Are Probiotics Useful for the Treatment of Vulvovaginal Candidiasis?

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.