection. In case of a chronic process, the duration of the course will be determined by the doctor. It is highly effective against fungal infections, easy to use, and has few side effects. Relief of symptoms occurs within a day after administration.

Nystatin

Nystatin. Photo: Biosynthesis

The remedy has been known for many years; it is one of the first antifungal drugs. Available in the form of tablets, vaginal suppositories, ointments for external use, and is part of many combination drugs. Dispensed with a doctor's prescription, used in a course, the duration of which is determined by a specialist.

Nystatin is indicated only for the treatment of acute, uncomplicated forms of thrush or its prevention. Helps fight the proliferation of fungi without being absorbed into the blood. For special indications, it can be used in pregnant and lactating women; it helps to quickly suppress the symptoms of candidiasis, including after a course of antibiotics. The longer the course of treatment, the higher the risk of side effects, which mainly include digestive disorders (nausea, abdominal cramps).

Pimafucin

Pimafucin. Photo: Astellas Pharma Europe BV

The drug has several forms of release - these are tablets, vaginal suppositories, cream for topical use, the main active ingredient is natamycin, a powerful antifungal component. Dispensed without a doctor's prescription.

It belongs to drugs with a minimum number of side effects and a high safety profile, effectively combating both acute, uncomplicated and chronic forms of candidiasis. Allowed during pregnancy and breastfeeding (as prescribed by a doctor); a cream for topical use and suppression of fungal growth is indicated for the partner during treatment of the woman.

For acute candidiasis, only local forms of treatment are sufficient; for recurrent forms of infection or severe chronic candidiasis, a combination of local forms with oral administration of the drug is indicated. The effect occurs a day after the start of treatment, but it is important to complete the entire course prescribed by the doctor in order to completely suppress the activity of fungi and prevent relapse. In parallel, treatment of the partner is recommended.

Clotrimazole

Clotrimazole. Photo: GlaxoSmithKlin0e Pharmaceuticals, SA

This is a drug for the local treatment of thrush, available in the form of vaginal soluble tablets and solutions, ointments for topical use. This drug is included in some combination topical medications. Available without a prescription.

The drug is used for the treatment of acute forms of thrush and recurrent pathologies, as part of complex therapy. Acceptable during pregnancy and nursing, but in consultation with a doctor. It has a small number of side effects, mainly in the form of increased discharge and discomfort in the intimate area during treatment. At the same time, you can treat your partner using a form of cream. The medicine is well compatible with other types of drugs, including antibiotics.

Klion and Klion-D

Klion-D. Photo: Gedeon Richter – RUS

Tablets for the treatment of thrush for both oral and local use (in the form of Klion-D). The oral tablets contain metronidazole, and the local form of the drug contains a combination of metronidazole and miconazole. Available by prescription, used in a course for recurrent or chronic thrush; you can combine two forms to achieve a more lasting and quick result.

The local form of the drug has a complex effect - bacteriostatic and antifungal, which helps in the treatment of complex forms of vaginosis. It has a number of contraindications and special instructions for use, therefore it is prescribed only by a doctor. Prohibited in the first trimester of pregnancy; in the presence of diabetes, it is prescribed with extreme caution. To achieve a lasting effect, a full course of treatment is necessary, even if all symptoms of thrush disappear at the beginning of therapy. It is used at night, before bedtime, is well tolerated, and has minimal side effects.

Suppositories Livarol

Suppositories for the treatment of fungal vulvovaginitis have ketoconazole as the active substance. This substance stops the vital activity of not only fungi, but also some bacteria, including staphylococcus and streptococcus. The substance helps well with primary infections. In the case of a chronic form of thrush, Livarol will not have the expected effect, because ketoconazole is a substance to which Candida fungi become resistant over time.

Livarol will cope with a mild form of thrush in 5 days. In special cases, the doctor may prescribe a 10-day course. The drug is sold in appropriate dosages: 5 and 10 suppositories per package.

The suppositories, once in the vagina, quickly take on a liquid form and envelop the mucous membranes of the organ. To achieve the maximum duration of contact of the substance with the contaminated surface, it is better to place suppositories at night. So that when the medicine becomes liquid, it does not leak out of the vagina.

Symptoms of the disease

Candidiasis manifests itself in different ways

Candidiasis can manifest itself in different ways, depending on the form and severity of the disease. Common factors for excessive fungal activity in the intestines include:

diarrhea – loose, frequent stools
flatulence - bloating of the intestines and increased formation of gases in it
there may be mucus or blood in the stool
discomfort and painful cramps in the abdominal area
elevated temperature (37-37.5 degrees)

In addition to all this, invasive fungal infection is characterized by a general inflammatory process in the intestine and its parts. The disease may be accompanied by oral candidiasis, systemic candidiasis and candidiasis of the urogenital area. Also, this disease can occur together with duodenal ulcer, often accompanied by ulcerative colitis. The disease is often resistant to treatment.

Inflammatory processes in the rectum - candidiasis, which most often affects homosexuals and AIDS patients. The course of the disease is characterized by frequent pain, false urge to defecate and constant itching in the anal area. In some cases, the disease is accompanied by perianal candidodermatitis.

Intestinal candidiasis can also occur in young children. This can be dangerous because, due to diarrhea, children begin to lose many different vitamins and other nutrients that they need for proper growth. As a result, children begin to lag behind in physical development, and their growth rates are lower than they should be.

The drug Clotrimazole

Clotrimazole is available in both ointment and tablet form. But the tablets are not intended for oral administration. They are used as suppositories, placed in the vagina. The active substance is clotrimazole. It disrupts the production of their main component by fungal cells. As a result, the fungus first cannot reproduce and then dies. The main advantage of vaginal tablets is their low cost.

The main contraindication to the use of Clotrimazole is pregnancy. In other cases, in the absence of allergic reactions to the drug, the drug can be used both at the first manifestations of thrush and in case of relapse.

Pimafucin for thrush

The main advantage of Pimafucin is the safety of use in pregnant and lactating women. The initial stages of the disease are easily eliminated with three suppositories. The active ingredient in Pimafucin is natamycin. It is a strong antifungal agent that can relieve a woman of candidiasis in three days. As a rule, the drug does not cause addiction, so it can successfully treat relapses of fungal infections.

I often use Pimafucin to treat both partners. This drug is available in the form of suppositories, creams and tablets for oral administration. The only downside of this drug is the price, which is slightly higher in comparison with other drugs.

How to choose anti-thrush pills for women

Today, pharmacies offer a wide selection of different drugs that are aimed against fungal infections, including candida. All drugs are divided into two large classes:

medications that have a systemic effect on the body - they are taken orally and are in the form of capsules or tablets;
medications for topical use that act directly at the site of infection - these include creams, gels, ointments, solutions and vaginal suppositories (suppositories), soluble tablets or capsules.

When choosing tablets or other forms of drugs for thrush in women, you should consult your doctor. He can prescribe drugs not only with antifungal action, but also with combined agents that restore microflora, have an anti-inflammatory effect. The selection should be based on the following criteria:

the main active ingredient that inhibits the growth of Candida fungi;
dosage of the drug and frequency of its administration, duration of the course;
speed of absorption of components and speed of onset of effects;
possible side effects that can be extremely unpleasant;
list of contraindications.

Thrush in women

Symptoms and recommendations of doctors for the treatment of this disease

Today, several groups of antifungal drugs have been identified that help in the treatment of thrush. They affect the pathogen differently and have a different range of effectiveness for acute or chronic thrush.

Polyene drugs (for example, Nystatin or Levorin) are of natural origin, affect yeast, destroying their cell membrane, and help in the prevention of fungal infection. They may not be suitable for recurrent forms; fungi develop resistance to them.

Triazole agents (for example, Diflucan or Flucostat) help suppress the reproduction and growth of fungal colonies, are eliminated from the body for a long time, the course of treatment is short, and are suitable for chronic forms of infection.

Imidazole drugs (for example, Ketoconazole or Clotrimazole) help disinfect mucous membranes, penetrate deep into them, helping to fight recurrent forms of fungal infections.

Macrolide drugs (for example, Pimafucin or Natamycin) have a wide spectrum of activity in mixed flora and a small number of side effects.

Combined agents are drugs that combine several components at once - antifungal, anti-inflammatory, antimicrobial. They help eliminate chronic and severe, advanced fungal infections.