Oral versus intra-vaginal imidazole and triazole anti-fungal agents for the treatment of uncomplicated vulvovaginal candidiasis (thrush): a systematic review Margaret C. Watson a, * , Jeremy M. Grimshaw b , Christine M. Bond a , Jill Mollison c , Anne Ludbrook d Objectives To compare the relative effectiveness, cost effectiveness and safety of oral versus intra-vaginal anti-fungal treatments for uncomplicated vulvovaginal candidiasis (thrush) and establish patient preference for the route of anti-fungal administration. Design A systematic review of studies comparing oral and intra-vaginal anti-fungal treatments for uncomplicated vulvovaginal candidiasis. Standard Cochrane Collaboration methods were used. Data sources The following sources were searched: the Cochrane Controlled Trials Register; the Cochrane Sexually Transmitted Disease review group Specialised Register of Controlled Trials; EMBASE (January 1980 to January 2000); and MEDLINE (January 1985 to May 2000). The reference list of each trial was checked for additional references. The manufacturers of anti-fungal treatments in the UK were asked for information on trials fulfilling the inclusion criteria. Methods There was duplicate, independent examination and selection of the electronic search results followed by duplicate data abstraction. Disagreements regarding inclusion status and data abstraction were resolved by discussion between reviewers and the editor of the Cochrane Sexually Transmitted Disease group. Randomised controlled trials conducted worldwide and published in any language were included. The primary outcome measure was clinical cure. Mycological cure, patient preference and safety were secondary outcome measures. Results Seventeen trials were included in the review, reporting 19 oral versus intra-vaginal anti-fungal treatment comparisons. No statistically significant differences were shown between oral and intra-vaginal anti-fungal treatment for clinical or mycological cure. All 10 trials that reported a preference favoured oral treatment (compared with intra-vaginal or no preference). No trials presented cost data. Conclusions There is no difference between the relative effectiveness of oral and intra-vaginal anti-fungal treatment for thrush. INTRODUCTION Seventy-five percent of women experience at least one episode of vulvovaginal candidiasis (thrush) before the menopause 1 . Candida albicans (C. albicans) is most often associated with candidiasis. However, other yeasts (e.g. C. glabrata, C. krusei) may also be associated with this infection 2 . Vulvovaginal candidiasis is treated with anti- fungal drugs 3 administered by the oral or intra-vaginal route. The objective of this review was to compare the relative effectiveness, cost effectiveness and safety of oral and intra-vaginal imidazole and triazole anti-fungal drugs for the treatment of uncomplicated vaginal candidiasis, and to establish patient preference regarding the route of admin- istration of anti-fungal treatment. METHODS Inclusion criteria For the purpose of this review, ‘anti-fungal’ refers to imidazole and/or triazole anti-fungal drugs. We included studies if they were randomised controlled trials published in any language, comparing oral versus intra-vaginal imi- dazole and triazole anti-fungal treatments in women (aged 16 years or over) with uncomplicated vulvovaginal candi- BJOG: an International Journal of Obstetrics and Gynaecology January 2002, Vol. 109, pp. 85–95 D RCOG 2002 BJOG: an International Journal of Obstetrics and Gynaecology PII:S1470-0328(02)01142-4 www.bjog-elsevier.com a Department of General Practice and Primary Care, University of Aberdeen, UK b Health Services Research Unit, University of Aberdeen, Medical School, UK c Department of Public Health, University of Aberdeen, Medical School, UK d Health Economics Research Unit, University of Aberdeen, Medical School, UK * Correspondence: Dr M. C. Watson, Department of General Practice and Primary Care, University of Aberdeen, Westburn Road, Aberdeen AB25 2AY, Scotland, UK.