Development of a Personal Formulary for Uncomplicated Vaginal Candidiasis by Residents of Pharmacology and Gynaecology

Background: Vaginal candidiasis is one of the most common causes of vulvovaginal complaints among women of reproductive age, with nearly 75% of women experiencing at least one episode during their lifetime. Although multiple azole antifungals are available for treatment, prescribing practices often vary and may not always be guided by systematic evaluation of efficacy, safety, cost, and convenience. The P-drug concept promotes rational and evidence-based selection of medicines through structured comparison.

Aim: To develop a personal formulary for uncomplicated vaginal candidiasis using the P-drug concept among residents of Pharmacology and Gynaecology.

Materials and Methods: This study was conducted in the Department of Pharmacology, IGIMS, Patna. The P-drug for uncomplicated vaginal candidiasis in adult non-pregnant women was selected using the WHO 6-step approach. Four azole antifungals available under the Janaushadhi scheme, Clotrimazole vaginal tablet, Clotrimazole 2% vaginal gel, Fluconazole tablet, and Itraconazole capsule, were evaluated. Drugs were compared based on four parameters: efficacy, safety, cost, and convenience according to the P-drug concept of Joshi and Jayawick Ramarajah. Each parameter was scored from 1 to 10 and assigned weighted values of 0.4, 0.3, 0.2, and 0.1, respectively. The total weighted score was calculated for each drug, and the highest-scoring drug was selected as the personal formulary drug.

Results: Among the evaluated drugs, Fluconazole 150 mg single-dose tablet achieved the highest total score (9.0), followed by Clotrimazole vaginal tablet (8.4), Clotrimazole vaginal gel (7.5), and Itraconazole capsule (7.3). Fluconazole demonstrated superior efficacy, lowest cost, and maximum convenience with an acceptable safety profile, making it the preferred P-drug for uncomplicated vaginal candidiasis.

Conclusion: By applying rational drug selection principles with greater emphasis on efficacy and safety, Fluconazole 150 mg single oral dose was selected as the personal formulary drug for uncomplicated vaginal candidiasis. The structured evaluation enhanced critical appraisal skills among residents and promoted safe, effective, and economical prescribing practices in routine gynaecological care.