BACKGROUND AND PURPOSE:

• 70-75% of women will experience vulvovaginal candidiasis (VVC)
• It is difficult to adequately research VVC because it is not reportable and often unconfirmed
• VVC is associated with a decrease in lactobacilli and overgrowth of Candida species
• Probiotics, consisting of bacteria or yeast, are live microorganisms that may provide health benefits and are regulated as dietary supplements and foods
• Probiotics used for prevention and treatement of Candida include
  • Lactobacillus fermentum RC-14 | Lactobacillus fermentum B-54 | Lactobacillus rhamnosus GR-1 | Lactobacillus rhamnosus GG and Lactobacillus acidophilus
• Routes of administration include oral, vaginal or combined
• Xie et al. (Cochrane Database Syst Rev, 2017) sought to determine the effectiveness and safety of probiotics for the treatment of VVC in non-pregnant women

METHODS:

• Systematic Review and meta-analysis
• Literature search, utilizing multiple databases, information from pharmaceutical companies and experts in the field
• Included data from randomized controlled trials (RCT) using probiotics, alone or as adjuvant therapy to antifungal drugs
• Probiotics were included from single or multiple species and in any preparation type/dosage/route of administration
• Primary Outcomes
  • Clinical cure rate: Including both ‘short-term clinical cure rate’ (zero to 14 days after treatment) and ‘long-term clinical cure rate’ (one, three and six months after treatment)
  • Mycological cure rate: Including both ‘short-term mycological cure rate’ (zero to 14 days after treatment)’ and ‘long-term mycological cure rate’ (one, three and six months after treatment)
  • Relapse rate: Symptom recurrence confirmed by microscopic examination or vaginal culture at one, three and six months
  • Rate of serious adverse events
• Secondary Outcomes
  • Time to relapse | non-serious events | need for additional treatment | patient satisfaction | cost effectiveness

RESULTS:

• Data was pooled from 10 RCTs, which all used probiotics as adjuvant therapy to antifungal drugs
• Women were between the ages of 16 and 50
• Women did not have recurrent VVC, diabetes or immunosuppressive disorders or using immunosuppressive medications
• Adjuvant probiotics vs conventional antifungal drugs alone
  • Improved the short-term clinical cure rate
    • Risk Ratio (RR) 1.14, 95% CI 1.05 to 1.24; 5 trials, 695 participants
  • Improved the short-term mycological cure rate
    • RR 1.06, 95% CI 1.02 to 1.10; 7 trials, 969 participants
  • Decreased the relapse rate at one month
  • RR 0.34, 95% CI 0.17 to 0.68; 3 trials, 388 participants
• Probiotics did not impact long term clinical cure or mycological cure
• Probiotics were not associated with serious adverse outcomes
• Additional research is needed to assess probiotic impact on first relapse, need for additional treatment, patient satisfaction and cost effectiveness

CONCLUSION:

• The use of probiotics as adjuvant therapy increases rates of clinical and mycological cure while not increasing serious risk
• The authors strongly caution that the primary studies used in this analysis were generally of low and very low quality and further research is still required

Learn More – Primary Sources:

Probiotics for vulvovaginal candidiasis in non-pregnant women.

Related ObG Topics:

FDA Reviews Fluconazole in Pregnancy

What is ‘Mixed’ Vaginitis? How and When to Treat

Bacterial Vaginosis – CDC Diagnosis and Treatment Recommendations