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Quercus Brantii Lindl. Vaginal Douche Versus Clotrimazole on Vaginal Candidiasis - a Randomized Clinical Trial

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Quercus Brantii Lindl. Vaginal Douche Versus Clotrimazole on Vaginal Candidiasis - a Randomized Clinical Trial ISSN 2093-6966 [Print], ISSN 2234-6856 [Online] Journal of Pharmacopuncture 2018;21[3]:185-194 DOI: https://doi.org/10.3831/KPI.2018.21.022 Original article Quercus Brantii Lindl. Vaginal Douche Versus Clotrimazole on Vaginal Candidiasis - A Randomized Clinical Trial - Zeinab Moshfeghy1,2 *, Khadegeh Asadi2, Marzieh Akbarzadeh3, Atefeh Zare2, Ta- hereh Poordast4,5, Masoumeh Emamghoreishi6, Fatemeh S.Najib4,5, Mehrab Saya- di7 1 Community Based Psychiatric Care Center, Shiraz University of Medical Sciences, Shiraz, Iran 2 Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran 3 Maternal-Fetal Research Center, Department of Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran 4 Infertility Research Center, Shiraz University of Medical Science, Shiraz, Iran 5 Department of OB/GYN, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran 6 Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran 7 Cardio-vascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Key Words vaginal douche of Q. Brantii extract. Groups were treat- ed for 7 days and KOH tests and cultures were evaluat- clotrimazole vaginal cream, extract, Quercus Brantii ed again. Data were analyzed via chi-square and inde- Lindl., Vaginal Candidiasis, vaginal douche pendent t-test, using SPSS software. Results: According to the results, there were no sig- Abstract nificant differences between experimental groups for demographic characteristics like age (p=0.403), BMI Objectives: Vaginal Candidiasis with an approximate (p=0.911), educational levels (p=0.862) and contra- prevalence of 30% is the second cause of vaginal infec- ceptive methods (p=0.702). Moreover, significant dif- tions. Antifungal azole is the first treatment forVaginal ferences were seen in vaginal discharge between the Candidiasis; however, some side effects have been re- groups after the treatments (P=0.043). ported for this chemical medicine. Based on the anti- fungal activity of Inner Stratum of Quercus Brantii (Q. Conclusion: The results suggested that the therapeu- Brantii), the aim of our study was to compare the effects tic effect of vaginal douche ofQ. Brantii extract was of vaginal douche of Q. Brantii extract and clotrimazole approximately similar to that of clotrimazole vaginal on vaginal candidiasis symptoms before and after the cream. treatments, in women. Methods: 89 non-pregnant women with positive KOH 1. Introduction test which is capable of identifying the presence of hy- phae and mycelium by adding KOH (10%), and a posi- Vaginal candidiasis is one of the most frequent infec- tive vaginal candidiasis culture were randomly divided tions of the female genital tract [1]. Vaginal candidiasis into two experimental groups, using permuted block is the second most common cause of vaginitis world- randomization method. One group received clotrima- wide, after the bacterial infection. The risk of vaginal zole vaginal cream (1%) and the other group received candidiasis for non-pregnant women is approximately 20%, but it increases by 30% during pregnancy [2]. No Received: Feb 11, 2018 Reviewed: Jul 11, 2018 Accepted: Aug 02, 2018 complete reporting of the number of women involved This is an Open-Access article distributed under the terms of the Creative Commons *Corresponding Author Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) Zeinab Moshfeghy. Community Based Psychiatric Care Research Center, Department of which permits unrestricted noncommercial use, distribution, and reproduction in any Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, medium, provided the original work is properly cited. Shiraz, Iran. Tel: +98-713-647-4256 Fax: +98-713-647-4252 This paper meets the requirements of KS X ISO 9706, ISO 9706-1994 and ANSI/NISO E-mail: [email protected] Z39.48-1992 (Permanence of Paper). ⓒ 2018 Korean Pharmacopuncture Institute http://www.journal.ac 186 http://www.journal.ac Journal of Pharmacopuncture 2018;21(3):185-194 in Candida vaginitis is available in Iran [3], but according investigation aimed at comparing the effects of two treat- to a study, the prevalence of vaginal candidiasis in Iran is ments, including vaginal douche of Q. Brantii extract and between 25% and 45% [4]. The main reasons for the re- clotrimazole vaginal cream (1%) on vaginal candidiasis currence of Candida are not fully understood [5]. Autoim- symptoms before and after the treatments in women. mune diseases, endocrine diseases, diabetes mellitus, and antibiotic therapy are the main causes of vaginal candidia- sis [6]. The typical symptoms ofvaginal candidiasis include pruritus, vaginal soreness, dyspareunia, external dysuria, 2. Materials and Methods and abnormal vaginal discharge [7]. Patients may be occa- sionally found to have candida based on a culture or Pap smear [8]. Vulvovaginal candidias is as an acute inflam- 2.1. Patients matory disease, caused by Candida sp. especially C. albi- cans through non-albicans species of Candida (C.glabrata, This research was a randomized, case-controlled clini- C.tropicalis and C.dubliniensis) are also associated with cal trial. In this study, 89 non-pregnant women, who had recurrent diseases. Candidiasis is associated with intense a positive KOH test and culture of vaginal candidiasis and pruritus, itching, dyspareunia, erythematous vulva, and had been referred to the gynecology clinics of Shiraz Uni- cottage cheese like discharges, positive vaginal smear and versity of Medical Sciences during 2016 were included culture, and a vaginal pH of less than 4.5. However, non-al- into the study. To select the samples, convenience sam- bicans species are usually less sensitive to azole antifun- pling were utilized and then we divided the patients into gal agents [9,10]. Antifungal azole drugs provide the first 2 groups based on the inclusion criteria of being married treatments for vaginal candidiasis. Nevertheless, some and having an age of 18-49 years and symptoms of vaginal side effects have been reported for this chemical medicine. candidiasis, respectively [22]. All the women were investi- Over-the-counter (OTC) of miconazole and clotrimazole gated for vaginal edema and erythema and other clinical medications for 7 days would provide a proper first-line symptoms of vaginal candidiasis. Also, only single sexual therapy for women with occasional yeast vaginitis [11]. partners married to their respective spouses were chosen Several topical and oral antifungals such as clotrimazole [3]. Other inclusion criteria were: having no abnormal vag- is used for the treatment of vaginal candidiasis [12]. Never- inal or uterine bleeding, no known sensitivity to clotrima- theless, some side effects, such as changes in hepatic en- zole or other herbal drugs including Q. Brantii or known zymes, painful urination, depression, irritation, and der- autoimmune diseases. Those women who were pregnant, matitis have been reported for clotrimazole [13]. Although had pelvic inflammatory diseases and lactation during the it has no side effects during pregnancy, it is associated with study, had menstruated during the study, and had taken embryotoxic effects. Thus, it should be consumed with hormone therapy, vaginal creams at least 7 days before the caution during breast-feeding [14]. Also, the long-term use study, and anti-inflammatory, anti-fungal, and immuno- of antifungal drugs would lead to recurrent vaginitis [11]. suppressive drugs 14 days before the study were excluded Unavailability and high costs of the drugs in low-income from the research. All the patients signed an agreement societies, as well as their probable side effects and resist- form before participating in the investigation and after be- ances have resulted in increased worries about synthetic ing informed about the study procedure [3]. The two codes chemicals [15]. In recent years, people have shown a grow- of A and B, which respectively represented the treatments ing interest in the general trends of natural remedies and with clotrimazole vaginal cream (1%) and vaginal douche herbal therapies when considering the lower costs, high of Q. Brantii, were written on small pieces of paper and put availabilities, and lower side effects of plants and plant- into the relevant patients’ pockets. The women were ran- based chemicals [16]. domly divided into 2 experimental groups by permuted Since long time ago, plants have been used in traditional block randomization method. Group A (n=45) received medicine practiced in almost all Asian countries including clotrimazole vaginal cream (1%) and group B (n=44) re- Iran. Herbal medicine still plays an essential role in various ceived vaginal douche of Q. Brantii. The women in group A therapeutic fields, though synthetic applications of drugs used a clotrimazole vaginal cream (1%) via a vaginal drug in modern medicine have advanced over the past decades. applicator for 7 nights, while those in group B dissolved the In fact, the interest in herbal medications has been raised extract of Q. Brantii in 150 cc of distilled water to use vag- due to the therapeutic properties of plants. Several stud- inal douche of Q. Brantii for 7 nights. They were informed ies have revealed that plants have great amounts of natural to lie on their backs for 30 minute after applying both the antioxidants, as well as large anti-inflammatory [17], anti- vaginal cream and douche. bacterial [18], and antiviral
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