With great interest we read the article “Recurrent vulvovaginal candidiasis” of Jack D. Sobel. The author presents oral and topical treatment strategies for recurrent vulvovaginal candidiasis. Therapy with oral fluconazole starts with an initial “induction therapy” and is followed by a maintenance phase, wherein the drug is given at certain intervals.

Although a systematic review confirms the advantage of the use of weekly fluconazole for 6 months, we missed the emphasis on the advantages of another, more individualized and patient-centered regimen that is common in Europe. In this regimen, the total dose of fluconazole is more individualized to the outcomes (“ReCiDiF” regimen).

Fluconazole is used weekly for only 8 weeks and is followed by dose reduction if the patient is symptom, culture, and microscopy free of Candida . After a period of 4 months of taking 1 dose every 2 weeks, patients can move on to the next level of maintenance treatment (monthly for 6 months), provided they are still symptom, culture, and microscopy free of Candida .

This regimen has several advantages compared with the 6 months/weekly regimen. Most women who experience recurrent vulvovaginal candidiasis do not need weekly fluconazole for 6 months; the optimal, and even suboptimal, responders received significant less total medication after 6 months than in the 6 months/weekly system.

Indeed, even if suboptimal responders stay for longer periods on their level of treatment to avoid clinical relapses, most of them do not need to be on weekly treatment. Clinicians and researchers should be aware of early identification of the group who had recurrences despite maintenance therapy and help them in a timely, more efficient way. Women on the ReCiDiF regimen were recurrence-free for a longer period of time and were shown to need less fluconazole per month than in the 6 months/weekly regimen. Furthermore, this regimen appears to prevent the frequent recurrences that are seen after suddenly stopping the 6 month/weekly period; after 1 year, 79% of the women were recurrence free in the ReCiDiF regimen vs 43% after the 6 month/weekly treatment.

This individualized fluconazole maintenance therapy is currently the standard of care in Belgium, Austria, and Germany and produces high satisfaction and adherence rates in patients. Hence, we regret that the review failed to inform the reader about the advantages of the ReCiDiF approach and that it is was not highlighted in its summary table.