Antifungal Drug Efficacy Profiles Against Vaginal Candida albicans: A Multi-Drug Comparative Analysis

<b>Background:</b><i>Candida albicans</i> infects most reproductive-aged women, causing a prevalent infection known as Vulvovaginal <i>Candida</i>. As there has been an increase in resistance to widely used antifungal agents, particularly fluconazole, used in infections, local susceptibility profiles are needed to inform treatment options. <b>Methods:</b> This comparative observational study was carried out to determine the in vitro susceptibility of six antifungal compounds [fluconazole, voriconazole, itraconazole, ketoconazole, nystatin, and amphotericin B] to 163 vaginal <i>Candida albicans</i> isolates obtained in three hospitals in Tabuk, Saudi Arabia. MIC₅₀, MIC₉₀, and MFC values were calculated in Broth microdilution tests according to the standards of CLSI M27-A3. Friedman and Wilcoxon signed-rank tests were used to carry out statistical analysis. <b>Results:</b> It was observed that Amphotericin B and itraconazole recorded the lowest MIC and MFC, revealing better antifungal action. The worst performer was fluconazole with MIC₅₀ (13.79 μg/mL), MIC₉₀ (27.59 μg/mL), and MFC (37.93 μg/mL), and 85% resistance. It was found that there are significant differences between antifungal agents (<i>p</i> < 0.001), and amphotericin B and itraconazole always performed best compared to fluconazole and voriconazole. <b>Conclusions:</b> The results shows antifungal effectiveness as Amphotericin B and itraconazole are the most effective against vaginal <i>Candida albicans</i> isolates. There is a high rate of resistance to fluconazole, suggesting it should no longer be the first choice of treatment in this area. These findings highlight the need for local monitoring of drug resistance to guide treatment choices and emphasize the importance of using antifungals properly to prevent increased resistance.