Probiotics for Fungal Infection Resistance
Specific Lactobacillus strains modestly reduce recurrence of vaginal candidiasis, though they do not replace antifungal treatment.
Overview
Verdict
Strain-specific and adjunctive. Generic probiotics are unlikely to help.
How It Works
Dosing & Protocol
Typical dose
- Recommended dose
- 10-20 billion CFU daily including L. rhamnosus and L. reuteri strains
- Expected timeframe
- 4-12 weeks
Protocol
- form
- Oral capsules or vaginal preparations. For oral candidiasis, some trials have used probiotic lozenges or fermented dairy
- duration
- 4 weeks to several months when used for recurrence prevention
- co factor
- Take with food; if used alongside antifungal treatment, complete the antifungal course as prescribed. Evidence is mixed. The best data concern vulvovaginal candidiasis, where some randomised trials and meta-analyses report that probiotics adjunctive to antifungal therapy improve short-term cure and reduce recurrence, while Cochrane and other reviews rate the evidence as low quality and inconsistent. Small trials in older adults suggest probiotic lozenges may reduce oral Candida counts. Evidence for systemic fungal resistance is absent. Mechanisms include competitive exclusion, lactic acid production lowering pH, hydrogen peroxide and bacteriocin secretion, and inhibition of Candida adhesion and hyphal formation.
- titration
- Up to 20 billion CFU/day
- starting dose
- 10 billion CFU/day of Lactobacillus rhamnosus GR-1 with Lactobacillus reuteri RC-14, the best-studied urogenital combination, 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.
Oral Probiotics to Prevent Recurrent Vulvovaginal Infections During Pregnancy: Multicenter Double-Blind, Randomized, Placebo-Controlled Trial
Oral probiotics were effective in secondary prevention of vulvovaginal infections including candidiasis during pregnancy.
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; check the label for studied strains. Avoid in severe immunosuppression.
Less likely to help if
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