Boric Acid Beats Fluconazole for Candidiasis in Diabetics

Boric acid vaginal suppositories appear to be more effective than oral fluconazole in the treatment of diabetics with non-albicans Candida glabrata vulvovaginal candidiasis. Dr. Ravinder Goswami of the All India Institute of Medical Sciences, New Delhi and associates note that vulvovaginal candidiasis in diabetics is often due to a non-albicans Candida species such as C. glabrata or C. tropicalis. Observational studies, they add, indicate that diabetic patients with C. glabrata infection respond poorly to azole drugs.

To investigate further, the researchers randomized 111 diabetic women with vulvovaginal candidiasis to a single oral 150-mg dose of fluconazole or to 14 days of daily 600-mg boric acid vaginal suppositories.

C. glabrata was isolated from 68 (61.3%) of the patients and C. albicans was found in 32 (28.8%). C. tropicalis was identified in only 4 (3.6%) of the subjects.

In intention-to-treat analyses, 63.6% of boric acid patients with C. glabrata infection showed mycological cure compared to 28.6% of their counterparts treated with fluconazole (p = 0.01). Per protocol analyses yielded similar results (72.4% versus 33.3%).

There were no significant between-group differences in mycological cure rates in patients with C. albicans infection.
The researchers conclude that "boric acid therapy should be considered as the front-line therapy for treating vulvovaginal candidiasis in diabetic women as it is effective against both C. albicans and C. glabrata." Fluconazole, they add, "is effective against C. albicans only."

These suppositories of 600mg of boric acid powder capsules can be made by most pharmacists.
Diabetes Care 2007;30:312-317.

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