Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
John Cavenagh, MBA, PhD, PA-C
Objective: The objective of this selective EBM review is to determine whether or not “Do oral probiotics in conjunction with fluconazole reduce symptoms among patients suffering from vulvovaginal candidiasis (VVC)?”
Study design: Systematic review of three randomized controlled trials published in 2009 and 2012.
Data sources: Three randomized controlled trials published in peer-reviewed journals comparing the effects of fluconazole in conjunction with probiotics in the treatment of VVC. Data sources found using Embase, EMBScohost, and CINAHL
Outcomes measured: Outcomes were measured based on patients reporting of: decrease in dysuria symptoms at 5-7 days post treatment, resolution of abnormal odorless cheese like vaginal discharge, dyspareunia, dysuria, and localized vulvovaginal irritation with VVC at 7 days post treatment, and decrease in vaginal discharges associated with at least one of the following (itching and burning vaginal feeling, dyspareunia and dysuria) at 4 weeks post treatment. All results were examined to determine whether or not oral probiotics in conjunction with fluconazole resulting in a significant difference in symptom reduction of VVC.
Results: In both Nouraei et al. and Martinez et al., oral probiotics in conjunction with fluconazole showed a statistically significant different and proved to be an effective treatment in reducing the symptoms associated with VVC (p= 0.02 and 0.03 respectively). Due to issue faced by the study design in the RCT by Anukam et al., a statistically significant difference was unable to be found when determining a reduction of VVC symptom (p=0.28).
Conclusions: Results of these RCT showed conflicting results. While both Nouraei et al. and Martinez et al. indicated that oral probiotics in conjunction with fluconazole was an effective treatment in the reduction of VVC symptoms Anukam et al. was unable to show a statistically significant difference due to loss of follow up. Further studies with more strict protocol and a larger sample size need to be explored in the future in order to reach more definitive answers.
McDaid, Kayla, "Do Oral Probiotics in Conjunction with Fluconazole Reduce Symptoms Among Patients Suffering from Vulvovaginal Candidiasis?" (2018). PCOM Physician Assistant Studies Student Scholarship. 331.