Oral versus intra-vaginal imidazole and triazole anti-fungal agents for the treatment of uncomplicated vulvovaginal candidiasis (thrush): a systematic review.
OBJECTIVE
To compare the relative effectiveness, cost effectiveness and safety of oral versus intra-vaginal anti-fungal treatments for uncomplicated vulvovaginal candidiasis (thrush) and establish patient preference for the route of anti-fungal administration.


METHODS
A systematic review of studies comparing oral and intra-vaginal anti-fungal treatments for uncomplicated vulvovaginal candidiasis. Standard Cochrane Collaboration methods were used.


METHODS
The following sources were searched: the Cochrane Controlled Trials Register; the Cochrane Sexually Transmitted Disease review group Specialised Register of Controlled Trials; EMBASE (January 1980 to January 2000); and MEDLINE (January 1985 to May 2000). The reference list of each trial was checked for additional references. The manufacturers of anti-fungal treatments in the UK were asked for information on trials fulfilling the inclusion criteria.


METHODS
There was duplicate, independent examination and selection of the electronic search results followed by duplicate data abstraction. Disagreements regarding inclusion status and data abstraction were resolved by discussion between reviewers and the editor of the Cochrane Sexually Transmitted Disease group. Randomised controlled trials conducted worldwide and published in any language were included. The primary outcome measure was clinical cure. Mycological cure, patient preference and safety were secondary outcome measures.


RESULTS
Seventeen trials were included in the review, reporting 19 oral versus intra-vaginal anti-fungal treatment comparisons. No statistically significant differences were shown between oral and intra-vaginal anti-fungal treatment for clinical or mycological cure. All 10 trials that reported a preference favoured oral treatment (compared with intra-vaginal or no preference). No trials presented cost data.


CONCLUSIONS
There is no difference between the relativeeffectiveness of oral and intra-vaginal anti-fungal treatment for thrush.
Watson
Margaret C
MC
Department of General Practice and Primary Care, University of Aberdeen, Scotland, UK.
Grimshaw
Jeremy M
JM
Bond
Christine M
CM
Mollison
Jill
J
Ludbrook
Anne
A
D000208:Acute Disease; D000282:Administration, Intravaginal; D000284:Administration, Oral; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D002181:Candidiasis, Vulvovaginal / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D017060:Patient Satisfaction; D016032:Randomized Controlled Trials as Topic; D014230:Triazoles / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics
D000935:Antifungal Agents; D007093:Imidazoles; D014230:Triazoles; C029899:imidazole