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Vaginal Infection Management

Rukmono Siswishanto
Depatment of Obstetrics & Gynecology
Dr. Sardjito Hospital/
School of Medicine Gadjah Mada University
Yogyakarta
 Introduction
Why Vaginal Infection is
important?
Dequalinium chloride: better
Outline locally delivered?

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Infective
Non-STI
STI

Non-infective

Vaginal Discharge

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Trends in Endocrinology & Metabolism, July 2016, Vol. 27, No. 7

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Vaginal Infectious Disease in
Different Flora Types

Best Practice & Research Clinical Obstetrics and Gynaecology Vol. 21,
No. 3, pp. 355373, 2007 5
Vaginal Infection

70%
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Metronidazole
Tinidazole
Clindamycin
Azole (clotrimazole, miconazole, fluconazole, itraconazole)
Doxycycline
Azithromycin
Erythromycin
Ceftriaxone
Cefixime
Ciprofloxacin
Ofloxacin
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(Algorithms for Obstetrics and Gynaecology, 2014)
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 Local vs systemic route
Significant proportion of
patients do not achieve an
adequate response
Recurrence of BV/ VVC
frequently occurs
Drug resistance may develop
Risk of post-treatment
candidiasis How to improve?
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Anaerobic gram-negative rod resistant

American Journal of Obstetrics and Gynecology (2004) 191, 1124-9

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 Estimated 2.5 to 5 ml
10 mg of vaginal fluid
vaginal (4000-2000 mg/l)

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 In vitro antimicrobial activity of DQC
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Arch Gynecol Obstet (2016) 293:469484
MIC of a. vaginae (different strains) for
DQC, clindamycin and metronidazole

(Dos Santos Santiago GL, et al. 2012)

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Dequalinium chloride 10 mg Povidone iodine 200 mg

(Petersen EE, et al. 2002)

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 DQC

Bacterial vaginosis Vulvovaginal candidosis

The total symptoms score

vaginal discharge
burning
pruritus (Petersen EE, et al. 2002)
redness of vulva/vagina

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 Incidence of post-treatment
BV Clinical cure rate symptomatic and culture-positive VVC

DQC DQC

(Weissenbacher ER, et al. 2012)

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Local tolerance (ADRs 2,4-7,8%)
Pregnant women (No ADRs, 1st
trimester use)
Minimal vaginal absorption

(Grishchenko, 2006; Demina, 2005)

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From a clinical point of view DQC could
offer an attractive treatment for vaginal
infections, both for BV and VVC as well as
in case of mixed infections

Thank you
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