ResearchResearch summary
Oral versus topical maintenance treatment for RVVC
A 2026 systematic review found the direct oral-versus-topical maintenance evidence too uncertain to rank either route.
In this pathway
- Current topic
- Oral versus topical maintenance treatment for RVVCCurrent
Bottom line
The direct evidence is too uncertain to say oral or topical RVVC maintenance is more effective or safer.
Why this source matters
It is the current direct comparison and prevents indirect evidence from being turned into a route ranking.
Study and population
Five completed randomized trials with results included 792 participants; outcome-specific analyses used smaller subsets, and one 432-participant completed trial had no results.
What was tested
The review compared oral and topical maintenance regimens for recurrence, satisfaction, quality of life, and adverse events.
Results
For no clinical or mycological recurrence at follow-up, estimates were 497 versus 540 per 1,000 for oral and topical treatment. Confidence intervals crossed no difference for every outcome.
Applicability
The review applies to studied direct route comparisons, mostly involving older regimens. It does not establish equivalence or select a route for an individual.
Limitations
High risk of bias, imprecision, heterogeneous regimens, missing trial results, and sparse patient-reported and long-term safety data made every outcome very uncertain.
Contribution to the evidence
No practical change. The review makes the no-ranking boundary more current and auditable.
Practical change
No practical change. Decisions still cannot assume one maintenance route is superior or equivalent.
Funding and conflicts
Open-access support came from STDF and the Egyptian Knowledge Bank; the research received no specific grant. The authors declared no competing interests.
Source
Read the original publication (published 18 March 2026).
Study type, population, and sample scale
- Study type
- Systematic review and common-effect meta-analysis of randomized controlled trials
- Population
- Adults with RVVC in randomized comparisons of oral fluconazole or itraconazole and topical clotrimazole, fenticonazole, nystatin, or related maintenance regimens
- Sample scale
- Five completed trials with results and 792 participants; one additional completed trial with 432 participants had no available results
Results
- At the end of follow-up, 497 of 1,000 participants assigned oral maintenance were estimated to have no clinical or mycological recurrence versus 540 of 1,000 assigned topical maintenance (risk ratio 0.92, 95% CI 0.82 to 1.03; five trials, 745 participants).
- At the end of maintenance, estimated absence of clinical recurrence was 902 per 1,000 with oral treatment and 884 per 1,000 with topical treatment (risk ratio 1.02, 95% CI 0.95 to 1.09; three trials, 246 participants).
- Adverse events were estimated in 43 per 1,000 oral-treatment participants and 46 per 1,000 topical-treatment participants, with a confidence interval compatible with substantial benefit or harm (risk ratio 0.94, 95% CI 0.41 to 2.18; four trials, 539 participants).
Limitations
- No pooled benefit or harm outcome differed significantly by route.
- Most trials had high risk of bias, estimates were imprecise, and all outcome evidence was rated very uncertain.
- The review identified five completed trials with results.
- Regimens and definitions varied, and another completed 432-participant trial had no available results.
- Satisfaction and adverse events were assessed.
- Satisfaction came from one small trial and long-term safety and quality-of-life reporting were sparse.
Applies to
- Direct oral-versus-topical maintenance comparisons in the studied RVVC populations and older regimens
Does not apply to
- Equivalence, superiority, or individualized route selection; newer oral agents were not directly compared
Contribution to the current conclusion
No practical change
The newest direct route comparison is conclusion-changing for the maintained comparison: five completed trials with results leave all benefit and harm outcomes very uncertain, so a public summary makes the no-ranking boundary auditable.
Related evidence mapPractical change or no change
No practical change. The direct evidence preserves the current no-route-ranking conclusion rather than establishing equivalence or superiority.
Funding and conflicts
- Funding
- Open-access support came from STDF and the Egyptian Knowledge Bank; the research received no specific public, commercial, or not-for-profit grant.
- Conflicts
- The authors declared no competing interests.
- Paper date
- 2026-03-18
Sources
View all 1 source
- Oral versus topical maintenance antifungal therapy for recurrent vulvovaginal candidiasis: a systematic review and meta-analysis
- Source type
- Systematic review
- Published
- 2026-03-18