The overall risk of bias of the included trials was high. The duration of follow-up varied between trials.
WHAT IS THRUSH IN VAG TRIAL
Finland (2), the Netherlands (2), Germany (1), Italy (1), Sweden (1) and one trial across multiple European countries, USA (7) Thailand (2), Iran (2), Japan (1) and Africa (Nigeria) (1).
Trials were conducted in Europe: UK (3), Croatia (2). All but three trials included participants with acute vulvovaginal candidiasis. This review includes 26 trials (5007 participants). The risk of women stopping treatment because of unwanted effects is low for both oral and intravaginal antifungal medicines. Oral antifungal medicines probably clear yeast from the vagina better than intravaginal antifungal medicines, although there is probably little to no difference between them for getting rid of thrush symptoms. The results from some studies varied widely and were not reported consistently and the women knew which treatment they had, which could have affected the results reported. Ten studies received support from pharmaceutical companies this could have affected how the studies were designed, conducted and reported. These results are likely to change if further evidence becomes available. We are less confident about the numbers of unwanted effects, preferred treatment, and how quickly symptoms get better. We are confident about the low risk of women stopping treatment because of unwanted effects of antifungal medicines, and further evidence is unlikely change this. These results might change if further evidence becomes available. We are moderately confident in our findings for clinical and mycological cure of thrush. Whether an antifungal medicine is oral or intravaginal may make little to no difference to how quickly thrush gets better. Our results suggested that women might prefer taking an oral antifungal medicine to an intravaginal one (12 studies).
Headache and digestive symptoms were more common with oral antifungal medicines unwanted effects of intravaginal antifungals commonly affected only the vaginal area. The numbers of unwanted effects reported were similar: whether an antifungal medicine is oral or intravaginal might make little to no difference to unwanted effects (13 studies). Only three women stopped using their antifungal medicine because of unwanted effects (23 studies) the risk of women stopping treatment with oral or intravaginal antifungal medicines is low. However, oral antifungal medicines probably cleared yeast from the vagina (mycological cure) better than intravaginal ones in both the short term (19 studies) and long term (13 studies). Whether an antifungal medicine is oral or intravaginal probably makes little to no difference to getting rid of thrush symptoms. No studies reported the costs of the oral or intravaginal antifungal medicines.Ĭlinical cure (no symptoms) was similar for oral and intravaginal antifungal medicines in both the short term (5 to 15 days 13 studies), and long term (2 to 12 weeks 9 studies).
The studies were conducted in Europe, the USA, Thailand, Iran, Japan and Nigeria. We found 26 studies in 5007 women with thrush who were treated with antifungal medicines called azoles. Search date: we included evidence published up to 29 August 2019. We were interested in how well - and how fast - antifungal medicines could get rid of yeast infections and improve symptoms whether they had any unwanted effects and whether women preferred oral or intravaginal treatment. We looked for randomised controlled studies, in which the treatments received were decided at random, because these studies usually give the most reliable evidence about the effects of treatments. We searched for studies of antifungal medicines to treat thrush that compared an oral antifungal with an intravaginal antifungal. We wanted to find out if oral antifungal medicines work better than intravaginal antifungal medicines to treat thrush infections. These can be taken by mouth (orally) or placed in the vagina (intravaginally). Thrush is usually treated with antifungal medicines. Thrush is usually harmless but it can be uncomfortable. Symptoms include itching and irritation around the vagina and a white discharge. Thrush (also called candidiasis) is a common vaginal infection caused by a type of fungus called a yeast.
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