Emerging treatments
Vitamin C vaginal tablets
Vitamin C vaginal tablets may be beneficial in the management of bacterial vaginosis, but there is very little evidence as yet and long-term studies are required.[55]
Ospemifene
Postmenopausal women who are not candidates for vaginal oestrogen therapy for atrophic vaginitis may be given ospemifene, a selective oestrogen receptor modulator. It is approved for use in moderate to severe dyspareunia. Ospemifene increased the percentage of superficial cells and reduced dyspareunia compared with placebo in one phase 3 trial.[56]
Ibrexafungerp
Ibrexafungerp is a first-in-class oral triterpenoid antifungal agent which acts by inhibiting glucan synthase and compromises the integrity of the fungal cell wall. On the basis that the drug demonstrated in-vitro activity to azole antifungal resistant strains of Candida albicans and was superior to placebo for the treatment of vulvovaginal candidiasis, the US Food and Drug Administration has approved its use as a 1-day treatment for vulvovaginal candidiasis.[57][58]
Oteseconazole
Oteseconazole is an oral azole antifungal that is effective in preventing the recurrence of acute vulvovaginal candidiasis infections and treating recurrent vulvovaginal candidiasis.[59][60] Oteseconazole has improved selectivity for fungal CYP51 and lower affinity for human cytochrome enzymes compared with other azole antifungals owing to the presence of a tetrazole moiety (rather than a triazole or imidazole moiety). The US Food and Drug Administration has approved its use for reducing the incidence of recurrent vulvovaginal candidiasis in women who have a history of recurrent vulvovaginal candidiasis but who are not of reproductive potential.
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