Table.

GRADE Evaluation of interventions for Candidiasis (vulvovaginal).

Important outcomes	Clinical cure rates
Studies (Participants)	Outcome	Comparison	Type of evidence	Quality	Consistency	Directness	Effect size	GRADE	Comment
What are the effects of drug treatments for acute vulvovaginal candidiasis in non-pregnant symptomatic women?
6 (1092)	Clinical cure rates	Oral fluconazole versus oral itraconazole	4	−2	0	0	0	Low	Quality point deducted for weak methods and incomplete reporting of results
3 (712)	Clinical cure rates	Intravaginal imidazoles versus placebo	4	−1	0	−1	0	Low	Quality point deducted for no ITT analysis; directness point deducted for high rates of attrition, especially in the placebo arm
22 (at least 790 women)	Clinical cure rates	Intravaginal imidazoles versus each other	4	−2	0	0	0	Low	Quality points deducted for no ITT analysis and for incomplete reporting
20 (at least 2721)	Clinical cure rates	Intravaginal imidazoles versus oral fluconazole or oral itraconazole	4	−1	0	−1	0	Low	Quality point deducted for lack of allocation concealment; directness point deducted for not reporting results of comparisons versus oral fluconazole and oral itraconazole separately
1 (70)	Clinical cure rates	Intravaginal imidazoles versus intravaginal nystatin	4	−2	0	0	0	Low	Quality points deducted for lack of blinding and incomplete reporting of results
1 (95)	Clinical cure rates	Oral itraconazole versus placebo	4	−1	0	0	0	Moderate	Quality point deducted for sparse data
1 (50)	Clinical cure rates	Intravaginal nystatin versus placebo	4	−1	0	−1	+1	Moderate	Quality point deducted for sparse data. Directness point deducted for uncertainty about definition of outcome. Effect-size point added for OR <0.2

We initially allocate 4 points to evidence from RCTs, and 2 points to evidence from observational studies. To attain the final GRADE score for a given comparison, points are deducted or added from this initial score based on preset criteria relating to the categories of quality, directness, consistency, and effect size. Quality: based on issues affecting methodological rigour (e.g., incomplete reporting of results, quasi-randomisation, sparse data [<200 people in the analysis]). Consistency: based on similarity of results across studies. Directness: based on generalisability of population or outcomes. Effect size: based on magnitude of effect as measured by statistics such as relative risk, odds ratio, or hazard ratio.