Have you used boric acid for Candida glabrata in pregnant patients?

From the Guidelines

I strongly advise against using boric acid for C. glabrata in pregnant patients due to potential risks to the fetus. Boric acid vaginal suppositories, although considered for non-pregnant women with resistant yeast infections like C. glabrata, as suggested by the Infectious Diseases Society of America in their 2016 clinical practice guideline update 1, are not recommended during pregnancy. This guideline suggests the use of topical intravaginal boric acid for C. glabrata vulvovaginitis unresponsive to oral azoles, but it does not specifically address pregnancy. Given the potential for systemic absorption and theoretical teratogenic effects, the use of boric acid in pregnant women is contraindicated. For pregnant patients with C. glabrata infections, consultation with an infectious disease specialist is crucial. Treatment options may include:

• Topical azoles for longer durations (7-14 days)
• In severe cases, oral fluconazole after the first trimester, with careful consideration of risks and benefits, as recommended by 1 for non-pregnant patients. Some clinicians use nystatin suppositories as an alternative, though efficacy against C. glabrata may be limited, as noted in the context of treatment options for vulvovaginitis 1. Management should focus on controlling symptoms while minimizing risks to both mother and fetus, with treatment decisions made on a case-by-case basis considering infection severity, gestational age, and patient-specific factors.

From the FDA Drug Label

When using this product • mild increase in vaginal irritation or burning may occur. Stop use and ask a doctor if • If symptoms persist or inflammation increases after 7 days of use or if the infection increases. • Increase in abdominal pain or foul discharge. Pregnant or Breast Feeding • Ask a Health Professional before use.

The use of boric acid in pregnant patients for C. glabrata is not directly addressed in the label. However, it does mention to ask a Health Professional before use in pregnant or breastfeeding patients.

• The label does not provide information on the effectiveness or safety of boric acid for C. glabrata in pregnant patients.
• It is recommended to consult a healthcare professional before using boric acid in pregnant patients 2.

From the Research

Treatment of C. Glabarata in Pregnant Patients

• The use of boric acid for treating C. Glabarata in pregnant patients has been studied in several research papers 3, 4, 5.
• According to a study published in 2003, topical boric acid treatment (600 mg daily for 2 to 3 weeks) achieved clinical and mycologic success in 64% of symptomatic women with C. Glabarata vaginitis 4.
• Another study published in 2011 reviewed the clinical evidence on the intravaginal use of boric acid for vulvovaginal candidiasis and found that boric acid is a safe, alternative, economic option for women with recurrent and chronic symptoms of vaginitis when conventional treatment fails 5.
• However, it is essential to note that boric acid treatment is not allowed in some countries, such as Germany, and its use should be approached with caution 3.

Efficacy of Boric Acid Compared to Other Treatments

• A study published in 2003 compared the treatment outcome of topical boric acid and flucytosine in women with C. Glabarata vaginitis and found that flucytosine was associated with a successful outcome in 90% of women whose condition had failed to respond to boric acid and azole therapy 4.
• Another study published in 2012 compared the efficacy of fluconazole and nystatin in the treatment of vaginal Candida species and found that fluconazole had a higher cure rate than nystatin, especially for non-albicans species like C. Glabarata 6.

Safety and Adverse Effects of Boric Acid

• The studies reviewed reported that boric acid is generally safe and well-tolerated, with few adverse effects, such as vaginal burning sensation, water discharge during treatment, and vaginal erythema 4, 5.
• However, it is crucial to carefully evaluate the risks and benefits of using boric acid in pregnant patients, as its safety profile may vary depending on individual circumstances 3.