Treatment

• In cutaneous candidiasis there is only limited evidence from studies on the effectiveness of "standard" nystatin.

• There is no evidence that newer topical or oral azole drugs are superior to nystatin.

• In general, clinical cure rates in all studies dealing with cutaneous candidiasis were high. The easier applicability of, for example, once-weekly oral treatment must be weighed against the greater chance of side-effects.

• In diaper dermatitis, application of an antifungal drug was superior in those cases in which Candida was identified at the start.

• In oropharyngeal candidosis one RCT showed itraconazole to be better than clotrimazole and another showed fluconazole to be better than nystatin. The differences, however, are only short lasting and may not have been demonstrable at longer follow up.

• In vulvovaginal candidosis the majority of RCTs have failed to demonstrate higher efficacy for any therapy approach. Short-term remission rates are between 70% and 80%, but many patients relapse after the end of treatment. Oral treatment is no better than local treatment, especially regarding long-term results. One RCT suggests that eradication of Candida in the sexual partner may improve long-term prognosis.

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