Bond Christine M, Watson Margaret C
Department of General Practice and Primary Care, University of Aberdeen, Westburn Road, Aberdeen, AB25 2AY, UK.
Pharm World Sci. 2003 Aug;25(4):177-81. doi: 10.1023/a:1024842712675.
The purpose of this study was to develop evidence-based guidelines for over-the-counter (OTC) treatment of vulvovaginal candidiasis with non-prescription anti-fungal medicines purchased from community pharmacies.
A multidisciplinary guideline development group was recruited from the locality where the guidelines were to be tested. A Nominal Group Technique (NGT) was used to achieve formal consensus within the group regarding the issues that the guidelines would address. Guideline recommendations were developed from the results of two systematic literature reviews that assessed which symptoms were predictive of vulvovaginal candidiasis (using data from epidemiological studies) and estimated the relative effectiveness of oral and intra-vaginal anti-fungals using data from randomised controlled trials.
Evidence-based guideline recommendations. The guideline statements were linked to the evidence using a standard hierarchy.
The guideline development group met four times. The use of NGT was an effective way of achieving consensus on guideline content. Two systematic reviews carried out as part of the guideline development process identified evidence for the guidelines on the efficacy of OTC treatments and symptoms suggestive of vulvovaginal candidiasis. The guideline recommendations were presented as a booklet and a laminated algorithm. In summary, the guidelines highlighted symptoms suggestive of vulvovaginal candidiasis, and symptoms associated with other vaginal conditions that should be referred to the GP. The guidelines stated that oral treatment and intra-vaginal treatment are equally effective, and that selection of an anti-fungal should be based upon safety, cost and patient preference. Many of the recommendations were influenced by OTC license restrictions of each antifungal product. Contra-indications to, and special precautions with, antifungals were also listed. In addition, the guidelines stated that the male sexual partner does not require treatment unless symptomatic.
There is sufficient evidence available to develop evidence-based guidelines for the treatment of vulvovaginal candidiasis in the community pharmacy setting. The NGT is a useful component in the guideline development process.
本研究旨在制定基于证据的指南，用于指导从社区药房购买非处方抗真菌药物对念珠菌性外阴阴道炎进行非处方（OTC）治疗。
从指南将进行测试的地区招募了一个多学科指南制定小组。采用名义小组技术（NGT），就指南将涉及的问题在小组内达成正式共识。指南建议是根据两项系统文献综述的结果制定的，这两项综述评估了哪些症状可预测念珠菌性外阴阴道炎（使用流行病学研究数据），并使用随机对照试验数据估计口服和阴道内抗真菌药物的相对疗效。
基于证据的指南建议。指南声明通过标准层次结构与证据相联系。
指南制定小组召开了四次会议。使用NGT是就指南内容达成共识的有效方法。作为指南制定过程一部分进行的两项系统综述，确定了关于OTC治疗疗效和提示念珠菌性外阴阴道炎症状的指南证据。指南建议以小册子和分层算法的形式呈现。总之，指南强调了提示念珠菌性外阴阴道炎的症状，以及与其他阴道疾病相关的症状，这些症状应转诊给全科医生。指南指出，口服治疗和阴道内治疗同样有效，抗真菌药物的选择应基于安全性、成本和患者偏好。许多建议受到每种抗真菌产品OTC许可限制的影响。还列出了抗真菌药物的禁忌症和特殊注意事项。此外，指南指出，男性性伴侣除非有症状，否则无需治疗。
有足够的证据可用于制定社区药房环境中念珠菌性外阴阴道炎治疗的基于证据的指南。NGT是指南制定过程中的一个有用组成部分。
