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Review
. 2017 Nov 23;11(11):CD010496.
doi: 10.1002/14651858.CD010496.pub2.

Probiotics for Vulvovaginal Candidiasis in Non-Pregnant Women

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Free PMC article
Review

Probiotics for Vulvovaginal Candidiasis in Non-Pregnant Women

Huan Yu Xie et al. Cochrane Database Syst Rev. .
Free PMC article

Abstract

Background: Vulvovaginal candidiasis (VVC) is estimated to be the second most common form of infection after bacterial vaginosis. The ability of probiotics in maintaining and recovering the normal vaginal microbiota, and their potential ability to resist Candidas give rise to the concept of using probiotics for the treatment of VVC.

Objectives: To assess the effectiveness and safety of probiotics for the treatment of vulvovaginal candidiasis in non-pregnant women.

Search methods: We searched the following databases to October 2017: Sexually Transmitted Infections Cochrane Review Group's Specialized Register, CENTRAL, MEDLINE, Embase and eight other databases. We searched in following international resources: World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, Web of Science and OpenGrey. We checked specialty journals, reference lists of published articles and conference proceedings. We collected information from pharmaceutical companies and experts in the field.

Selection criteria: Randomized controlled trials (RCT) using probiotics, alone or as adjuvants to conventional antifungal drugs, to treat VVC in non-pregnant women. Trials recruiting women with recurrent VVC, coinfection with other vulvovaginal infections, diabetes mellitus, immunosuppressive disorders or taking immunosuppressant medication were ineligible for inclusion. Probiotics were included if they were made from single or multiple species and in any preparation type/dosage/route of administration.

Data collection and analysis: Two review authors independently assessed trials for eligibility and quality and extracted data. We resolved any disagreements through consensus. The quality of the evidence was assessed using the GRADE approach.

Main results: Ten RCTs (1656 participants) met our inclusion criteria, and pharmaceutical industry funded none of these trials. All trials used probiotics as adjuvant therapy to antifungal drugs. Probiotics increased the rate of short-term clinical cure (risk ratio (RR) 1.14, 95% confidence interval (CI) 1.05 to 1.24, 695 participants, 5 studies, low quality evidence) and mycological cure (RR 1.06, 95% CI 1.02 to 1.10, 969 participants, 7 studies, low quality evidence) and decreased relapse rate at one month (RR 0.34, 95% CI 0.17 to 0.68, 388 participants, 3 studies, very low quality evidence). However, this effect did not translate into a higher frequency of long-term clinical cure (one month after treatment: RR 1.07, 95% CI 0.86 to 1.33, 172 participants, 1 study, very low quality evidence; three months after treatment: RR 1.30, 95% CI 1.00 to 1.70, 172 participants, one study, very low quality evidence) or mycological cure (one month after treatment: RR 1.26, 95% CI 0.93 to 1.71, 627 participants, 3 studies, very low quality evidence; three months after treatment: RR 1.16, 95% CI 1.00 to 1.35, 172 participants, one study, very low quality evidence). Probiotics use did not increase the frequency of serious (RR 0.80, 95% CI 0.22 to 2.94; 440 participants, 2 studies, low quality evidence). We found no eligible RCTs for outcomes as time to first relapse, need for additional treatment at the end of therapy, patient satisfaction and cost effectiveness.

Authors' conclusions: Low and very low quality evidence shows that, compared with conventional treatment, the use of probiotics as an adjuvant therapy could increases the rate of short-term clinical and mycological cure and decrease the relapse rate at one month but this did not translate into a higher frequency of long-term clinical or mycological cure. Probiotics use does not seem to increase the frequency of serious or non-serious adverse events. There is a need for well-designed RCTs with standardized methodologies, longer follow-up and larger sample size.

Conflict of interest statement

HX: none.

DF: none.

DW: none.

LM: none.

HC: none.

XW: none.

FF: none.

Figures

Figure 1
Figure 1
Study flow diagram. RCT: randomized controlled trial.
Figure 2
Figure 2
Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies.
Figure 3
Figure 3
Risk of bias summary: review authors' judgments about each risk of bias item for each included study.
Figure 4
Figure 4
Forest plot of comparison: 2 Probiotics + conventional antifungal drugs versus conventional antifungal drugs, outcome: 1.1 Clinical cure rate (short‐term).
Figure 5
Figure 5
Forest plot of comparison: 2 Probiotics + conventional antifungal drugs versus conventional antifungal drugs, outcome: 1.6 Mycological cure rate (short‐term).
Figure 6
Figure 6
Forest plot of comparison: 2 Probiotics + conventional antifungal drugs versus conventional antifungal drugs, outcome: 1.10 Mycological cure rate (long‐term/1 month after treatment).
Figure 7
Figure 7
Forest plot of comparison: 2 Probiotics + conventional antifungal drugs versus conventional antifungal drugs, outcome: 1.13 Relapse rate.
Figure 8
Figure 8
Forest plot of comparison: 2 Probiotics + conventional antifungal drugs versus conventional antifungal drugs, outcome: 1.14 Non‐serious adverse events.
Figure 9
Figure 9
Forest plot of comparison: 2 Probiotics + conventional antifungal drugs versus conventional antifungal drugs, outcome: 1.3 Clinical cure rate (short‐term): subgroup analysis.
Figure 10
Figure 10
Forest plot of comparison: 2 Probiotics + conventional antifungal drugs versus conventional antifungal drugs, outcome: 1.8 Mycological cure rate (short‐term): subgroup analysis.
Analysis 1.1
Analysis 1.1
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 1 Clinical cure rate (short‐term).
Analysis 1.2
Analysis 1.2
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 2 Clinical cure rate (short‐term): sensitivity analysis.
Analysis 1.3
Analysis 1.3
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 3 Clinical cure rate (short‐term): subgroup analysis.
Analysis 1.4
Analysis 1.4
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 4 Clinical cure rate (long‐term/1 month after treatment).
Analysis 1.5
Analysis 1.5
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 5 Clinical cure rate (long‐term/3 months after treatment).
Analysis 1.6
Analysis 1.6
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 6 Mycological cure rate (short‐term).
Analysis 1.7
Analysis 1.7
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 7 Mycological cure rate (short‐term): sensitivity analysis.
Analysis 1.8
Analysis 1.8
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 8 Mycological cure rate (short‐term): subgroup analysis.
Analysis 1.9
Analysis 1.9
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 9 Mycological non‐cure (short‐term/Candida albicans versus non‐albicans).
Analysis 1.10
Analysis 1.10
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 10 Mycological cure rate (long‐term/1 month after treatment).
Analysis 1.11
Analysis 1.11
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 11 Mycological cure rate (long‐term/1 month after treatment): sensitivity analysis.
Analysis 1.12
Analysis 1.12
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 12 Mycological cure rate (long‐term/3 months after treatment).
Analysis 1.13
Analysis 1.13
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 13 Relapse rate.
Analysis 1.14
Analysis 1.14
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 14 Rate of serious adverse events.
Analysis 1.15
Analysis 1.15
Comparison 1 Probiotics plus conventional antifungal drugs versus conventional antifungal drugs, Outcome 15 Rate of non‐serious adverse events.

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  • Cochrane Database Syst Rev. doi: 10.1002/14651858.CD010496

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