A Cochrane review [Abstract] 1 included 10 studies with a total of 940 subjects. Drugs absorbed from the gastrointestinal (GI) tract (ketoconazole or fluconazole) were beneficial in eradication of oral candidiasis compared with drugs not absorbed from the GI tract (nystatin or amphotericin B) (RR 1.29, 95% CI 1.09 to 1.52; 3 studies), however there was significant heterogeneity (I2 =78%). There were only two trials that compared the treatment of candidiasis using an active drug with a placebo. Ketoconazole, a drug absorbed from the gastrointestinal tract, was more beneficial than placebo in eradicating oral candidiasis (RR 3.61, 95% CI 1.47 to 8.88; 1 study, n=56). In the other placebo controlled trial on the partially absorbed drug, clotrimazole, no benefit was demonstrated (RR 3.43, 95% CI 0.51 to 22.94; 1 study, n=13). However, clotrimazole was more effective at 50 mg dose than at 10 mg dose in eradicating oral candidiasis, when assessed mycologically (RR = 2.00, 95% CI 1.11 to 3.60; 1 study, n=52).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding) and by imprecise results (limited study size for each comparison).
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