Response: Re: Effect of Antibiotics on Vulvovaginal Candidiasis: A Metronet Study
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* Jinping Xu

*To the Editor:* We appreciate the interest of Dr. Tandon1 in our recent paper on the association of antibiotic use with subsequent vulvovaginal candidiasis (VVC).2 As we stated in our paper, the small sample size limits our ability to determine the effects of antibiotic type, dosage, or duration on the primary outcomes. In fact, the 6 women who later developed symptomatic VVC were on 6 different antibiotics, and 1 was on 2 antibiotics, with range of antibiotic duration of 5 to 10 days. Because the majority of our study participants had respiratory infections, penicillins (eg, amoxicillin or augmentin) and macrolides (eg, azithromycin) were the most frequently prescribed antibiotics, with less usage of quinolones or cephalosporins. Although it is likely that each type of antibiotic has a different effect on the vaginal flora, we were not able to find any distinctive pattern of risk by antibiotic used or the duration of antibiotic therapy. Furthermore, the association of VVC with particular antibiotics has been indirectly indicated by epidemiologic studies3,4 rather than directly supported by mycological studies, which are sorely needed.

## References

1.  Tandon S. Re: Effect of antibiotics on vulvovaginal candidiasis: A Metronet study. J Am Board Fam Med 2009; 22(2): 223.
    
    [FREE Full Text](http://www.jabfm.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NToiamFiZnAiO3M6NToicmVzaWQiO3M6ODoiMjIvMi8yMjMiO3M6NDoiYXRvbSI7czoyMjoiL2phYmZwLzIyLzIvMjIzLjIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  Xu J, Schwartz K, Bartoces M, Monsur J, Severson RK, Sobel JD. Effect of antibiotics on vulvovaginal candidiasis: A MetroNet study. J Am Board Fam Med 2008; 21(4): 261–68.
    
    [Abstract/FREE Full Text](http://www.jabfm.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NToiamFiZnAiO3M6NToicmVzaWQiO3M6ODoiMjEvNC8yNjEiO3M6NDoiYXRvbSI7czoyMjoiL2phYmZwLzIyLzIvMjIzLjIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

3.  MacDonald TM, Beardon PH, McGilchrist MM, Duncan ID, McKendrick AD, McDevitt DG. The risks of symptomatic vaginal candidiasis after oral antibiotic therapy. Q J Med 1993; 86(7): 419–24.
    
    [Abstract/FREE Full Text](http://www.jabfm.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NToicWptZWQiO3M6NToicmVzaWQiO3M6ODoiODYvNy80MTkiO3M6NDoiYXRvbSI7czoyMjoiL2phYmZwLzIyLzIvMjIzLjIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

4.  Menday AP. Symptomatic vaginal candidiasis after pivmecillinam and norfloxacin treatment of acute uncomplicated lower urinary tract infection. Int J Antimicrob Agents 2002; 20(4): 297–300.
    
    [CrossRef](http://www.jabfm.org/lookup/external-ref?access_num=10.1016/S0924-8579(02)00171-1&link_type=DOI) 
    
    [PubMed](http://www.jabfm.org/lookup/external-ref?access_num=12385688&link_type=MED&atom=%2Fjabfp%2F22%2F2%2F223.2.atom)