Nurbhai M, Grimshaw J, Watson M, Bond CM, Mollison JA, Ludbrook A. Oral versus intravaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Cochrane Database of Systematic Reviews 2007, Issue 4. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002845/frame.html Accessed 23.09.14. RATIONALE: No statistically significant differences were observed in clinical cure rates of antifungals administered by the oral or the intravaginal route. At short-term follow-up, 74% cure was achieved with oral treatment and 73% cure with intra-vaginal treatment (OR 0.94, 95% CI 0.75 to 1.17).

UKTIS. Use of fluconazole in pregnancy. The UK Teratology Information Service. 2008. (Tel: 0844 892 0909, http://www.uktis.org/docs/fluconazole.pdf ) Accessed 23.09.14. RATIONALE: Fluconazole is a triazole antifungal commonly used in the treatment of candidiasis. Data on the outcomes of over 1,700 pregnancies exposed to low dose fluconazole (150 mg as a single dose) show no increased incidence of spontaneous abortions or malformations and no pattern of defects. However, there may be an increased risk of malformations associated with high dose chronic therapy (>400 mg/day). First-line treatment of candidal infection in pregnancy is with a topical imidazole such as clotrimazole. Fluconazole (150 mg as a single dose) may be a suitable second-line treatment if clotrimazole is ineffective.

Young GL, Jewell D. Topical treatment for vaginal candidiasis (thrush) in pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 4. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000225/frame.html Accessed 23.09.14. RATIONALE: This Cochrane review found that topical imidazole appears more effective than nystatin at treating vaginal candidiasis in pregnancy. In addition, treatment for only four days was less effective than treatment for seven days (OR 11.7, 95% CI 4.21 to 29.15).

Schaefer C, Peters P, Miller RK. Drugs during pregnancy and lactation: treatment options and risk assessment. Academic Press 2007. RATIONALE: Clotrimazole and miconazole are the topical antifungals of choice during pregnancy. There is no evidence of an increased risk of spontaneous abortions or malformations with use of clotrimazole or miconazole during pregnancy.

Public Health England and the British Infection Association recommend 6 nights treatment with clotrimazole 100mg pessaries during pregnancy because this is the quantity in one original pack of clotrimazole 100 mg pessaries.

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).