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The following is a summary of “Treatment of uncomplicated vulvovaginal candidiasis. Topical or oral drugs? Single-day or multiple-day therapy? A network meta-analysis of randomized trials,” published in the March 2025 issue of American Journal of Obstetrics & Gynecology by GARDELLA et al. 

Researchers conducted a retrospective study to evaluate early (7–10 days) and late (24–35 days) clinical and mycological cure rates associated with single or multiple-day topical or oral treatment of uncomplicated vulvovaginal candidiasis (VVC).  

They analyzed data from multiple sources, including the Cochrane Central Register of Studies Online, MEDLINE, Ovid platform (1946 to 31 March 2024), Embase, Google Scholar, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and European Clinical Trials Register. A total of 50 randomized studies (N = 7,208 subjects) comparing topical or oral treatments with or without placebo were included. Confidence in network meta-analysis (NMA) results was assessed using an online tool integrating direct comparisons with NMA estimates. The risk of bias (ROB) in individual studies was estimated using the Revised Cochrane risk-of-bias tool for randomized trials. Bayesian NMA was conducted using an interactive web-based tool with the R packages gemct and BUGSNET, and treatment ranking success probabilities were calculated based on the surface under the cumulative ranking curve (SUCRA).  

The results showed that all treatments were highly effective (>75%) for clinical and mycological cure of VVC compared to placebo. Single-day fluconazole (150 mg) demonstrated slightly higher efficacy than multiple-day topical therapy for early clinical cure in both pairwise (pooled Odds Ratio (OR) = 1.9, 95% CI = 1.31-2.74, I²= 0%) and NMA (OR = 1.52, 95% CI = 1.13-2.07). No significant differences were observed between oral and topical treatments for late clinical cure (3,983 subjects in the network). Single-dose fluconazole showed marginal superiority over multiple-day topical therapy for late mycological cure (OR = 1.42, 95% CI = 1–1.99). Ranking analysis indicated that single-day fluconazole had the highest probability of achieving early (SUCRA = 74.1%) and late (SUCRA = 84.2%) mycological cure, while multiple-day itraconazole ranked highest for early (SUCRA = 99%) and late (SUCRA = 75.7%) symptom relief.  

Investigators concluded that while a strict hierarchy of competing treatments for uncomplicated VVC was probably inappropriate given the high efficacy of both oral and topical drugs. 

Source: ajog.org/article/S0002-9378(25)00177-2/abstract