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Evidence summaries

Topical Treatment for Vaginal Candidiasis in Pregnancy

Topical imidazole is effective and safe, and more effective than nystatin for treating symptomatic vaginal candidiasis in pregnancy. Treatments for seven days may be necessary. Level of evidence: "A"

Ten trials were included in a Cochrane review [Abstract] 1. Based on five trials, imidazole drugs were more effective than nystatin (OR 0.21, 95% CI 0.16 to 0.29). Nystatin was more effective than hydrargaphen in one trial. A trial of clotrimazole was more effective than placebo (OR 0.14, 95% CI 0.06 to 0.31). Single-dose treatment was no more or less effective than three or four days when assessed by culture or by symptoms. Treatment lasting for four days (miconazole 2% vaginal cream) was less effective than treatment for seven days (OR 9.73, 95% CI 2.91 to 33.89). Four-day courses will cure just over half of infections whereas a seven day course cures over 90%.

A cohort study 2 in Israel between years 2003 and 2009 including a total of 65457 pregnancies assessed the risk of spontaneous abortion following exposure to vaginal antibiotics. 9.91% ended with a spontaneous abortion. Overall, 3246 (5%) pregnancies were exposed to vaginal antimycotic medications until the 20th gestational week (clotrimazole 2712 and miconazole 633). Exposure was not associated with spontaneous abortions (adjusted hazard ratio, 1.11; 95% CI 0.96 to 1.29). No association was found between categories of dosage of vaginal antimycotics and spontaneous abortions.

    References

    • Young GL, Jewell D. Topical treatment for vaginal candidiasis (thrush) in pregnancy. Cochrane Database Syst Rev 2001;(4):CD000225. [PubMed]
    • Daniel S, Rotem R, Koren G et al. Vaginal antimycotics and the risk for spontaneous abortions. Am J Obstet Gynecol 2018;(March 3) [PubMed]

Primary/Secondary Keywords