Itraconazole, Fiuconazol And Intravaginal Antifungal For The Treatment Of Recurrent Vulvovaginal Candidiasis In China:a Systematic Review

Objective:To evaluate the clinical efficacy of itraconazole, fluconazol and intravaginal medicine for women with recurrent vulvovaginal candidiasis.Methods:We searched many databases, including Embase (1979to January2011), PubMed (1979to January2011), CBMdisc (1979to January2011), CNKI (1979to January2011), QINGHUATONGFANG DATABASE (1979to January2011) and WANFANG DATABASE (1979to January2011). Relevant journals and references were also manually searched. And we screened the randomized controlled trials (RCTs) on Itraconazole, fluconazol and intravaginal antifungal for the treatment of women with recurrent vulvovaginal candidiasis. Two reviewers independently accomplished study selection and quality assessment, data extraction and analyses according to the Cochrane Handbook for systematic reviews of interventions. RevMan5.0was used to account the data. Results18RCTs were included.Results:The meta-analyses showed that the fluconazol with nystatin is more effective than nystatin [cure rate OR=4.38,95%CI (1.82,10.53) P=0.001]. Fluconazol with clotrimazole is no more effective than clotrimazole and same safety as clotrimazole [total effective rate OR=1.15,95%CI (0.42,3.17) P=0.97, side effect rate OR=1.93,95%CI(0.58,6.42) P=0.28]. Fluconazol with miconazole has better effect than miconazole in the long time observation [total effective rate OR=5.54,95%CI (2.49,12.30) P＜0.0001]. The recurrent rate of itraconazole is lower than miconazole [recurrent rate OR=0.1295%CI (0.04,0.40) P=0.0005]. Itraconazole is more effective than clotrimazole [total effective rate OR=8.97,95%CI (2.58,31.17) P=0.0006, side effect rate OR=19.1095%CI (2.51,145.15) P=0.004]. Itraconazole with miconazole is more effective than miconazole [curen rate OR=12.66,95%CI (2.92,54.92) P=0.0007]. Itraconazole with miconazole is no more effective than itraconazole [cure rate OR=0.3995%CI(0.06,2.57) P=0.33].Conclusion:The Meta-analyses showed that the itraconazole or fluconazol with intravaginal antifungal is more effective than the other treatment. Comparing with the intravaginal antifungal, the combined treatment is the same safety.