ResearchResearch summary
Probiotics alongside antifungals for vulvovaginal candidiasis
A Cochrane review found small short-term signals but no established durable benefit and excluded recurrent and higher-risk populations.
In this pathway
- Current topic
- Probiotics alongside antifungals for vulvovaginal candidiasisCurrent
Bottom line
Adding probiotics to antifungals produced small short-term signals, but the evidence did not establish durable benefit and did not include recurrent or higher-risk populations.
Why this source matters
It separates short-term adjunct results from durable outcomes, recurrence prevention, monotherapy, and product-specific claims.
Study and population
The review included 10 randomized trials and 1,656 nonpregnant outpatients with VVC; recurrent VVC and several higher-risk groups were excluded.
What was tested
Every trial compared probiotics used alongside conventional antifungals with conventional antifungals alone.
Results
Short-term clinical resolution occurred in 286/347 versus 251/348 participants. One-month relapse occurred in 10/202 versus 27/186, but long-term clinical and mycological resolution were not clearly improved.
Applicability
The result concerns adjunct treatment for nonpregnant people with VVC, not recurrent VVC prevention, monotherapy, pregnancy, higher-risk groups, or every probiotic product.
Limitations
Evidence was low or very low certainty, trials had bias and imprecision, and durable, cost, and strain-specific evidence was inadequate.
Contribution to the evidence
Supporting. The review supplies auditable short-term estimates while defining the important durability and population gaps.
Practical change
No practical change. The review does not justify a durable-benefit claim or selection of a probiotic product.
Funding and conflicts
None of the ten trials reported pharmaceutical-industry funding. One included trial reported a lactobacilli-related patent interest; no review-level author conflict was identified in the accessible record.
Source
Read the original Cochrane review (published 23 November 2017).
Study type, population, and sample scale
- Study type
- Cochrane systematic review of randomized controlled trials
- Population
- Nonpregnant outpatients with confirmed vulvovaginal candidiasis; trials involving recurrent VVC, diabetes, immunosuppression, immunosuppressive medication, or another vulvovaginal infection were excluded
- Sample scale
- 10 trials with 1,656 participants; individual outcome analyses ranged from one to seven trials and 172 to 969 participants
Results
- Short-term clinical resolution occurred in 286 of 347 participants receiving probiotics plus antifungals and 251 of 348 receiving antifungals alone (five trials, 695 participants).
- At one month, relapse occurred in 10 of 202 participants receiving adjunct probiotics and 27 of 186 receiving antifungals alone (three trials, 388 participants); long-term clinical and mycological resolution were not clearly improved.
Limitations
- Adjunct probiotics were associated with more short-term clinical cure and fewer relapses at one month.
- Evidence was low or very low certainty because of high risk of bias, small samples, imprecision, and few trials per outcome.
- Ten trials included 1,656 participants.
- All excluded recurrent and higher-risk populations, all used probiotics alongside antifungals, and no trial reported cost effectiveness.
Applies to
- Short-term group outcomes from adjunct probiotic regimens studied with conventional antifungals in nonpregnant outpatients with VVC
Does not apply to
- Recurrent VVC prevention, pregnancy, diabetes, immunosuppression, probiotic monotherapy, every strain or product, or durable resolution
Contribution to the current conclusion
Supporting
This 10-trial synthesis makes the exact short-term effect estimates, low and very-low certainty, excluded recurrent and higher-risk populations, lack of durable cure, and missing cost-effectiveness outcomes auditable in one source-level summary.
Related evidence mapPractical change or no change
No practical change. The review does not establish durable benefit, recurrence prevention, monotherapy benefit, or a recommendation for a probiotic product or strain.
Funding and conflicts
- Funding
- Cochrane reports that none of the ten included trials was funded by the pharmaceutical industry; included-study disclosures varied.
- Conflicts
- One included probiotic trial reported that an author held patents associated with lactobacilli; review-level author conflicts were not identified in the accessible record.
- Paper date
- 2017-11-23
Sources
View all 1 source
- Probiotics for vulvovaginal candidiasis in non-pregnant women
- Source type
- Systematic review
- Published
- 2017-11-23