Treatments for thrush
Over-the-counter antifungals are the treatment of choice when it comes to treating common fungal infections. They can be divided into the following groups:
- Imidazoles (e.g. clotrimazole, ketoconazole, miconazole, tolnaftate). Imidazoles are mainly used for vaginal thrush and fungal infections of the skin including athlete's foot and sweat rash. These compounds also act against certain bacteria. A variety of topical formats is available (e.g. creams, lotions, ointment, pessaries and sprays)
- Triazoles (e.g. fluconazole) are used to treat vaginal thrush and are available in oral format.
Imidazoles and triazoles work by inhibiting the synthesis of ergosterol, an essential component of fungal cell membranes. By inhibiting the enzyme 14-alphadimethylase, the cell is unable to build up demethyl-lanosterol out of lanosterol, and therefore also unable to build up ergosterol. When this important building block is missing, the cell membrane is damaged, cell contents leak and thus lead to the destruction of the fungus. Antifungal agents are often classed as fungistatic because they inhibit the growth of the fungus.
Whilst thrush is an infection that starts internally, women may only experience the external symptoms of vaginal itching and irritation. Therefore, when making a product recommendation it is important to offer products that will clear the internal infection and at the same time relieve the external symptoms of thrush. This will often mean recommending two products or a combination product, such as a pessary and external cream or an oral capsule and external cream.
Clotrimazole, the active ingredient in all topical Canesten products for thrush, is a broad spectrum imidazole derivative which was first synthesised at Bayer AG's research laboratories in 1967. It is highly effective, because it penetrates the skin in a sufficiently high concentration. As the active ingredient hardly reaches the blood stream, general side-effects due to a treatment with clotrimazole are not to be expected. A primary or secondary resistance of fungi against clotrimazole is unlikely. Furthermore, clotrimazole also has antibacterial properties.
