medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2026-142medsovet-10032Research ArticleИНФЕКЦИИINFECTIONSРецидивирующий кандидозный вульвовагинит у беременных: роль натамицина в терапииRecurrent vulvovaginal candidiasis in pregnant women: The role of natamycin in therapyhttps://orcid.org/0000-0001-8576-1359БоровиковИ. О.BorovikovI. O.

Боровиков Игорь Олегович, д.м.н., доцент, профессор кафедры акушерства, гинекологии и перинатологии №1

350063, Россия, Краснодар, ул. Митрофана Седина, д. 4

Igor O. Borovikov, Dr. Sci. (Med.), Professor of the Department of Obstetrics, Gynecology and Perinatology No. 1

4, Mitrofan Sedin St., Krasnodar, 350063, Russia

bio2302@mail.ruhttps://orcid.org/0000-0003-0938-8286КуценкоИ. И.KutsenkoI. I.

Куценко Ирина Игоревна, д.м.н., профессор, заведующая кафедрой акушерства, гинекологии и перинатологии №1

350063, Россия, Краснодар, ул. Митрофана Седина, д. 4

Irina I. Kutsenko, Dr. Sci. (Med.), Professor of the Department Obstetrics, Gynecology and Perinatology No. 1

4, Mitrofan Sedin St., Krasnodar, 350063, Russia

luzum69@mail.ruАндрееваА. А.AndreevaA. A.

Андреева Анастасия Александровна, аспирант кафедры акушерства, гинекологии и перинатологии №1

350063, Россия, Краснодар, ул. Митрофана Седина, д. 4

Anastasia A. Andreeva, Postgraduate Student of the Department of Obstetrics, Gynecology and Perinatology No. 1 

4, Mitrofan Sedin St., Krasnodar, 350063, Russia

nastyagorbulina@bk.ruhttps://orcid.org/0000-0002-1391-8203ФилипповаЛ. А.FilippovaL. A.

Филиппова Людмила Аркадьевна, клинический ординатор кафедры акушерства, гинекологии и перинатологии №1

350063, Россия, Краснодар, ул. Митрофана Седина, д. 4

Lyudmila A. Filippova, Clinical Resident of the Department of Obstetrics, Gynecology and Perinatology No. 1

4, Mitrofan Sedin St., Krasnodar, 350063, Russia

ludmilaf188@gmail.comhttps://orcid.org/0009-0004-8363-0127ВоронаяС. И.VoronayaS. I.

Вороная Софья Игоревна, аспирант кафедры акушерства, гинекологии и перинатологии №1

350063, Россия, Краснодар, ул. Митрофана Седина, д. 4

Sofia I. Voronaya, Postgraduate Student of the Department of Obstetrics, Gynecology and Perinatology No. 1

4, Mitrofan Sedin St., Krasnodar, 350063, Russia

voronaya_sonya@mail.ruhttps://orcid.org/0009-0005-5075-0058БагдасарянЗ. А.BagdasaryanZ. A.

Багдасарян Зоя Арменовна, студент Института клинической медицины

350063, Россия, Краснодар, ул. Митрофана Седина, д. 4

Zoya A. Bagdasaryan, Student of the Institute of Clinical Medicine

4, Mitrofan Sedin St., Krasnodar, 350063, Russia

bagdasaryan.zoya@bk.ruhttps://orcid.org/0009-0008-8030-7606ТеванянИ. Г.TevanyanI. G.

Теванян Илона Геворговна, студент Института клинической медицины

350063, Россия, Краснодар, ул. Митрофана Седина, д. 4

Ilona G. Tevanyan, Student of the Institute of Clinical Medicine

4, Mitrofan Sedin St., Krasnodar, 350063, Russia

tevananilona@gmail.comКубанский государственный медицинский университетРоссияKuban State Medical UniversityRussian Federation20261105202604104113Copyright © Боровиков И.О., Куценко И.И., Андреева А.А., Филиппова Л.А., Вороная С.И., Багдасарян З.А., Теванян И.Г., 20262026Боровиков И.О., Куценко И.И., Андреева А.А., Филиппова Л.А., Вороная С.И., Багдасарян З.А., Теванян И.Г.Borovikov I.O., Kutsenko I.I., Andreeva A.A., Filippova L.A., Voronaya S.I., Bagdasaryan Z.A., Tevanyan I.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/10032

Введение. Рецидивирующий кандидозный вульвовагинит (РКВВ) у беременных представляет собой клиническую и акушерскую проблему, требующую применения местных противогрибковых препаратов с доказанным профилем безопасности. Натамицин – полиеновый антибиотик с минимальной системной абсорбцией – рассматривается как один из препаратов выбора в данной группе пациенток.Цель. Оценить клиническую и микробиологическую эффективность, а также безопасность интравагинального применения натамицина (100 мг) у беременных с РКВВ во II и III триместрах гестации.Материалы и методы. Проведено проспективное открытое рандомизированное клиническое исследование. Обследованы 94 беременные женщины (22–35-я нед. гестации) с верифицированным РКВВ. Пациентки получали натамицин 100 мг интравагинально 1 раз в сутки в течение 6 дней. Оценка эффективности проводилась на 2-й и 21-й день после окончания терапии по клиническим, микроскопическим (нативный мазок, окраска по Граму) и микробиологическим критериям. Оценивались комплаенс (шкала Мориски – Грина), нежелательные явления и исходы беременности.Результаты. На 2-й день после окончания терапии клиническое выздоровление достигнуто у 93,6% пациенток (исчезновение патологических выделений), зуд/жжение купированы у 97,9%. Микробиологическая санация (отсутствие псевдогиф в нативном мазке) отмечена у 90,4% женщин. На 21-й день частота рецидивов составила 9,6% по клиническим проявлениям и 11,7% по микробиологическим данным. Удовлетворительный комплаенс (4 балла по шкале Мориски – Грина) выявлен у 94,7% пациенток. Системных нежелательных явлений не зарегистрировано, локальное жжение отмечено у 2,4%. Частота преждевременных родов составила 8,5%, что не превышает популяционных показателей.Заключение. Интравагинальное применение натамицина в дозе 100 мг у беременных с РКВВ демонстрирует высокую клиническую и микробиологическую эффективность, благоприятный профиль безопасности и хорошую приверженность терапии, что позволяет рекомендовать его в качестве препарата выбора для местного лечения данной категории пациенток.

Introduction. Recurrent vulvovaginal candidiasis (RVVC) in pregnant women represents a clinical and obstetric challenge requiring the use of topical antifungal agents with a proven safety profile. Natamycin, a polyene antibiotic with minimal systemic absorption, is considered one of the drugs of choice in this patient population.Aim. To evaluate the clinical and microbiological efficacy as well as the safety of intravaginal natamycin (100 mg) in pregnant women with RVVC during the second and third trimesters of gestation.Material and methods. A prospective open-label randomized clinical trial was conducted. A total of 94 pregnant women (22–35 weeks of gestation) with confirmed RVVC were enrolled. The patients received natamycin 100 mg intravaginally once daily for 6 days. Treatment efficacy was assessed on day 2 and day 21 after completion of therapy using clinical, microscopic (native smear, Gram staining), and microbiological criteria. Adherence (Morisky–Green scale), adverse events, and pregnancy outcomes were evaluated.Results. On day 2 after completion of therapy, clinical cure was achieved in 93.6% of patients (resolution of pathological discharge), and pruritus/burning was relieved in 97.9%. Microbiological eradication (absence of pseudohyphae in native smear) was observed in 90.4% of women. On day 21, the recurrence rate was 9.6% based on clinical manifestations and 11.7% based on microbiological findings. Satisfactory adherence (4 points on the Morisky–Green scale) was found in 94.7% of patients. No systemic adverse events were recorded; local burning was reported in 2.4%. The preterm birth rate was 8.5%, which does not exceed population-based rates.Conclusion. Intravaginal administration of natamycin 100 mg in pregnant women with RVVC demonstrates high clinical and microbiological efficacy, a favorable safety profile, and good treatment adherence, supporting its recommendation as a first-line agent for topical treatment in this patient population.

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The authors declare that there are no conflicts of interest present.