Therapeutic Tools for Vulvovaginal Candidiasis: Current and Emerging Antifungal Agents

TL;DR

This review discusses current and new treatments for vulvovaginal candidiasis, a common fungal infection, focusing on addressing drug resistance and improving therapeutic options.

Contribution

The paper introduces novel antifungal agents like ibrexafungerp and oteseconazole with new mechanisms of action for resistant cases.

Findings

Azole-resistant non-Candida albicans species are complicating VVC treatment.

Ibrexafungerp and oteseconazole show promise as new therapeutic options for resistant infections.

Emerging approaches like mucoadhesive formulations and immunomodulation are being explored.

Abstract

Vulvovaginal candidiasis (VVC) represents a widespread gynaecological challenge, affecting approximately 75% of women at some point during their reproductive years, with a significant subset progressing to recurrent forms (RVVC). Classical azoles and polyenes remain the cornerstone of therapy. However, their clinical utility is undermined by the rise of azole-resistant non-Candida albicans species, the capacity of Candida to form biofilms, and a complex variety of host-related factors that complicate disease expression and therapeutic response. This narrative review provides a critical up-to-date examination of the therapeutic landscape, integrating current diagnostic algorithms with pharmacological strategies for both acute, recalcitrant and recurrent VVCs. We assess the efficacy and safety of established antifungal agents alongside the breakthrough introduction of novel drug classes, with a particular interest in the oral triterpenoid ibrexafungerp and the tetrazole oteseconazole, which offer new mechanisms of action for cases that fail to respond to standard regimens. Furthermore, we address the management of a special clinical scenarios, including pregnancy and lactation, and explore promising emerging innovative approaches such as mucoadhesive formulations, immunomodulatory approaches, and alternative non-antifungal therapies. Ultimately, this review aims to support clinical decision-making by balancing the accessibility and user-friendliness of conventional treatments with the targeted precision offered by modern antifungal agents.

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