FPIN's Clinical Inquiries
Probiotics to Augment Antifungal Treatment of Vulvovaginal Candidiasis
Am Fam Physician. 2020 Apr 1;101(7):432-433.
How effective are probiotics for augmenting antifungal treatment of vulvovaginal candidiasis?
Adding probiotics (typically Lactobacillus species) to antifungal therapy for vulvovaginal candidiasis improves short-term cure rates by 14% and reduces one-month relapse rates by 66%. (Strength of Recommendation [SOR]: B, based on a meta-analysis of low-quality randomized controlled trials [RCTs].) Adding probiotics to antifungal therapy for women with recurrent vulvovaginal candidiasis may improve long-term cure rates over three to six months. (SOR: C, based on a small RCT that conflicted with low-quality RCTs.)
A 2017 Cochrane review of five low-quality RCTs (n = 695) found that adding probiotics to antifungal regimens increased the short-term clinical cure rate in women with vulvovaginal candidiasis.1 The studies included nonpregnant Chinese and Iranian women 16 to 50 years of age. The diagnosis of vulvovaginal candidiasis was initially made symptomatically, then confirmed by microscopy. Women with recurrent vulvovaginal candidiasis, diabetes mellitus, immunosuppression, or evidence of coinfections were excluded. Patients were randomized to antifungal therapy alone or antifungals plus probiotics (vaginal capsules in four studies and oral capsules in one study; capsules contained single or multiple strains of Lactobacillus species [L. delbrueckii, L. casei, L. rhamnosus, or L. acidophilus], Streptococcus species [S. thermophilum or S. faecalis], and/or Bifidobacterium species [B. breve or B. longum]). Short-term clinical cure was defined as resolution of symptoms plus absence of Candida on microbiologic culture within 14 days. Probiotics significantly improved cure rates (relative risk [RR] = 1.14; 95% CI, 1.05 to 1.24). Three of the RCTs (n = 388) found that adding probiotics to antifungal therapy reduced the relapse rate at one month (RR = 0.34; 95% CI, 0.17 to 0.68) compared with antifungal therapy alone. Relapse was defined
Referencesshow all references
1. Xie HY, Feng D, Wei DM, et al. Probiotics for vulvovaginal candidiasis in non-pregnant women. Cochrane Database Syst Rev. 2017;(11):CD010496....
2. Russo R, Superti F, Karadja E, et al. Randomised clinical trial in women with recurrent vulvovaginal candidiasis: efficacy of probiotics and lactoferrin as maintenance treatment. Mycoses. 2019;62(4):328–335.
3. Vladareanu R, Mihu D, Mitran M, et al. New evidence on oral L. plantarum P17630 product in women with history of recurrent vulvovaginal candidiasis (RVVC): a randomized double-blind placebo-controlled study. Eur Rev Med Pharm acol Sci. 2018;22(1):262–267.
4. Van Schalkwyk J, Yudin MH; Infectious Disease Committee. Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis. J Obstet Gynaecol Can. 2015;37(3):266–274.
5. Mendling W, Brasch J, Cornely OA, et al. Guideline: vulvovaginal candidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candidosis). Mycoses. 2015;58(suppl 1):1–15.
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