To the Editor:
It was with great pleasure that we read last year's annual Board Review issue (May 2004). Even though we are in the Obstetrics and Gynecology Department, we find these reviews to be helpful exercises for all disciplines. We were even happier to see our article referenced in the answer to one of the review questions in family medicine (question 8, page 11).
However, we would like to correct and perhaps update that question and answer. The question stated that the over-the-counter (OTC) topical yeast medications (eg, fluconazole) the patient used had not been effective. However, fluconazole currently is only available by prescription, not OTC, and as an oral tablet.
Similarly, because fluconazole cream is not available in the United States, the alternative answer to treat with fluconazole cream for 7 days and to treat simultaneously with oral fluconazole was not an appropriate option.
An alternative answer to this patient's case would have been to treat the suspected with boric acid vaginal capsules, 600 mg twice daily for 14 days, or to try one of the few topical antifungals that appears to have a moderate response rate and is commercially available. This would include tioconazole, available OTC, or terconazole (Terazol), available by prescription only.
Again, it was with pleasure that we read the board reviews for other specialties, and we look forward to the continuation of this series.
Mark G. Martens, MD
Department of Obstetrics and Gynecology