Table 1.

Characteristics of 6 clinical trials included in study

Author Year and country	Design	Participants	Intervention	Comparison	Tool	Outcome
Anukam et al (2009) Nigerian	RCT	Premenopausal women with acute vulvovaginitis(n=59)	One oral dose of fluconazole (150 mg), plus a daily probiotic capsule containing lactobacillus rhamnosus and lactobacillus roteri for 3 months	One oral dose of fluconazole (150 mg), plus one daily placebo capsule	Structured clinical evaluation questionnaire, standard laboratory culture techniques	The results of the study showed that the adjunctive treatment of vulvovaginitis with lactobacillus rhamnosus probiotic and rotari does not affect the recovery rate on the 7th day, but it reduces recurrence. It becomes vulvovaginitis again
Davar et al. (2016) Iran	RCT	Patients with candidal vulvovaginitis (number = 59),	The probiotic group (n=28)	Placebo group (n=31)	Fungal culture	The findings demonstrated that taking probiotics with azole antifungal drugs could be highly effective in treating VVC
Ehrström et al. (2010) Sweden	RCT	Women (N=95)	Vaginal Capsules containing L gasseri LN40, Lactobacillus fermentum LN99, L. Casei subsp. Rhamnosus LN113 and P. Acidilactici LN23	Placebo	Fungal culture	Vaginal Administration of LN strains after conventional treatment of bacterial vaginosis and/or vulvovaginal candidiasis lead to vaginal colonization, Somewhat fewer recurrences and less malodorous discharge.
Kovachev et al. (2015) Bulgaria	RCT	Women between 17 and 50 years (N=436)	Followed the Same treatment schedule; however, ten applications of a Vaginal probiotic containing lactobacillus acidophilus, l. Rhamnosus, streptococcus thermophilus, and l. Delbrueckii Subsp. Bulgaricus were also administered n=209)	150 mg fluconazole and a single vaginal Globule of fenticonazole (600 mg) (n=207)	Microbiological analysis	The local application of probiotics after Administration of combined azoles for treatment of vaginal C. Albicans infections increases therapy efficacy and could Prevent relapse.
Martinez et al. (2008) Brazil	RCT	Women diagnosed with VVC	Fluconazole (150 mg) supplemented Every morning for the following 4 weeks with two probiotic Capsules (containing lactobacillus rhamnosus gr-1 and lactobacillus Reuteri rc-14) (n = 29).	Fluconazole (150 mg) supplemented Every morning for the following 4 weeks with two placebo(n = 26)	Microbiological analysis	Probiotic lactobacilli can increase the Effectiveness of an anti-fungal pharmaceutical agent in curing disease
Pirotta et al. (2004) UK	RCT, factorial design, Protocol	Women, aged 18–50 years (N=496)	Active oral and Vaginal group (n=124)	Active oral, Vaginal placebo (n = 124), Placebo Oral, active Vaginal (n=124), Placebo Oral and Vaginal (n=124)	Culture of Candida species survey	Use of oral or vaginal forms of lactobacillus was not effective in prevention of post-antibiotic vulvovaginitis.