{
  "abstract": "Background and Importance Vaginal fungal infections are a common complication following broad-spectrum antibiotic therapy due to the disruption of the normal vaginal flora. Candida krusei is an uncommon but clinically significant pathogen due to its resistance to conventional antifungal treatments, such as fluconazole.Aim and Objectives To present the case of a 90-year-old female patient diagnosed in March 2024 with vaginal candidiasis after using oral antibiotics, in this case, amoxicillin-clavulanate 875 mg/125 mg every 8 hours for 10 days. She underwent treatment with vaginal miconazole and oral fluconazole 150 mg for 3 days without success. The vaginal swab culture revealed Candida krusei, which was resistant to fluconazole but sensitive to amphotericin B. The pharmacy service was asked to develop a 5% amphotericin B vaginal emulsion due to the lack of topical alternatives.Material and Methods The galenic development and validation of the formula were achieved by following the procedures described in the National Formulary (PN/L/FF/002/00) and through quality control. Three samples were collected and analysed initially and again after 1 month. The validity period was determined by applying the risk matrix for non-sterile formulations outlined in the ‘Guide to Good Practice in the Preparation of Medicines in Hospital Pharmacy Services’. Formula design and clinical data of the patient was obtained from the software CPFarma and OrionClinic respectively.Results Due to the hydrophobic nature of amphotericin B, an O/W emulsion was designed. The final formula included: amphotericin B 1.5 g, glycerin 4 g, and Ginebase (emulsion o/w for vaginal application) as vehicle up to 30 g. The galenic validation of the preparation—organoleptic characteristics (colour, odour, occlusiveness, extensibility, and consistency), homogeneity of particles, and exudation—was adequate and remained stable. The shelf life was set at 30 days under refrigerated conditions (2-8°C).After 14 days of self-application of the vaginal emulsion once daily, the patient experienced a complete resolution of symptoms with no reported adverse effects.Conclusion and Relevance The 5% amphotericin B vaginal emulsion resolved the drug-resistant infection. This case demonstrates the critical role of the hospital pharmacist in managing fungal-resistant infections, such as Candida krusei. The successful treatment with the compounded amphotericin B preparation underscores the importance of microbiological cultures in guiding antifungal therapy.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Hospital General Universitario De Elche, Servicio De Farmacia, Elche, Spain"
      ],
      "name": "V Garcia Zafra"
    },
    {
      "affiliations": [
        "Hospital General Universitario De Elche, Servicio De Farmacia, Elche, Spain"
      ],
      "name": "I Castejon Grao"
    },
    {
      "affiliations": [
        "Hospital General Universitario De Elche, Servicio De Farmacia, Elche, Spain"
      ],
      "name": "S Macia Soriano"
    },
    {
      "affiliations": [
        "Hospital General Universitario De Elche, Servicio De Farmacia, Elche, Spain"
      ],
      "name": "L Peral Ballester"
    },
    {
      "affiliations": [
        "Hospital General Universitario De Elche, Servicio De Farmacia, Elche, Spain"
      ],
      "name": "L Soriano Irigaray"
    },
    {
      "affiliations": [
        "Hospital General Universitario De Elche, Servicio De Farmacia, Elche, Spain"
      ],
      "name": "AC Murcia Lopez"
    }
  ],
  "title": "3PC-031 Amphotericin B 5% vaginal emulsion for the treatment of candida krusei: a case report",
  "uid": "43130768-5871-5482-9201-31b1588aee57"
}