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Re: Candida albicansFrom: J. Hellriegel (jhellrie@pce.net)Fri Mar 3 19:50:36 2000
At Fri, 03 Mar 2000, Robert Woolley wrote: > >> Several years ago, I became annoyingly aware that Pacificare's formulary >> does not cover terconazole for treatment of vulvo-vaginal candidiasis. >> On the other hand they do cover miconazole, clotrimazole and >> fluconazole. From what I am aware, those three drugs all have similar >> coverage and miss the non-albicans Candida sp. Most patients who come >> in have already tried OTC available drugs, and if they have not >> responded, it makes little sense to retry more of same. In my >> experience, terconazole is a much better treatment choice, for 3 or 7 >> days. > >1) What is the cotst difference? > The cost difference for the different medications depends on the amount of the "kickback" (or refund) the drug company offers the HMO for the different medication. The KOH prep I perform in my office cost the HMO nothing. If I order cultures and fungal sensitivities, there is considerable cost to the HMO. If I wait for those results - up to 2 weeks - before ording treatment, I will have very unhappy patients. Thus, the most cost effective, timely, and appropriate management is a KOH prep for ID and a local treatment (vaginal cream) which covers the broadest spectrum of vaginal fungi.
-- J. Hellriegel >2) Are you doing cultures to demonstrate that these patients have an >organism sensitive to terconazole but not other azoles?
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