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.
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