Recurrent vulvovaginal candidiasis in pregnant women: The role of natamycin in therapy

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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