Probiotics for Candida Control
Lactobacillus-based probiotics modestly reduce recurrence of vulvovaginal candidiasis but do not replace antifungal therapy.
Overview
Verdict
Lactobacillus-based probiotics modestly reduce recurrence of vulvovaginal candidiasis but do not replace antifungal therapy.
How It Works
Dosing & Protocol
Typical dose
- Recommended dose
- 10-20 billion CFU daily of Lactobacillus strains
- Expected timeframe
- 4 weeks to several months
Protocol
- form
- Oral capsules for urogenital colonisation, or vaginal preparations, which some trials found more effective. Saccharomyces boulardii has separate evidence in gastrointestinal contexts
- duration
- 4 weeks to several months for recurrence prevention
- co factor
- Take with food; if using alongside antifungals, follow the antifungal course as prescribed. Evidence is mixed. Some randomised trials and meta-analyses suggest probiotics as an adjunct to antifungal treatment improve short-term cure rates and reduce recurrence in vulvovaginal candidiasis, and specific Lactobacillus strains restore vaginal lactobacilli and lower pH. Other reviews, including Cochrane assessments, conclude the evidence is low quality with inconsistent findings and poor trial methodology. For oral or intestinal candidiasis the data are weaker still. Mechanisms include competitive exclusion, lactic acid production lowering pH, and hydrogen peroxide and bacteriocin production inhibiting Candida adhesion.
- titration
- Up to 20 billion CFU/day; some recurrent candidiasis regimens use probiotics alongside or after antifungal treatment
- starting dose
- 10 billion CFU/day orally of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, the strains with most urogenital data, taken with food
Evidence
What the studies say
Probiotics for vulvovaginal candidiasis in non-pregnant women
Xie HY, Feng D, Wei DM
Probiotics as adjuncts to antifungals may improve short-term cure and reduce one-month relapse of candidiasis.
Comparing the Effect of Probiotic and Fluconazole on Treatment and Recurrence of Vulvovaginal Candidiasis: a Triple-Blinded Randomized Clinical Trial
et al
Probiotic treatment achieved cure rates comparable to fluconazole with lower recurrence at follow-up.
The Role of Probiotics in the Treatment of Vulvovaginal Candidiasis: A Systematic Review and Meta-Analysis
et al
Probiotics added to antifungal therapy improved short-term clinical and mycological cure rates in vulvovaginal candidiasis.
Randomised clinical trial in women with recurrent vulvovaginal candidiasis: efficacy of probiotics and lactoferrin as maintenance treatment
Russo R, et al
Oral probiotics with lactoferrin as maintenance therapy reduced recurrence of vulvovaginal candidiasis versus control.
Treatment for recurrent vulvovaginal candidiasis (thrush)
Cooke G, et al
Evidence for complementary and alternative treatments of recurrent vulvovaginal candidiasis is of low certainty.
Safety
Caveats
Benefits are strain specific; generic multi-strain blends may not reproduce trial results.
Less likely to help if
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