Comparison of a novel treatment protocol with oral fluconazole vs probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 in the treatment of recurrent vulvovaginal candidiasis

ABSTRACT
Objective. The recurrence of vulvovaginal candidiasis represents a therapeutic challenge. The aim of this prospective case-control study on a series of women with recurrent vulvovaginal candidiasis (RVVC) was to evaluate the efficacy of a new treatment schedule based on fluconazole 200 mg oral capsules in comparison with oral capsules of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14.
Patients and Methods. The study was conducted from April 2020 to June 2021 at the Units of Gynecology and Dermatology, Tor Vergata University Hospital, Rome. One hundred and one adult female patients enrolled in the study were divided into two groups: group A treated with 200 mg fluconazole capsules on day 1, 4, 11, 26, then once a month for three months; group B, two oral capsules of L. rhamnosus GR-1 and L. reuteri RC-14 daily for 15 days/month for three months. Statistical analysis was performed using the Chi-square test. A p < 0.05 was considered statistically significant.
Results. A complete clinical response was observed in all 50 patients of the group A at 6 months with no relapse. In the group B, a complete clinical response was observed in 29 patients with ten relapses at 6 months. Itch, leucorrhoea and vulvodynia showed a statistically significant better outcome in the group A (respectively, p < 0.001, p < 0.001, p < 0.002).
Conclusions. The proposed new treatment schedule using fluconazole allows the fungal biofilm to be directed into the different growth stages, with greater efficacy than the administration of probiotics alone.