Details of 22 studies (n=1,980) were tabulated, of which 11 (n=1,609) were randomised controlled trials (RCTs). An unknown number of other studies was also included.
Effect of antifungal medications on oral candidiasis (6 studies).
The authors stated that the quality of the included studies was mainly high (A), but none of the 6 studies included in this section received a quality rating of A. Two trials of itraconazole reported clinical response rates of 55% and 65%. One study reported that the continuous use of fluconazole was significantly associated with fluconazole failure when compared with no use. One study reported no statistically significant difference in recurrence rate before and after initiation of therapy with fluconazole. One case report showed fluconazole to be successful, while another study seemed to show that fluconazole increased resistance.
Efficacy of different interventions for the treatment of oral candidiasis in HIV-positive patients (9 studies).
All 9 studies were graded level A in terms of quality. Fluconazole was more effective than clotrimazole (1 study), ketconazole (1 study) and nystatin (2 studies). Clotrimazole (1 study) and itraconazole (3 studies) were as effective as fluconazole. Ketoconazole was as effective as itraconazole (1 study).
Guidelines for the management of oral candidiasis in primary health care settings (number of studies unclear).
One study was level A in terms of quality. The authors did not attempt to pool the results of these guidelines and urged caution when interpreting their results (no further details were given).
Drug resistance and interactions (7 studies: one level A, three level B and three level C).
One study (12 patients) found that voriconazole for 7 days was effective in 83% of patients resistant to fluconazole. One study (2 patients) found that amphoteracin B was effective in two patients with azole-resistant thrush. Other studies used fluconazole, but it was not stated what drugs the patients were resistant to.