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Abstract

Bacterial vaginosis (BV) is a common cause of genital discomfort in women in reproductive ages, which causes many complications. Bacterial vaginosis is usually treated by metronidazole and clindamycin. However, this protocol does not prevent its recurrence, which is a main complaint of the patients. The number of lactobacilli in the vagina of women with BV is significantly lower than that in healthy women. Hence, efforts have been made to normalize vaginal flora by oral or vaginal administration of lactobacilli. The objective of the present study was to review clinical evidences available regarding the efficacy of probiotics in the prevention and treatment of BV. Published randomized controlled trials were searched in PubMed, Science Direct, and the Cochrane Database between 1990 and 2011. Search terms included bacterial vaginosis, urinary tract infection, lactobacillus, and probiotics. Orally consumed probiotics are believed to ascend to the vaginal tract after they are excreted from the rectum; vaginal administration allows for direct replacement of the probiotics for unhealthy vaginal microbiota and occupation of specific adhesion sites at the epithelial surface of the urinary tract, which consequently results in maintenance of a low pH and production of antimicrobial substances like acids and hydrogen peroxide. Receiving Lactobacillus acidophilus, Lactobacillus rhamnosus GR-1, and Lactobacillus fermentum RC-14 at a dose of at least 10 CFU/day for 2 months has been shown to present the patients with better results. Although the results of different studies are controversial, most studies have been in favor of the probiotics in the prevention or treatment of BV, and no adverse effects have been reported. Therefore, it may be helpful to recommend daily consumption of probiotic products to improve public health among women.
... , preterm labour(El-Saied, Amer, Elbohoty, Saad, & Mansour, 2016;Homayouni et al., 2014), preterm prelabour rupture of the membrane (PPROM)(El-Saied et al., 2016;Homayouni et al., 2014),chorioamnionitis, postpartum infection(El-Saied et al., 2016;Rao et al., 2016), and postpartum endometritis(Homayouni et al., 2014;Laue et al., 2018). Approximately 30% of spontaneous preterm births are caused due to genital tract infection as micro-organisms from the vagina and cervix can enter through the uterine cavity and infect the membranes, placenta, and fetus(McDonald et al., 1997). ...
... , preterm labour(El-Saied, Amer, Elbohoty, Saad, & Mansour, 2016;Homayouni et al., 2014), preterm prelabour rupture of the membrane (PPROM)(El-Saied et al., 2016;Homayouni et al., 2014),chorioamnionitis, postpartum infection(El-Saied et al., 2016;Rao et al., 2016), and postpartum endometritis(Homayouni et al., 2014;Laue et al., 2018). Approximately 30% of spontaneous preterm births are caused due to genital tract infection as micro-organisms from the vagina and cervix can enter through the uterine cavity and infect the membranes, placenta, and fetus(McDonald et al., 1997). ...
... , preterm labour(El-Saied, Amer, Elbohoty, Saad, & Mansour, 2016;Homayouni et al., 2014), preterm prelabour rupture of the membrane (PPROM)(El-Saied et al., 2016;Homayouni et al., 2014),chorioamnionitis, postpartum infection(El-Saied et al., 2016;Rao et al., 2016), and postpartum endometritis(Homayouni et al., 2014;Laue et al., 2018). Approximately 30% of spontaneous preterm births are caused due to genital tract infection as micro-organisms from the vagina and cervix can enter through the uterine cavity and infect the membranes, placenta, and fetus(McDonald et al., 1997). ...
Chapter
The commonest vaginal infection seen in the Gynecological OPDs in reproductive age is bacterial vaginosis (BV) that causes abnormal vaginal discharge and if not treated, it is allied to severe problems or complications. It is a polymicrobial syndrome categorized by normal vaginal florareplacement that leads to a significant absence or reduction of normal “hydrogen peroxide” producing lactobacillus species and an upsurge in anaerobic bacteria (Atopobium vaginae, Prevotella spp., Gardnerella vaginalis, Mobiluncus spp., and Mycoplasma hominis). The incidence of BV varies from 4% to 61% from asymptomatic to symptomatic women who visits sexually transmitted disease clinics. Its prevalence among reproductive-aged women globally ranges from 23% to 29% in different regions such as 24% in East Asia, 23% in Europe and Central Asia and it varies from 17.8% to 63.7% in India. The risk factors are age, marital status, race and ethnicity, education, socioeconomic status, excessive perineal hygiene, sexual behavior, contraceptive methods, cigarette smoking, alcohol intake, stress, HIV, and dietary factor. The clinical features are abnormal vaginal discharge, which is malodorous, and occasionally leads to irritation that impacts activity in society and also affect sexual life. The diagnosis of BV includes Nugent score system (NSS), Amsel's criteria, Spiegel's criteria, anaerobic culture, Hays/Ison system, Schmidt's scoring system, gas–liquid chromatography, sialidase activity, and DNA probes for Gardnerella vaginalis. Metronidazole is the first line for the management of BV. The positive effect of herbal medicines such as Zataria multiflora, Nigella sativa, Hypericum perforatum vaginal gel 3%, Myrtus communis L. or Berberis vulgaris along with metronidazole, Hypercum perforatum, Calendula officinalis, Saugella lavanda, garlic, pepper vaginal gel, P. ferulacea, B. vulgaris, and Allium sativum are reported. Therefore, herbal medicine is considered probable to combat bacterial vaginosis. Further, phase III and post-marketing trials in large sample sizes are recommended to prove the efficacy of herbal medicines.
... Clinical studies have reported that BV is linked to adverse pregnancy outcomes such as spontaneous miscarriages, postabortion endometritis, posthysterectomy vaginal cuff infection (Donders, 2010;Rao et al., 2016), preterm labour (El-Saied, Amer, Elbohoty, Saad, & Mansour, 2016Homayouni et al., 2014), preterm prelabour rupture of the membrane (PPROM) (El-Saied et al., 2016;Homayouni et al., 2014),chorioamnionitis, postpartum infection (El-Saied et al., 2016;Rao et al., 2016), and postpartum endometritis (Homayouni et al., 2014;Laue et al., 2018). Approximately 30% of spontaneous preterm births are caused due to genital tract infection as micro-organisms from the vagina and cervix can enter through the uterine cavity and infect the membranes, placenta, and fetus (McDonald et al., 1997). ...
... Clinical studies have reported that BV is linked to adverse pregnancy outcomes such as spontaneous miscarriages, postabortion endometritis, posthysterectomy vaginal cuff infection (Donders, 2010;Rao et al., 2016), preterm labour (El-Saied, Amer, Elbohoty, Saad, & Mansour, 2016Homayouni et al., 2014), preterm prelabour rupture of the membrane (PPROM) (El-Saied et al., 2016;Homayouni et al., 2014),chorioamnionitis, postpartum infection (El-Saied et al., 2016;Rao et al., 2016), and postpartum endometritis (Homayouni et al., 2014;Laue et al., 2018). Approximately 30% of spontaneous preterm births are caused due to genital tract infection as micro-organisms from the vagina and cervix can enter through the uterine cavity and infect the membranes, placenta, and fetus (McDonald et al., 1997). ...
... Clinical studies have reported that BV is linked to adverse pregnancy outcomes such as spontaneous miscarriages, postabortion endometritis, posthysterectomy vaginal cuff infection (Donders, 2010;Rao et al., 2016), preterm labour (El-Saied, Amer, Elbohoty, Saad, & Mansour, 2016Homayouni et al., 2014), preterm prelabour rupture of the membrane (PPROM) (El-Saied et al., 2016;Homayouni et al., 2014),chorioamnionitis, postpartum infection (El-Saied et al., 2016;Rao et al., 2016), and postpartum endometritis (Homayouni et al., 2014;Laue et al., 2018). Approximately 30% of spontaneous preterm births are caused due to genital tract infection as micro-organisms from the vagina and cervix can enter through the uterine cavity and infect the membranes, placenta, and fetus (McDonald et al., 1997). ...
Chapter
Alzheimer's disease (AD) is a neurological disease caused by the growth of protein in the brain that affects people older than 65 years. It is a degenerative disease that affects not only patients but also their caregivers. Although researchers are actively studying the disease, there is no cure; thus, the focus is now on early detection. Using subjective methods for early prediction is quite difficult; there is only one cognitive tool that can accurately predict AD, the Mini Mental State Examination (MMSE). As such, machine learning methods are now being used to diagnose AD, but these too have limitations. For example, these methods can only use past patient data. Deep learning methods, however, can learn automatically from real-time data and thus are being developed to overcome the challenges of machine learning in predicting AD. In this chapter, we propose hand gesture recognition for the prediction of AD. In our model, data are collected and processed using deep learning algorithms such as convolutional neural network (CNN), recurrent neural network (RNN), and long short-term memory (LSTM). We used the proposed deep learning model for both static image and dynamic image processing of real-time videos of hand movements. Results show the proposed system detected AD with an accuracy of 90% from static images and an accuracy of 87% from dynamic images.
... Vaginal probiotic supplements containing live lactobacilli are available in different formulations over-the-counter. Although evidence is limited, probiotics may have beneficial effects in restoring normal vaginal colonization in bacterial vaginosis (20)(21)(22)(23). However, it is unclear whether lactobacilli-loaded vaginal capsules represent an effective means of improving the vaginal microbiota diagnosed as of low implantation potential. ...
Article
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Objective To investigate whether treatment with proprietary lactobacilli-loaded vaginal capsules improves an unfavorable vaginal microbiome diagnosed using a commercially available test and algorithm. Design A randomized, double-blinded, placebo-controlled study was conducted in 74 women prior to undergoing fertility treatment at a single university fertility clinic between April 2019 and February 2021. The women were randomly assigned in a 1:1 ratio to receive one vaginal capsule per day for 10 days containing either a culture of more than 10 ⁸ CFU of Lactobacillus gasseri and more than 10 ⁸ CFU Lactobacillus rhamnosus (lactobacilli group) or no active ingredient (placebo group). Vaginal swabs for microbiota analysis were taken at enrollment, after treatment and in the cycle following treatment. Participants and methods Women aged 18–40 years who prior to fertility treatment were diagnosed with an unfavorable vaginal microbiota, characterized by either a low relative load of Lactobacillus or a high proportion of disrupting bacteria using the criteria of the IS-pro™ diagnostic system (ARTPred, Amsterdam, the Netherlands), were enrolled in the study. The primary outcome measure was the proportion of women with improvement of the vaginal microbiota after intervention. Results The vaginal microbiota improved after intervention in 34.2% of all participants (lactobacilli group 28.9%, placebo group 40.0%), with no significant difference in the improvement rate between the lactobacilli and placebo groups, RR = 0.72 (95% CI 0.38–1.38). Conclusion This study indicates that administering vaginal probiotics may not be an effective means of modulating the vaginal microbiome for clinical purposes in an infertile population. However, a spontaneous improvement rate of 34.2% over a period of one to three months, confirming the dynamic nature of the vaginal microbiota, indicates that a strategy of postponing further IVF treatment to await microbiota improvement may be relevant in some patients, but further research is needed. Clinical trial registration ClinicalTrials.gov , identifier NCT03843112.
... The use of antibiotics for BV treatment in pregnant and non-pregnant women remains the method of choice, which is still too frequently ineffective [30]. Some studies reported that lactobacilli can decrease BV recurrence and grow lactobacilli abundance in the vagina of non-pregnant and pregnant women [31,32]. The results of this study showed that probiotic use did not increase the rate of preterm delivery or duration of pregnancy compared with placebo. ...
Article
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Introduction The prevalence of preterm labor (PTL) is growing, and annually one in ten babies is born prematurely. Various studies have examined the effect of oral or vaginal probiotics on the prevention of preterm labor, which has yielded contrasting results. This study aimed to compare the impact of vaginal and oral probiotics on the prevention of preterm delivery. Methods This clinical trial was performed among 185 pregnant women with a gestational age greater than or equal to 25 weeks visiting Kamali Hospital, Karaj, Iran in 2020. The participants were divided into three groups; intervention group 1 receiving Oral probiotic pill once a day until 37 weeks of pregnancy, intervention group 2 receiving probiotic vaginal suppository once a day until 37 weeks of pregnancy, and control group not receiving any intervention. Patients were then followed up until the end of pregnancy. Results Demographic characteristics and gestational age at the time of intervention were not significantly different among the three groups. Overall, 26.7 % in the control group, 30 % in intervention group 1 %, and 22.5 % in intervention group 2 had deliveries less than 37 weeks. There was no significant difference in the frequency of preterm labor and the duration of pregnancy among the groups (all p > 0.05). Conclusion Probiotics use does not increase the rate of preterm delivery or reduce the duration of pregnancy, but the rate of preterm delivery was lower in the oral probiotic group. Further clinical studies on the impact of probiotics on PTL can yield valuable results.
... Although there are limited reports on prebiotic and synbiotic approach for promoting vaginal health, use of probiotic for vaginal health is reported by both oral and topical route [11,12] and had supported the possibility of restoration of vaginal microbiota after oral administration of lactobacilli. Clinical studies have reported the efficacy of probiotics in treatment and prevention of vaginal infections such as bacterial vaginosis [13], vaginal candidiasis [14], and urinary tract infections [15] when administered topically. Current reports on vaginal probiotics suggest that it may serve as an important approach for faster recovery and prevention of recurrences of vaginal infections [16]. ...
... The prevalence of BV in different parts of the world varies at approximately between 19 and 24%, and its incidence is higher in developing countries. According to national data from the CDC, the prevalence of this infection in women of reproductive age is about 29%, or approximately 21 million persons (Homayouni et al., 2014). ...
Article
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Introduction Bacterial Vaginosis (BV) is the most common cause of vaginal discharge. However, in some cases, side effects and resistance rates have been reported when antibiotics are administered. This problem has prompted several investigations on the administration of probiotics as an adjunct therapy to treat this infection. Objection This study aims to conduct a meta-analysis based on evidence to determine the efficacy and safety of probiotic and antibiotic treatments. Methods The meta-analysis was performed using PRISMA guidelines. The literature review was conducted in December 2020 using PubMed, Science Direct, Cochrane Library, and RevMan V.5.3. Result The results showed a high and significant cure rate from the analysis of 1006 and 528 samples of probiotics and non-probiotics or control in 16 studies. The recurrence rate was statistically significant with probiotic treatment. Furthermore, neither procedures nor therapy failure showed a significantly lower adverse event rate than the control group. Conclusion Probiotic shows better results compared to the control group. However, both have the same occurrence of adverse event.
... Probiotics is an efficacious prophylactic agent to prevent post-treatment BV recurrences at intervals of at least 1 month, regardless of route of administration. Numerous studies had demonstrated improvement in the BV cure rate after probiotic administration (39)(40)(41)(42). Research on the prevention of BV recurrences using probiotic supplementation was critically inadequate. ...
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Introduction The evidence for probiotic efficacy in preventing bacterial vaginosis (BV) recurrences among women aged 18 years and above is sparse. We aimed to ascertain the efficacy of probiotics in preventing BV recurrences after at least one menstrual cycle in this population. Methods We conducted a systematic literature search using PubMed, MEDLINE (Ovid interface), Web of Science (WoS), Scopus, Embase, ProQuest Dissertations and Theses Global, Cochrane Library databases and registries comprised of Open Science Framework (OSF) preprints registry, the ClinicalTrials.gov (USA), WHO International Clinical Trials Registry Platform (WHO-ICTRP), International Standard RCT Number (ISRCTN) registry, limited to randomized clinical trials (RCTs) in English published between January 2000 and December 2021. The inclusion criteria were trials that administered probiotics to BV-positive women in an experimental arm of at least 20 samples. The usage of probiotics should be preceded with standard antibiotic regimen and followed by a reassessment of BV status after at least a single menstrual cycle. Risk of bias assessment was completed using revised Cochrane risk-of-bias tool for randomized trials (RoB 2). The PROSPERO registration number of the review is CRD42022302044. Results From 8,162 identified records, we included 10 studies ( n = 1,234 participants) for final analysis; 7 trials compared probiotics vs. placebo, whereas 3 trials compared probiotics vs. metronidazole alone. Using random-effects meta-analysis, probiotics were shown to reduce the risk of BV recurrences by 45% compared to either placebo or metronidazole [14.8 vs. 25.5%, RR: 0.55 (95%CI: 0.33, 0.91), p = 0.03, I ² = 45.4% (95%CI: 0, 73.7%)]. Sensitivity analysis revealed the robustness of results upon removal of studies with high risk of bias [RR: 0.54 (95%CI: 0.38, 0.77), p = 0.006] and reporting bias (RR: 0.53, 95%CI: 0.39, 0.74, p = 0.002). Meta-regression demonstrated that the route of administration ( p vaginal = 0.67; p oral = 0.44), the total dosage of probiotics ( p = 0.17), cumulative days of probiotic administration ( p = 0.76), and the number of species in probiotic preparation ( p = 0.40) were not linked to BV recurrences. Interpretation Probiotics were associated with more than twofold reduction in BV recurrences when BV status was assessed after at least 1-month postintervention. Further high-quality and methodologically standardized RCTs should evaluate probiotic efficacy for BV prevention in a diverse community setting. Systematic review registration [ https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021290613 ], identifier [CRD42021290613].
Article
Objective To determine and compare the efficacy of Kakrasingi (Pistacia integerrima J.L. Stewart ex Brandis) with metronidazole in bacterial vaginosis (BV). Methods A randomized (1:1) standard controlled, single-centre study was conducted in diagnosed patients (n=62) of BV. The intervention group (n=31) and standard group (n=31) received orally, the gall of P. integerrima powder (1 g) and metronidazole (400 mg) respectively twice a day for 7 days. The primary efficacy endpoint included clinical cure as assessed by Amsel’s criteria evaluated at the test of cure visit (day 14-18). The secondary efficacy endpoints were a microbiologic cure (considered as a Nugent score of 0–3), therapeutic cure (includes both clinical and microbiologic cure) evaluated at the test of cure visit (day 14-18), and vaginal symptoms scale (VSS) at day 14-18, 21-24, and 30-34 and safety profile. The data were statistically inferred by the parametric and non-parametric tests with a 5% level of significance and a 95% confidence interval. Results The clinical, microbiological, and therapeutic cure rates were 54.83%, 51.61%, and 51.61% for the intervention and 51.61%, 45.16%, and 45.16% for the control group. The comparison showed no significant difference in clinical (p=0.88), microbiological (p=0.93), and therapeutic cure rates (p=0.93). The VSS mean score on days 14-18 was 3.67±2.90 and 4.22±2.61 in the intervention and control groups respectively, moderately statistically more significant (p=0.03) in the intervention than in the control group. Conclusion P. integerrima showed a similar effect as metronidazole in treating BV with no adverse effects.
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Human aging, a natural process characterized by structural and physiological changes, leads to alterations of homeostatic mechanisms, decline of biological functions, and subsequently, the organism becomes vulnerable to external stress or damage. In fact, the elderly population is prone to develop diseases due to deterioration of physiological and biological systems. With aging, the production of reactive oxygen species (ROS) increases, and this causes lipid, protein, and DNA damage, leading to cellular dysfunction and altered cellular processes. Indeed, oxidative stress plays a key role in the pathogenesis of several chronic disorders, including hepatic diseases, such as non-alcoholic fatty liver disease (NAFLD). NAFLD, the most common liver disorder in the Western world, is characterized by intrahepatic lipid accumulation; is highly prevalent in the aging population; and is closely associated with obesity, insulin resistance, hypertension, and dyslipidemia. Among the risk factors involved in the pathogenesis of NAFLD, the dysbiotic gut microbiota plays an essential role, leading to low-grade chronic inflammation, oxidative stress, and production of various toxic metabolites. The intestinal microbiota is a dynamic ecosystem of microbes involved in the maintenance of physiological homeostasis; the alteration of its composition and function, during aging, is implicated in different liver diseases. Therefore, gut microbiota restoration might be a complementary approach for treating NAFLD. The administration of probiotics, which can relieve oxidative stress and elicit several anti-aging properties, could be a strategy to modify the composition and restore a healthy gut microbiota. Indeed, probiotics could represent a valid supplement to prevent and/or help treating some diseases, such as NAFLD, thus improving the already available pharmacological intervention. Moreover, in aging, intervention of prebiotics and fecal microbiota transplantation, as well as probiotics, will provide novel therapeutic approaches. However, the relevant research is limited, and several scientific research works need to be done in the near future to confirm their efficacy.
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Dear Editor, I read with interest the paper entitled with ‘‘Effects of inulin and sugar levels on the viability of yogurt and probiotic bacteria and the physical and sensory characteristics in probiotic ice-cream” by Akin, M. B. et al. (2007) Food Chemistry, 104, 93–99. The authors are to be congratulated for their valuable work on the probiotic dairy products. However, in the third paragraph of introduction section, they have written that ‘‘probiotics, such as oligosaccharides, are added to food, mainly to allow the preferential growth of probiotic organisms” which is a wrong sentence. I think that the word ‘‘probiotics” should be changed to ‘‘prebiotics”. Probiotics are defined as live microorganisms which, when administered in adequate amounts confer a health benefit on the host (FAO/WHO., 2002). Prebiotics are non-digestible substances that provide a beneficial physiological effect on the host by selectively stimulating the favorable growth or activity of a limited number of indigenous bacteria (Cummings, Macfarlane, & Englyst, 2001). A food product containing both of probiotics and prebiotics is named as synbiotic or functional ...
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Human studies on health effects of probiotics and prebiotics were reviewed and evaluated. The main results can be summaries as follows: Certain probiotic lactobacilli may improve lactose digestion and reduce symptoms of lactose intolerance. The effect of probiotics on serum cholesterol is still inconclusive. Animal studies showing triacylglycerol-lowering effects of prebiotics need confirmation in humans. Data on effects of probiotics on constipation are not convincing, whereas inulin has dose-related laxating effect. Effects of a probiotic drink have been reported on symptoms in irritable bowel syndrome, but more studies are needed for firm conclusions. A significant shortening of acute watery rotavirus-included diarrhoea has been demonstrated for two lactobacilli, whereas possible effects on the risk of getting traveller's diarrhoea need further studies. There are promising indications that probiotics could be useful against antibiotic-associated diarrhoea, and a yeast preparation has been shown to reduce the risk of relapsing Clostridium difficile diarrhoea. Promising results from studies on the effect of probiotic products in the treatment of gastritis and inflammatory bowel disease should encourage further studies with pro-, pre- and synbiotic foods. Certain prebiotic oligosaccharides may increase calcium absorption. Probiotics can be regarded as safe although occasional infections have been reported in immunosuppressed patients. Prebiotics such as fructans may cause dose dependent gastrointestinal side-effects. The documentation of health-promoting effects of probiotic and prebiotic products is rapidly increasing. The food industry that develops pro- and prebiotic products should increase their efforts to develop high quality research and well-designed clinical trials on ordinary food products. This area is of great importance for improving human health.
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The purpose of this study was to evaluate the effectiveness of lactobacilli on vaginal health and proinflammatory cytokines. Sixty-seven patients with bacterial vaginosis (BV), 50 with intermediate flora and 42 with normal vaginal flora were enrolled in this double-blind study. The subjects were randomized to receive probiotic lactobacilli vaginal tablets (L. brevis CD2, L. salivarius subsp. salicinius, L. plantarum) or the vaginal pH tablet (active comparator). Cervico-vaginal lavage was collected to measure the concentrations of IL-1β, TNFα and IL-6 by ELISA. Neutral sphingomyelinase activity was also quantified in both arms before and after treatment. The probiotic vaginal tablet was well tolerated and no side effects were reported. The study demonstrated a cure rate of nearly 80 %; i.e., 32 % of the women could restore normal vaginal flora and 47 % had improved Nugent score, whereas 20 % of the subjects did not clear BV in the first follow-up (after 8 days treatment). The pH tablet containing pH lowering compounds induced resolution of BV and restoration of normal vaginal flora in 74 % and 26 %, respectively. The lactobacilli tablet was found to be better than the pH tablet in preventing BV in healthy subjects. A significant reduction in IL-1β and IL-6 vaginal cytokines was observed after treatment with lactobacilli, while the active comparator did not have any effect on local proinflammatory cytokines. Vaginal neutral sphingomyelinase activity was not modified in either group. Vaginal tablets containing lactobacilli can cure BV and reduce vaginal inflammatory response.
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Eighty-four patients with bacterial vaginosis diagnosed according to Amsel's criteria were randomized to receive either oral metronidazole 500 mg twice a day for seven days, or one vaginal tablet containing freeze-dried Lactobacillus rhamnosus once a week at bedtime for two months starting one week after the last antibiotic administration. Followup was performed at days 30, 90 and 180. Chi-squared analysis showed a significant difference between the two treatment groups at day 90 (P = 0.05). Safe and effective long-term vaginal administration of Lactobacillus rhamnosus appears to be a useful complementary approach in the management of bacterial vaginosis.
Article
Larsson PG, Forsum U. Bacterial vaginosis – a disturbed bacterial flora and treatment enigma. Review. APMIS 2005;113:305–16. The syndrome bacterial vaginosis (BV) is characterized by a disturbed vaginal microflora in which the normally occurring lactobacilli yield quantitatively to an overgrowth of mainly anaerobic bacteria. As BV is a possible cause of obstetrics complications and gynaecological disease – as well as a nuisance to the affected women – there is a strong impetus to find a cure. In BV treatment studies, the diagnosis criteria for diagnosis of BV vary considerably and different methods are used for cure evaluation. The design of study protocols varies and there is no consensus respecting a suitable time for follow-up visits. For the purpose of this review, available data were recalculated for 4-week post treatment cure rates. For oral metronidazole the 4-week cure rate was found not to exceed 60–70%. Treatment regimens with topical clindamycin or topical metronidazole have the same cure rates. It can thus be said that no sound scientific basis exists for recommending any particular treatment. There is no evidence of beneficial effects on BV engendered by partner treatment, or by addition of probiotics or buffered gel. Long-term follow-up (longer than 4 weeks) shows a relapse rate of 70%. With a primary cure rate of 60–70%, and a similar relapse rate documented in the reviewed literature, clinicians simply do not have adequate data for determining treatment or designing clinical studies. This is unfortunate since – apart from the obvious patient benefits – clinical studies can often serve as a guide for more basic studies in the quest for underlying disease mechanisms. In the case of BV there is still a need for continued basic studies on the vaginal flora, local immunity to the flora and host-parasite interactions as an aid when designing informative clinical studies.
Article
To investigate the advantages of long-term vaginal administration of Lactobacillus rhamnosus after oral treatment with metronidazole to prevent the recurrence of bacterial vaginosis (BV). A total of 49 women with a diagnosis of BV were randomized into 2 groups. Group A was treated with a twice daily dose of 500 mg oral metronidazole for 7 days. Group B was treated with the same schedule followed by a once-weekly vaginal application of 40 mg of Lactobacillus rhamnosus for 6 months. A non-parametric analysis of variance for repeated measures was used to test whether there were significant changes in the vaginal ecosystems in the 2 groups. During the first 6 months of follow-up, a constant percentage (96%) of patients in group B had a balanced vaginal ecosystem. Follow-up over 12 months showed no statistically significant difference among vaginal ecosystems in patients in group B (P=0.40), whereas in group A there was a significant increase in the number of women with abnormal flora over time (P=0.01). The vaginal administration of the probiotic Lactobacillus rhamnosus allows stabilization of the vaginal ecosystem and reduces the recurrence of BV.