Abstract
Background
Vaginal candidiasis (moniliasis or thrush) is a common and frequently distressing infection for many women. It is even more common in pregnancy. There is no evidence that thrush in pregnancy is harmful to the baby.
Objectives
The objective of this review was to assess the effects of different methods of treating vaginal candidiasis in pregnancy.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2001). We updated this search on 1 October 2009 and added the results to the awaiting classification section.
Selection criteria
Randomised trials of any treatment for vaginal candidiasis in pregnancy.
Data collection and analysis
Two reviewers assessed trial quality and extracted data.
Main results
Ten trials were included. Based on five trials, imidazole drugs were more effective than nystatin when treating vaginal candidiasis in pregnancy (odds ratio 0.21, 95% confidence interval 0.16 to 0.29). In turn, Nystatin was as effective as hydrargaphen in one trial (odds ratio 0.29, 95% confidence interval 0.05‐1.84). A trial of clotrimazole was more effective than placebo (odds ratio 0.14, 95% confidence interval 0.06 to 0.31). Single dose treatment was no more or less effective than three or four days treatment. However, two trials involving 81 women, showed that treatment lasting for four days was less effective than treatment for seven days (odds ratio 11.7, 95% confidence interval 4.21 to 29.15). Based on two trials, treatment for seven days was no more or less effective than treatment for 14 days (odds ratio 0.41, 95% confidence interval 0.16 to 1.05). Terconazole was as effective as clotrimazole (odds ratio 1.41, 95% confidence interval 0.28‐ 7.10).
Authors' conclusions
Topical imidazole appears to be more effective than nystatin for treating symptomatic vaginal candidiasis in pregnancy. Treatments for seven days may be necessary in pregnancy rather than the shorter courses more commonly used in non‐pregnant women.
[Note: The seven citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
Keywords: Female; Humans; Pregnancy; Administration, Topical; Antifungal Agents; Antifungal Agents/therapeutic use; Candidiasis, Vulvovaginal; Candidiasis, Vulvovaginal/drug therapy; Pregnancy Complications, Infectious; Pregnancy Complications, Infectious/drug therapy; Randomized Controlled Trials as Topic
Plain language summary
Topical treatment for vaginal candidiasis (thrush) in pregnancy
Imidazoles are best but pregnant women may need longer (7 not 4 day) courses. Thrush is a common vaginal infection in pregnancy causing itching and soreness. There is no evidence that this yeast infection harms the baby. Antifungal creams are effective. Imidazoles (such as clotrimazole) are more effective than older treatments such as nystatin and hydrargaphen. Longer courses (7 days) cured more than 90% of women whereas standard (4 day) courses only cured about half the cases.
Background
Vaginal candidiasis (moniliasis) is a common and frequently distressing complaint for many women. It is even more common in pregnancy.
It is caused by a yeast ‐ Candida albicans. This yeast often inhabits warm moist areas of the body such as the mouth, vagina, perineum and groin. Often it is harmless and causes no symptoms. However, it can cause vaginal soreness and itching sometimes with a white curdy discharge and reddening of the labia. In certain circumstances such as pregnancy or after the use of broad spectrum antibiotics, thrush becomes more common.
It is possible that infection can be passed between the penis and vagina but recurrent infection is more likely to be a result of reinfection from the bowel. Preventive measures can therefore include wiping from front to back and avoiding tight underwear (especially synthetics). Excessive washing, use of bubble baths and perfumed soaps may, like antibiotics, damage the natural protective flora of the vagina and should be avoided. There is no evidence that thrush harms the unborn child.
Objectives
To assess the effects of different topical treatments on vaginal candidiasis in pregnancy.
Methods
Criteria for considering studies for this review
Types of studies
All randomised controlled trials or 'quasi‐randomised' studies (e.g. using alternation) comparing any topical treatment either with placebo or with another topical treatment, or with the same treatment over two different treatment periods.
Types of participants
Pregnant women with symptomatic vaginal candidiasis proven by culture.
Types of interventions
Nystatin was compared with hydrargaphen. Two different imidazoles were compared with nystatin. Clotrimazole was compared with placebo. One day treatment with imidazole was compared with three days treatment. Three or four days treatment with imidazole was compared with seven days treatment. Seven days treatment by imidazole was compared with 14 days treatment. Terconazole was compared with clotrimazole.
Types of outcome measures
Some trials assessed cure by negative culture. Other trials assessed symptom relief. Most trials used both measures. To avoid splitting the results into many different tables, either measure has been accepted in the meta‐analysis.
Search methods for identification of studies
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2001). We updated this search on 1 October and added the results to Studies awaiting classification.
The Cochrane Pregnancy and Childbirth Group’s Trials Register is maintained by the Trials Search Co‐ordinator and contains trials identified from:
quarterly searches of the Cochrane Central Register of Controlled Trials (CENTRAL);
weekly searches of MEDLINE;
handsearches of 30 journals and the proceedings of major conferences;
weekly current awareness alerts for a further 44 journals plus monthly BioMed Central email alerts.
Details of the search strategies for CENTRAL and MEDLINE, the list of handsearched journals and conference proceedings, and the list of journals reviewed via the current awareness service can be found in the ‘Specialized Register’ section within the editorial information about the Cochrane Pregnancy and Childbirth Group.
Trials identified through the searching activities described above are each assigned to a review topic (or topics). The Trials Search Co‐ordinator searches the register for each review using the topic list rather than keywords.
We did not apply any language restrictions.
Data collection and analysis
Trials under consideration were evaluated for methodological quality and appropriateness for inclusion, without consideration of their results. Included trial data were processed as described in Clarke 2000. All studies were read by both reviewers, who made independent assessments of quality of allocation concealment and who extracted data independently of each other. Differences were resolved by discussion.
Results
Description of studies
Risk of bias in included studies
Tan 1974 used sealed opaque envelopes for randomisation. McNellis 1977 used alternation. Milne 1973 used plain containers from the pharmacy. In all the other trials the method of randomisation is not described. In the trials comparing different lengths of the same treatment, no placebos were used so the patients would have been aware which arm of the trial they were in except Lebherz 1982. This same criticism is made of trials comparing treatments where different numbers of tablets were to be taken per day (Davis 1974; McNellis 1977; Milne 1973; Pasquale 1978; Qualey 1975 and Tan 1974). (Three reports from an updated search in October 2009 have been added to Studies awaiting classification.)
Effects of interventions
The earliest study (Milne 1973) showed that 14 days treatment with nystatin was as effective as hydrargaphen. All four trials comparing imidazoles (Davis 1974; McNellis 1977 and Qualey 1975 used miconazole cream while Tan 1974 used clotrimazole pessaries) with nystatin pessaries showed imidazoles to be more effective as judged by symptom relief and negative culture (Davis 1974; McNellis 1977 and Qualey 1975) or by negative culture alone (Tan 1974). Ruiz‐Velasco 1978 showed that clotrimazole was more effective than placebo. Pasquale 1978 using miconazole and Rubin 1980 using econazole both showed that a one week course of treatment is as effective as two weeks. However, the same trial by Pasquale 1978 showed that courses of miconazole of four days were not as effective as a one week course. Lebherz 1982 found the same. A later study by the same author (Lebherz 1985) showed that one day of high dose clotrimazole is as effective as three days at a lower dose. However, this study included nine non pregnant women among the 101 in the trial and it has not therefore been possible to include the results in the tables as data are not presented separately for the pregnant women. Del Palacio‐Hernanz found that terconazole cream was as effective as clotrimazole cream.
Discussion
Vaginal candidiasis becomes more common during pregnancy. Though there are now effective one dose oral treatments, these are not known to be safe or effective in pregnancy. The above trials do show that imidazoles are effective though it seems that longer courses of treatment may be needed in pregnancy (one week) to achieve symptom relief. Though Ruiz‐Velasco 1978 looked for the presence of candida on neonatal skin, the importance of such skin contamination is completely unknown. Vaginal thrush in pregnancy is not known to be harmful to the fetus.
Authors' conclusions
Implications for practice.
Topical imidazoles and not nystatin, should be used if possible for symptomatic vaginal candidiasis in pregnancy. There is no evidence to suggest that asymptomatic women need to be treated. Treatment courses lasting more than one week confer no extra benefit. Four day courses will cure just over half of infections whereas a seven day course cures over 90%. Pregnant women should be offered longer courses of treatment than non‐pregnant women. There is no evidence that any one imidazole is any more effective than another. There are no reliable studies on the safety or efficacy of any complimentary therapies for prevention or cure (e.g. live yoghurt). Such treatments cannot therefore be recommended.
Implications for research.
Studies could be set up to explore whether neonatal contamination with candida is of any clinical importance. Longer acting formulations could be tried to improve compliance. As topical treatment is very rarely ineffective, research into the relative safety of any systemic treatment would appear to be of limited value.
[Note: The seven citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
What's new
| Date | Event | Description |
|---|---|---|
| 30 January 2013 | Amended | Contact details updated. |
History
Protocol first published: Issue 2, 1996 Review first published: Issue 2, 1996
| Date | Event | Description |
|---|---|---|
| 1 October 2009 | Amended | Search updated. Three reports added to Studies awaiting classification (Dunster 1974; Pawlaczyk 2006; Wajnberg 1981). |
| 6 November 2008 | Amended | Converted to new review format. |
| 1 July 2001 | New search has been performed | Four further studies have been added to this review. The reviewers await a response from the author of a fifth study (Goormans 1985) before it can be included. Such a response is unlikely to be forthcoming after this interval. The conclusions of previous editions of this review are not substantially altered by the four additional studies which have come to light since the last edition of this review, but which were published between 1973 and 1985. |
Notes
We are looking for new authors to update this review. Please contact Sonja Henderson (s.l.henderson@liv.ac.uk), Managing Editor, for information on how to apply to update this review.
Acknowledgements
The authors would like to thank the Scientific Foundation Board of the Royal College of General Practitioners for the grant which made the updating of this review possible.
Alterations were made following helpful comments from the Consumer Panel.
Data and analyses
Comparison 1. clotrimazole versus placebo for vaginal candidiasis.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 Persistent candidiasis | 1 | 100 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.14 [0.06, 0.31] |
1.1. Analysis.
Comparison 1 clotrimazole versus placebo for vaginal candidiasis, Outcome 1 Persistent candidiasis.
Comparison 2. 4 versus 7 days imidazoles for vaginal candidiasis.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 Persistent candidiasis | 2 | 81 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 11.07 [4.21, 29.15] |
2.1. Analysis.
Comparison 2 4 versus 7 days imidazoles for vaginal candidiasis, Outcome 1 Persistent candidiasis.
Comparison 3. 7 versus 14 days imidazoles for vaginal candidiasis.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 Persistent candidiasis | 2 | 91 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.41 [0.16, 1.05] |
3.1. Analysis.
Comparison 3 7 versus 14 days imidazoles for vaginal candidiasis, Outcome 1 Persistent candidiasis.
Comparison 4. Nystatin versus hydrargaphen for vaginal candidiasis.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 Presence of symptoms at 14 days after start of treatment | 1 | 50 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.29 [0.05, 1.84] |
4.1. Analysis.
Comparison 4 Nystatin versus hydrargaphen for vaginal candidiasis, Outcome 1 Presence of symptoms at 14 days after start of treatment.
Comparison 5. Imidazoles versus nystatin for vaginal candidiasis.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 Persistent candidiasis | 5 | 793 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.21 [0.16, 0.29] |
5.1. Analysis.
Comparison 5 Imidazoles versus nystatin for vaginal candidiasis, Outcome 1 Persistent candidiasis.
Comparison 6. terconazole versus clotrimazole for vaginal candidiasis.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 persistence of candidiasis at 28 days after treatment | 1 | 38 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 1.41 [0.28, 7.10] |
6.1. Analysis.
Comparison 6 terconazole versus clotrimazole for vaginal candidiasis, Outcome 1 persistence of candidiasis at 28 days after treatment.
Characteristics of studies
Characteristics of included studies [ordered by study ID]
Davis 1974.
| Methods | Randomisation method is not stated. | |
| Participants | 46 pregnant women in California with vaginal candidiasis proven by culture. | |
| Interventions | Miconazole cream, 100 mg each night for 14 nights, compared with nystatin vaginal tablets, 100,000 units twice daily for 15 days. | |
| Outcomes | Cure assessed by combination of microscopy, culture and full symptomatic relief, 30 days after treatment ended. | |
| Notes | Treatment regimens were clearly different. Women could have known which arm of the trial they were in. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Allocation concealment? | High risk | C ‐ Inadequate |
Del Palacio‐Hernanz.
| Methods | Randomisation method not described. | |
| Participants | 38 pregnant women (18‐37 years old) in Spain with vaginal candidiasis proven by culture. | |
| Interventions | Terconazole vaginal cream 0.4% 5g daily for 7 days versus clotrimazole vaginal cream 1% 5g daily for 7 days. | |
| Outcomes | Cure assessed both by disappearance of symptoms and negative culture. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Allocation concealment? | Unclear risk | B ‐ Unclear |
Lebherz 1982.
| Methods | Randomisation method not described. | |
| Participants | 65 pregnant women in California with vaginal candidiasis confirmed by mycological culture. | |
| Interventions | Miconazole vaginal cream 2% one applicator full daily for 4 days versus 7 days. | |
| Outcomes | Cure assessed only by culture. | |
| Notes | This study did give placebo treatment when the short course of active treatment had ended. Women should have been unable to tell which arm of the trial they were in. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Allocation concealment? | Low risk | A ‐ Adequate |
McNellis 1977.
| Methods | Alternate assignment. | |
| Participants | 535 pregnant women in New Jersey with vaginal candidiasis proven by culture. | |
| Interventions | Miconazole cream, 100 mg each night for 14 nights, compared with nystatin vaginal tablets, 100,000 units twice daily for 15 days. | |
| Outcomes | Cure assessed by combination of microscopy, culture and full symptomatic relief, 8‐10 days after treatment ended. | |
| Notes | Main author was an employee of sponsoring pharmaceutical company. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Allocation concealment? | High risk | C ‐ Inadequate |
Milne 1973.
| Methods | Randomisation by plain numbered containers from the pharmacist. | |
| Participants | 33 women attending an antenatal clinic in Edinburgh received 50 courses of treatment overall. | |
| Interventions | Hydrargaphen 5mg pessary every night for 14 days versus nystatin 100,000 units pessary twice daily for 14 days. | |
| Outcomes | Cure assessed by both symptom relief and negative culture. | |
| Notes | One form of treatment was daily, the other twice daily. No additional placebo was given to women receiving daily treatment. Women would have been aware which arm of the trial they were in. Hydrargaphen is no longer available as far as the reviewers can tell. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Allocation concealment? | High risk | C ‐ Inadequate |
Pasquale 1978.
| Methods | Randomisation by lists 'generated by Ortho Pharmaceuticals'. No explanation is given for the allocation. | |
| Participants | Pregnant women with symptomatic vaginal candidiasis proven by culture. The pregnant women were beyond the first trimester. The results for the pregnant women are given separately. | |
| Interventions | Five different regimens were tested: 1, 2, 4, 7 and 14 days of miconazole 2% vaginal cream 5g at bedtime. 4 day against 7 days and 7 against 14 days regimens are compared here. | |
| Outcomes | Therapeutic cure defined as combined as clearance of symptoms and negative culture results. | |
| Notes | The address of one of the authors and the address for reprints is Ortho Pharmaceuticals. No placebo was given after the shorter courses of treatment had ended. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Allocation concealment? | High risk | C ‐ Inadequate |
Qualey 1975.
| Methods | Method of randomisation is not described. | |
| Participants | 51 pregnant women in Florida with symptomatic vaginal candidiasis proven by culture. | |
| Interventions | Miconazole cream 5g one applicator full each night for 14 days versus one nystatin tablet 100,000 units intravaginally morning and evening for 15 days. | |
| Outcomes | Cure was assessed by symptom relief and negative culture. | |
| Notes | The two forms of treatment were clearly different. in form and schedule. Women would have known which arm of the trial they were in. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Allocation concealment? | High risk | C ‐ Inadequate |
Rubin 1980.
| Methods | Method of randomisation is not described. | |
| Participants | Black pregnant women attending a hospital antenatal clinic in South Africa. All women were culture positive at the start but it is not stated that they were necessarily symptomatic. | |
| Interventions | All women used econazole vaginal cream one applicator full at night for 7 days. Women still positive for candida were then either given no treatment or a further 7 days of the cream. Comparison is therefore between 7 days and 14 days of the same treatment. | |
| Outcomes | Diminution of symptoms was 'considered a cure'. | |
| Notes | Trial entry was by being culture positive for monilia. Cure however was assessed by symptom relief. Treatment in the second week was compared with discontinuation of treatment. A placebo effect might be expected but the results show 2 weeks treatment to be worse than 1 week. This appears inexplicable. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Allocation concealment? | High risk | C ‐ Inadequate |
Ruiz‐Velasco 1978.
| Methods | Method of randomisation not stated. | |
| Participants | Women between 32 and 36 weeks' pregnancy with proven vaginal moniliasis in Mexico City. | |
| Interventions | Clotrimazole 0.1gm vaginal tablet and vulvar cream daily for 6 days versus placebo tablets and cream. | |
| Outcomes | Presence of monilia on vaginal swab at delivery. | |
| Notes | Swabs were also obtained from the baby's skin at delivery and at three days old. The significance of monilia on neonatal skin is not the subject of this review. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Allocation concealment? | Low risk | A ‐ Adequate |
Tan 1974.
| Methods | Randomisation was thorough with a pharmacist holding the key. | |
| Participants | 62 women attending antenatal clinic in an Edinburgh hospital with vaginal candidiasis proven by culture. | |
| Interventions | Clotrimazole 100mg vaginal tablet at night, for 6 nights, compared with nystatin 100,000 units vaginal tablets, 2 at night for 6 nights. | |
| Outcomes | Eradication of infection proved by culture only, 1 week after therapy ended. | |
| Notes | One of the four authors of this paper listed as an employee of Bayer pharmaceuticals. Treatment was not blinded as one arm of the trial used two tablets and the other one. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Allocation concealment? | High risk | C ‐ Inadequate |
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
|---|---|
| Benijts 1980 | Results failed to separate pregnant from non‐pregnant women in this trial. |
| Bloch 1980 | Results failed to separate pregnant from non‐pregnant women in this trial. |
| Chaisilwattana 1986 | Results failed to separate pregnant from non‐pregnant women in this trial. |
| Corkill 1972 | Results failed to separate pregnant from non‐pregnant women in this trial. |
| Eliot 1979 | Results failed to separate pregnant from non‐pregnant women in this trial. |
| Elliott 1979 | Results did not separate pregnant from diabetic women in this trial. |
| Fleury 1985 | Only four women in this study were pregnant. |
| Higton 1973 | Results failed to separate pregnant from non‐pregnant women in this trial. |
| Lebherz 1981 | Only three of 63 women were pregnant. |
| Lebherz 1985 | Of 101 women with complete data, 9 were not pregnant. The results do not separate out these 9 women and it was therefore not possible to include the data in the meta‐analysis. |
| Lecart 1979 | Results failed to separate pregnant from non‐pregnant women in this trial. |
| Pigott 1972 | Results failed to separate pregnant from non‐pregnant women in this trial. |
| Stettendorf 1982 | Results failed to separate pregnant from non‐pregnant women in this trial. |
Contributions of authors
Gavin Young was the main author but all the papers were assessed by both authors who discussed the classification together.
Declarations of interest
None known.
Edited (no change to conclusions)
References
References to studies included in this review
Davis 1974 {published data only}
- Davis JE, Frudenfeld JH, Goddard JL. Comparative evaluation of monistat and mycostatin in the treatment of vulvovaginal candidiasis. Obstetrics and Gynecology 1974;44:403‐6. [PubMed] [Google Scholar]
Del Palacio‐Hernanz {published data only}
- Palacio‐Hernanz A, Sanz‐Sanz F, Rodriquez‐Noriega A. Double‐blind investigation of R‐42470 (terconazole cream 0.4%) and clotrimazole (cream 1%) for the topical treatment of mycotic vaginitis. Chemioterapia 1984;3:192‐5. [PubMed] [Google Scholar]
Lebherz 1982 {published data only}
- Lebherz TB, Ford LC. Candida albicans vaginitis: the problem is diagnosis, the enigma is treatment. Chemotherapy 1982;28 Suppl 1:73‐9. [DOI] [PubMed] [Google Scholar]
McNellis 1977 {published data only}
- McNellis D, McLeod M, Lawson J, Pasquale SA. Treatment of vulvovaginal candidiasis in pregnancy. A comparative study. Obstetrics and Gynecology 1977;50:674‐8. [PubMed] [Google Scholar]
Milne 1973 {published data only}
- Milne LJR, Brown ADG. Comparison of nystatin (Nystan) and hydrargaphen (Penotrane) in the treatment of vaginal candidosis in pregnancy. Current Medical Research and Opinion 1973;1:524‐7. [DOI] [PubMed] [Google Scholar]
Pasquale 1978 {published data only}
- Pasquale SA, Lawson J, Sargent EC, Newdeck JP. A dose‐response study with monistat cream. Obstetrics and Gynecology 1979;53:250‐3. [PubMed] [Google Scholar]
Qualey 1975 {published data only}
- Qualey JR, Cooper C. Monistat cream (miconazole nitrate) a new agent for the treatment of vulvovaginal candidiasis. Journal of Reproductive Medicine 1975;15:123‐5. [PubMed] [Google Scholar]
Rubin 1980 {published data only}
- Rubin A, Russell JM, Mauff A. Efficacy of econazole in the treatment of candidiases and other vaginal discharges. South African Medical Journal 1980;57:407‐8. [PubMed] [Google Scholar]
Ruiz‐Velasco 1978 {published data only}
- Ruiz‐Velasco V, Rosas‐Arceo J. Prophylactic clotrimazole treatment to prevent mycoses contamination of the newborn. International Journal of Gynaecology and Obstetrics 1978;16:70‐1. [DOI] [PubMed] [Google Scholar]
Tan 1974 {published data only}
- Tan CG, Milne LJR, Good CS, Loudon JDO. A comparative trial of six day therapy with clotrimazole and nystatin in pregnant patients with vaginal candidiasis. Postgraduate Medical Journal 1974;50 Suppl 1:102‐5. [PubMed] [Google Scholar]
References to studies excluded from this review
Benijts 1980 {published data only}
- Benijts G, Vignalli M, Kreysing W, Stettendorf S. Three day therapy of vaginal candidiasis with clotrimazole vaginal tablets and econazole ovules: a multicentre comparative study. Current Medical Research and Opinion 1980;7:55‐61. [DOI] [PubMed] [Google Scholar]
Bloch 1980 {published data only}
- Bloch B, Kretzel A. Econazole nitrate in the treatment of candidal vaginitis. South African Medical Journal 1980;58:314‐6. [PubMed] [Google Scholar]
Chaisilwattana 1986 {published data only}
- Chaisilwattana P, Bhiraleus P. A comparative study of 3‐day and 6‐day clotrimazole therapy in patients with vaginal candidosis. Journal of the Medical Association of Thailand 1986;69:432‐7. [PubMed] [Google Scholar]
Corkill 1972 {published data only}
- Corkill, BM, McCarthy, NJ. Comparative trial of Fungilin (amphotericin B) and Pimafucin (natamycin) pessaries in the treatment of vaginal candidiasis. Medical Journal of Australia 1972;2:33‐4. [PubMed] [Google Scholar]
Eliot 1979 {published data only}
- Eliot BW, Howat RCL, Mack AE. A comparison between the effects of nystatin, clotrimazole and miconazole on vaginal candidiasis. British Journal of Obstetrics and Gynaecology 1979;86:572‐7. [DOI] [PubMed] [Google Scholar]
Elliott 1979 {published data only}
- Elliott P. Therapeutic evaluation of elase as adjunctive therapy in the treatment of monilial vaginitis. Australian and New Zealand Journal of Obstetrics and Gynaecology 1979;19:56‐8. [DOI] [PubMed] [Google Scholar]
Fleury 1985 {published data only}
- Fleury F, Hughes D, Floyd R. Therapeutic results obtained in vaginal mycoses after single‐dose treatment with 500 mg clotrimazole vaginal tablets. American Journal of Obstetrics and Gynecology 1985;152:968‐70. [DOI] [PubMed] [Google Scholar]
Higton 1973 {published data only}
- Higton BK. A trial of clotrimazole and nystatin in vaginal moniliasis. Journal of Obstetrics and Gynaecology of the British Commonwealth 1973;80:992‐5. [DOI] [PubMed] [Google Scholar]
Lebherz 1981 {published data only}
- Lebherz TB, Ford LC, Kleinkopf V. A comparison of a three‐day and seven‐day clotrimazole regimen for vulvovaginal candidiasis. Clinical Therapeutics 1981;3(5):344‐8. [PubMed] [Google Scholar]
Lebherz 1985 {published data only}
- Lebherz T, Guess E, Wolfson N. Efficacy of single‐ versus multiple‐dose clotrimazole therapy in the management of vulvovaginal candidiasis. American Journal of Obstetrics and Gynecology 1985;152:965‐7. [DOI] [PubMed] [Google Scholar]
Lecart 1979 {published data only}
- Lecart C, Claerhout F, Franck R, Godts P, Lilien C, Macours L, et al. A new treatment of vaginal candidiasis: three‐day treatment with econazole. European Journal of Obstetrics, Gynecology and Reproductive Biology 1979;9:125‐7. [DOI] [PubMed] [Google Scholar]
Pigott 1972 {published data only}
- Pigott PV. An evaluation of a modified nystatin vaginal tablet in a multi‐centre study. Current Medical Research and Opinion 1972;1:159‐65. [DOI] [PubMed] [Google Scholar]
Stettendorf 1982 {published data only}
- Stettendorf S, Benijts G, Vignali M, Kreysing W. Three‐day therapy of vaginal candidiasis with clotrimazole vaginal tablets and econazole ovules: a multicenter comparative study. Chemotherapy 1982;28:87‐91. [DOI] [PubMed] [Google Scholar]
References to studies awaiting assessment
Dunster 1974 {published data only}
- Dunster GD. Vaginal candidiasis in pregnancy ‐ a trial of clotrimazole. Postgraduate Medical Journal 1974;50 Suppl 1:86‐8. [PubMed] [Google Scholar]
Goormans 1985 {published data only}
- Goormans E. Comparative double‐blind evaluation of the efficacy and tolerability of Terconazole 240‐mg suppository (1 day) and 80‐mg suppositories (3 days) versus clotrimazole 200‐mg (3 days) in pregnant patients with vulvovaginal candidosis. Gynakologische Rundschau 1985;25 Suppl 1:74‐82. [DOI] [PubMed] [Google Scholar]
Pawlaczyk 2006 {published data only}
- Pawlaczyk M, Friebe Z, Pawlaczyk MT, Sowinska‐Przepiera E, Wlosinska J. The effect of treatment for vaginal yeast infection on the prevalence of bacterial vaginosis in early pregnancy. Acta Dermatovenerologica Croatica 2006;14(1):26‐9. [PubMed] [Google Scholar]
Poludniewski 1995 {published data only}
- Poludniewski G, Bielecki M, Kluz‐Kowal AB. Prophylaxis of puerperal infections using the gyno‐pevaryl 150 preparation [translation]. Ginekologia Polska 1995 Feb;66:117‐20. [PubMed] [Google Scholar]
Sobel 1993 {published data only}
- Sobel J, Brooker D, Stein G, Thomason J, Wermeling D, Bradley B, et al. Single dose fluconazole vs multidose clotrimazole for vaginal candidiasis. Fluconazole Vaginitis Study Group. Proceedings of 41st Annual Clinical Meeting of The American College of Obstetricians and Gynaecologists; 1993 May 3‐6; Washington DC, USA. 1993:12.
Wajnberg 1981 {published data only}
- Wajnberg M, Wajnberg A. A comparative double blind trial with vaginal cremes of ciclopiroxolamine and miconazole in vulvovaginal candidosis [Doppelblind‐Vergleichsstudie mit Ciclopiroxolamin‐ und miconazol‐Vaginalcreme bei vulvovaginaler Candidose]. Mykosen 1981;24(12):721‐30. [PubMed] [Google Scholar]
Wallenburg 1976 {published data only}
- Wallenburg HC, Wladimiroff JW. Recurrence of vulvovaginal candidosis during pregnancy. Comparison of miconazole vs nystatin treatment. Obstetrics & Gynecology 1976;48(4):491‐4. [PubMed] [Google Scholar]
Additional references
Clarke 2000
- Clarke M, Oxman AD, editors. Cochrane Reviewers' Handbook 4.1 [updated June 2000]. In: Review Manager (RevMan) [Computer program]. Version 4.1. Oxford, England: The Cochrane Collaboration, 2000.
References to other published versions of this review
Young 1995a
- Young GL. 4‐day vs 7‐day treatment for vaginal candidiasis. [revised 30 April 1993]. In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software, 1995.
Young 1995b
- Young GL. 7‐day vs 14‐day treatment for vaginal candidiasis. [revised 30 April 1993]. In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2 Oxford: Update Software, 1995.
Young 1995c
- Young GL. Imidazoles vs nystatin for vaginal candidiasis. [revised 30 April 1993]. In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software, 1995.
Young 1995d
- Young GL. Clotrimazole for vaginitis in pregnancy. [revised 30 April 1993]. In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software, 1995.