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Pharmacy World and Science

, Volume 25, Issue 4, pp 129–134 | Cite as

Evidence-based guidelines for non-prescription treatment of vulvovaginal candidiasis (VVC)

  • M.C. Watson
  • C.M. Bond
Commentary

Abstract

In the UK, there has been a rapid increase in the reclassification of prescription only medicines (POMs) to pharmacy only (P) and general sales list (GSL) status. This means that community pharmacy staff have a greater range of non‐prescription medicines to recommend for the treatment of minor illness. Strategies are needed to promote good professional practice in the supply of non‐prescription medicines. Guidelines have been shown to promote quality of care in other health care settings. In this article, we present evidence based guidelines for the treatment of vulvovaginal candidiasis using non‐prescription anti‐fungal medicines.

Community pharmacy Evidence‐based practice Guidelines Vulvovaginal candidiasis 

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References

  1. 1.
    Royal Pharmaceutical Society of Great Britain. Bibliography: Prescription only medicines reclassified to pharmacy only medicines. London: RPSGB, 2001.Google Scholar
  2. 2.
    Department of Health. Pharmacy in the future - implementing the NHS Plan. A programme for pharmacy in the National Health Service. Department of Health. London: Department of Health, 2000.Google Scholar
  3. 3.
    Department of Health. Saving lives: executive summary. London: DoH, 1999.Google Scholar
  4. 4.
    Anonymous. Counter advice. Consumers are still not receiving the right advice when buying medicines from pharmacists. WHICH (April), 22–25, 1999.Google Scholar
  5. 5.
    Goodburn E, Mattosinho S, Mongi P, Waterston A. Management of childhood diarrhoea by pharmacists and parents: is Britain lagging behind the Third World? BMJ 1991; 302: 440–3.Google Scholar
  6. 6.
    Krska J, Greenwood R, Howitt E. Audit of advice provided in response to symptoms. Pharm J 1994; 252: 93–6.Google Scholar
  7. 7.
    Mobey N, Wood A, Edwards C, Jepson MH. An assessment of the response to symptoms in community pharmacies. Pharm J 1986; December 13: 807.Google Scholar
  8. 8.
    Nyirjesy P, Weitz M, Grody M, Lorber B. Over-the-counter and alternative medicines in the treatment of chronic vaginal symptoms. Obstet Gynaecol Surv 1997; 90: 50–3.Google Scholar
  9. 9.
    Sihvo S, Ahonen R, Mikander H, Hemminki E. Self-medication with vaginal antifungal drugs: physicians' experiences and women's utilization patterns. Fam Pract 2000; 17: 145–9.Google Scholar
  10. 10.
    Ferris D, Nyirjesy P, Sobel J, Soper D, Pavletic A, Litaker M. Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstet Gynecol 2002; 99: 419–24.Google Scholar
  11. 11.
    Sobel J, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy P et al. Vulvovaginal candidiasis: epidemiologic, diagnostic and therapeutic considerations. Am J Obstet Gynecol 1998; 178: 203–11.Google Scholar
  12. 12.
    Field MJ, Lohr KN. Guidelines for clinical practice. From development to use. Washington, DC: National Academy Press, 1992.Google Scholar
  13. 13.
    Deeks J, Glazier RH, Sheldon T. Undertaking systematic reviews on effectiveness: CRD guidelines for those carrying out or commissioning reviews. Centre for Review and Dissemination, No. 4. York, UK: York Publishing Services, 1996.Google Scholar
  14. 14.
    Anonymous. NPA launches training with a W-WHAM. Pharm J 1989; 40.Google Scholar
  15. 15.
    Sharpe S, Norris G, Ibbitt M, Staton T, Riley J. Protocols: getting started. Pharm J 1994; 253: 804–5.Google Scholar
  16. 16.
    Bisschop MPJM, Merkus J, Scheygrond H, Van Cutsem J. Cotreatment of the male partner in vaginal candidosis: a double-blind randomized control study. BJOG 1986; 93: 79–81.Google Scholar
  17. 17.
    Centers for Disease Control and Prevention. 1998 Guidelines for treatment of sexually transmitted disease. MMWR Morb Mortal Weekly Report 47(RR-1), 6–10, 1998.Google Scholar
  18. 18.
    Clinical Effectiveness Group (Association of Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases). National guideline on the management of vulvovaginal candidiasis. Sex Transm Infect 1999; 75: S19–S20.Google Scholar
  19. 19.
    Fong IW. The value of treating the sexual partners of women with recurrent vaginal candidiasis with ketoconazole. Genitourin Med 1992; 68: 174–6.Google Scholar
  20. 20.
    Bergman J, Berg A. How useful are symptoms in the diagnosis of candida vaginitis? J Fam Pract 1983; 16: 509–11.Google Scholar
  21. 21.
    Eckert LO, Hawes SE, Stevens C, Koutsky LA, Eschenbach DA, Holmes KK. Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. Obstet Gynecol 1998; 92: 757–65.Google Scholar
  22. 22.
    Geiger AM, Foxman B, Sobel JD. Chronic vulvovaginal candidiasis: characteristics of women with Candida albicans, C glabrata and no candida. Genitourin Med 1995; 71: 304–7.Google Scholar
  23. 23.
    Mårdh P, Tchoudomirova K, Elshibly S, Hellberg D. Symptoms and signs in single and mixed genital infections. Int J Gynaecol Obstet 1998; 63: 145–52.Google Scholar
  24. 24.
    McCormack WM, Starko KM, Zinner S. Symptoms associated with vaginal colonization with yeast. Am J Obstet Gynecol 1988; 158: 31–3.Google Scholar
  25. 25.
    Ryan C, Courtois B, Hawes S, Stevens C, Eschenbach D, Holmes K. Risk assessment, symptoms, and signs as predictors of vulvovaginal and cervical infections in an urban US STD clinic: implications for use of STD algorithms. Sex Transm Infect 1998; 74: S59–S76.Google Scholar
  26. 26.
    Abbott J. Clinical and microscopic diagnosis of vaginal yeast infection: a prospective analysis. Ann Emerg Med 1995; 25: 587–91.Google Scholar
  27. 27.
    Goldacre M, Watt B, Loudon N, Milne M, Loudon J, Vessey M. Vaginal microbial flora in normal young women. BMJ 1979; 1: 1453–5.Google Scholar
  28. 28.
    Wathne B, Holst E, Hovelius B, Mårdh P. Vaginal dischargecomparison of clinical, laboratory and microbial findings. Acta Obstet Gynecol Scand 1994; 73: 802–8.Google Scholar
  29. 29.
    Wright H. The prevalence and clinical diagnosis of vaginal candidosis in non-pregnant patients with vaginal discharge and pruritus vulvae. J R Coll Gen Pract 1978; 28: 719–23.Google Scholar
  30. 30.
    Handsfield H, Jasman L, Roberts P, Hanson V, Kothenbeutel R, Stamm W. Criteria for selective screening for chlamydia trachomatis infection in women attending family planning clinics. JAMA 1986; 255: 1730–4.Google Scholar
  31. 31.
    Eschenbach DA, Hillier SL, Critchlow C, Stevens C, DeRouen T, Holmes K. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol 1988; 158: 819–28.Google Scholar
  32. 32.
    Watson MC, Grimshaw JM, Bond CM, Mollison J, Ludbrook A. Oral versus intra-vaginal imidazole and triazole anti-fungal agents for the treatment of uncomplicated vulvovaginal candidiasis (thrush): a systematic review. BJOG 2002; 109: 85–95.Google Scholar
  33. 33.
    Watson MC, Grimshaw JM, Bond CM, Mollison J, Ludbrook A. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of acute, uncomplicated vulvovaginal candidiasis (thrush) (Cochrane Review). The Cochrane Library 2(2001).Google Scholar
  34. 34.
    Proprietary Association of Great Britain. OTC Directory 2000/2001. London: Communications International Group, 2000.Google Scholar
  35. 35.
    Watson M, Walker A, Bond C. Community pharmacists' views and beliefs about the treatment of symptoms of vaginal thrush in community pharmacies. PWS 2000; 22: 130–5.Google Scholar
  36. 36.
    Watson MC, Bond CM, Grimshaw JM, Mollison J, Ludbrook A, Walker A. Educational strategies to promote evidence-based community pharmacy practice: a cluster randomised controlled trial (RCT). Fam Pract 2002; 19: 529–36.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • M.C. Watson
    • 1
  • C.M. Bond
    • 1
  1. 1.Department of General Practice and Primary CareUniversity of AberdeenAberdeenUK E‐mail

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