Planta Med 2009; 75(5): 466-471
DOI: 10.1055/s-0029-1185318
Clinical Study
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Exploratory Study on the Clinical and Mycological Effectiveness of a Herbal Medicinal Product from Solanum chrysotrichum in Patients with Candida Yeast-Associated Vaginal Infection

Armando Herrera-Arellano1 , Enrique Jiménez-Ferrer1 , Alejandro Zamilpa1 , María de los Angeles Martínez-Rivera2 , Aída Verónica Rodríguez-Tovar2 , Sara Herrera-Alvarez3 , María Luisa Salas-Andonaegui3 , María Yemina Nava-Xalpa3 , Ansberto Méndez-Salas2 , Jaime Tortoriello1
  • 1Centro de Investigación Biomédica del Sur, Instituto Mexicano del Seguro Social (IMSS), Xochitepec, Morelos, Mexico
  • 2Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional (IPN), Mexico City, Mexico
  • 3Hospital General Regional No. 1, IMSS, Cuernavaca, Morelos, Mexico
Further Information

Publication History

received July 7, 2008 revised Nov. 26, 2008

accepted Dec. 3, 2008

Publication Date:
02 February 2009 (online)

Abstract

Mexican traditional medicine uses Solanum chrysotrichum to treat fungi-associated dermal and mucosal illness; its methanolic extract is active against dermatophytes and yeasts. Different spirostanic saponins (SC-2 – SC-6) were identified as the active molecules; SC-2 was the most active in demonstrating a fungicidal effect against Candida albicans and non-albicans strains. The aim of the present study was to compare the clinical (elimination of signs and symptoms) and mycological effectiveness (negative mycological studies) of an S. chrysotrichum herbal medicinal product (Sc-hmp), standardized in 1.89 mg of SC-2, against ketoconazole (400 mg) in the topical treatment of cervical and/or vaginal infection by Candida. Both treatments (vaginal suppositories) were administered daily during 7 continuous nights. The study included 101 women (49 in the experimental group) with a confirmed clinical condition and positive mycological studies (direct examination and/or culture) of Candida infection. Basal conditions did not show differences between the groups; a moderate clinical picture was present in 62 % of the cases, direct examination was positive in 69 %, and the culture was positive with C. albicans predominating (65 %). At the end of the administration period, both treatments demonstrated 100 % tolerability, and clinical cure in 57.14 % of S. chrysotrichum-treated cases and in 72.5 % of ketoconazole-treated cases (p = 0.16), as well as 62.8 % and 97.5 % of mycological effectiveness, respectively (p = 0.0 001). We conclude that, at the doses used, Sc-hmp exhibits the same clinical effectiveness as ketoconazole, but with lower percentages of mycological eradication. Additional clinical studies with Sc-hmp are necessary, with increasing doses of SC-2, for improving the clinical and mycological effectiveness.

References

  • 1 Vermitsky J P, Self M J, Chadwick S G, Trama J P, Adelson M E, Mordechai E, Gygax S E. Survey of vaginal-flora Candida species isolates from women of different age groups by use of species-specific PCR detection.  J Clin Microbiol. 2008;  46 1501-1503
  • 2 Arechavala A I, Bianchi M H, Robles A M, Santiso G, Negroni R. Identification and susceptibility against fluconazole and albaconazole of 100 yeasts' strains isolated from vaginal discharge.  Rev Iberoam Micol. 2007;  24 305-308
  • 3 Kwong-Chung K JC, Bennett J E. Medical mycology. Philadelphia; Publisher Lea and Febiger 1992: 81-102
  • 4 Pitsouni E, Iavazzo C, Falagas M E. Itraconazole vs. fluconazole for the treatment of uncomplicated acute vaginal and vulvovaginal candidiasis in nonpregnant women: a metaanalysis of randomized controlled trials.  Am J Obstet Gynecol. 2008;  198 153-160
  • 5 Lozoya X, Navarro V, Garcia M, Zurita M. Solanum chrysotrichum (Schldl.) a plant used in Mexico for the treatment of skin mycosis.  J Ethnopharmacol. 1992;  36 127-132
  • 6 Zamilpa A, Tortoriello J, Navarro V, Delgado G, Alvarez L. Five new steroidal saponins from Solanum chrysotrichum leaves and their antimycotic activity.  J Nat Prod. 2002;  65 1815-1819
  • 7 Herrera-Arellano A, Martínez-Rivera M A, Hernández-Cruz M, López-Villegas E O, Rodríguez-Tovar A V, Alvarez L, Marquina-Bahena S, Navarro-García V M, Tortoriello J. Mycological and electron microscopic study of Solanum chrysotrichum saponin SC‐2 antifungal activity on Candida species of medical significance.  Planta Med. 2007;  73 1568-1573
  • 8 Herrera-Arellano A, Rodríguez-Soberanes A, Martínez-Rivera M A, Martínez-Cruz E, Zamilpa A, Alvarez L, Tortoriello J. Effectiveness and tolerability of a standardized phytodrug derived from Solanum chrysotrichum on Tinea pedis: a controlled and randomized clinical trial.  Planta Med. 2003;  69 390-395
  • 9 Herrera-Arellano A, Jiménez-Ferrer E, Vega-Pimentel A M, Martínez-Rivera M A, Hernández-Hernández M, Zamilpa A, Tortoriello J. Clinical and mycological evaluation of therapeutic effectiveness of Solanum chrysotrichum standardized extract on patients with Pityriasis capitis (dandruff). A double blind and randomized clinical trial controlled with ketoconazole.  Planta Med. 2004;  70 483-488
  • 10 Richter S S, Galask R P, Messer S A, Hollis R J, Diekema D J, Pfaller M A. Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases.  J Clin Microbiol. 2005;  43 2155-2162
  • 11 Kwon-Chung K J, Bennett J E. Medical mycology. Philadelphia; Publisher Lea and Febiger 1992: 280-336
  • 12 Hoffstetter S E, Barr S, LeFevre C, Leong F C, Leet T. Self-reported yeast symptoms compared with clinical wet mount analysis and vaginal yeast culture in a specialty clinic setting.  J Reprod Med. 2008;  53 402-406
  • 13 Arenas R. Micología médica ilustrada. México; McGraw-Hill Interamericana 2008
  • 14 López Martínez R, Méndez Tovar L J, Hernández Hernández F, Castañón Olivares R. Micología médica. Procedimientos para el diagnostico de laboratorio. México; Editorial Trillas 1995
  • 15 Anonymous. Chronic recurrent candidiasis of the genitalia in females due to non-albicans Candida spp.  Antibiot Khimioter. 2007;  52 56-62
  • 16 Bradshaw C S, Morton A N, Garland S M, Morris M B, Moss L M, Fairley C K. Higher-risk behavioral practices associated with bacterial vaginosis compared with vaginal candidiasis.  Obstet Gynecol. 2005;  106 105-114
  • 17 Girón L M, Aguilar G A, Cáceres A, Arroyo G L. Anticandidal activity of plants used for the treatment of vaginitis in Guatemala and clinical trial of a Solanum nigrescens preparation.  J Ethnopharmacol. 1988;  22 307-313
  • 18 Khosravi A R, Eslami A R, Shokri H, Kashanian M. Zataria multiflora cream for the treatment of acute vaginal candidiasis.  Int J Gynaecol Obstet. 2008;  101 201-202
  • 19 Craig W A. Choosing an antibiotic on the basis of pharmacodynamics.  Ear Nose Throat J. 1998;  77 7-11
  • 20 Martín Herrero J E, García Rey C, Giménez Mestre M J, Aguilar Alfaro L. Estrategias para superar las resistencias de patógenos respiratorios en Atención Primaria.  Rev Esp Quimioterap. 2003;  16 108-114

Dr. Armando Herrera-Arellano

Centro de Investigación Biomédica del Sur
IMSS

Argentina 1

62790 Xochitepec

Morelos

México

Phone: + 52 77 73 61 21 55

Fax: + 52 77 73 61 21 94

Email: armandoha_mx@yahoo.com.mx