According to a meta-analysis published in Infectious and Drug Resistance, antifungal drugs have variable efficacy in the treatment of vulvovaginal candidiasis (VVC), fluconazole being the most effective.
Researchers conducted a meta-analysis of 41 randomised trials that compared the efficacy of antifungal drugs vs placebo in the treatment of VVC.
The pooled results of pairwise meta-analysis showed that fluconazole (OR, 6.45; 95% Credible Interval [CrI], 4.42–9.41), clotrimazole (OR, 2.99; 95% CrI 1.61–5.55), miconazole (OR, 5.96; 95% CrI, 3.17–11.2), itraconazole (OR, 2.29; 95% CrI 1.21–4.33), ketoconazole (OR, 2.40; 95% CrI 1.55–3.71), butoconazole (OR, 1.18; 95% CrI 1.06–1.31), and terconazole (OR, 5.60; 95% CrI 2.78–11.3) were more effective in the treatment of VVC vs placebo. The surface under the cumulative ranking curve values for each drug were as follows: fluconazole (91.5%), clotrimazole (61.8%), miconazole (33.8%), itraconazole (50.5%), ketoconazole (42.8%), econazole (46.8%), butoconazole (82.2%), terbinafine (20.9%), and terconazole (65.0%) vs placebo (0.5%).
The authors said: “The American and European guidelines for the treatment of VVC, based on a large number of evidence-based clinical practice, recommended the use of fluconazole (150 mg) for the treatment of moderate-to-severe VVC, which is consistent with our results." The authors call for further high-quality studies with large sample sizes to strengthen the results.