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Candida - female genital - Evidence
What drugs effectively treat acute uncomplicated vulvovaginal candidiasis?
The imidazole antifungals (butaconazole, clotrimazole, econazole, fenticonazole, flutrimazole, isoconazole, ketoconazole, miconazole, sertaconazole, and terconazole), and triazole antifungals (itraconazole and fluconazole) are all effective against acute uncomplicated vulvovaginal candidiasis. Nystatin (a polyene antifungal drug) is also an effective treatment for vulvovaginal candidiasis. Direct evidence from five placebo controlled trials is summarized below. Indirect evidence from more than 20 'head-to-head' comparisons is reviewed in the section Regimens for uncomplicated infection.
- Intravaginal butaconazole, clotrimazole, miconazole compared with placebo:
- A BMJ Clinical Evidence review [Spence, 2006] found three randomized controlled trials (RCTs) (841 participants, three different drugs, eight different regimens for the active treatments); two of the RCTs were included in an earlier systematic review [Reef et al, 1995].
- The BMJ Clinical Evidence review compared outcomes 4–5 weeks after treatment and reported that all three RCTs found statistically significant reduced rates of persistent symptoms. However, there were methodological weaknesses in all the studies.
- Oral itraconazole compared with placebo:
- A BMJ Clinical Evidence review [Spence, 2006] found one RCT (90 participants, three interventions), which had been included in an earlier Cochrane systematic review [Watson et al, 2001].
- Oral itraconazole significantly reduced the proportion of women with persistent symptoms at 1 week after treatment, compared with placebo.
- Intravaginal nystatin compared with placebo:
- A BMJ Clinical Evidence review [Spence, 2006] found one RCT (50 participants). Intravaginal nystatin (500,000 IU twice daily for 14 days) significantly reduced the proportion of women with a symptomatic response categorized as 'poor'.
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