The Effectiveness of Adding Probiotic to Antimicrobial Agents for the Treatment of Bacterial Vaginosis: A Systematic Review

Authors

  • Aquartuti Tri Darmayanti Masters Program in Public Health, Universitas Sebelas Maret
  • Bhisma Murti Masters Program in Public Health, Universitas Sebelas Maret
  • Tri Nugraha Susilawati Department of Microbiology, Faculty of Medicine, Universitas Sebelas Maret

Abstract

Background: Common antimicrobial regimens for treating bacterial vaginosis often cause recurrence and bacterial resistance. Previous studies have reported that a combination of antimicrobial and probiotic consisting of Lactobacillus spp. Is an effective treatment for recurrent bacterial vaginosis. Lactobacillus plays an important role in vaginal health by replacing the pathogenic colonies in vagina. This study aimed to determine the effectiveness of adding probiotic to antimicrobial therapeutic for the prevention of  bacterial vaginosis(BV) recurrence.

Subjects and Method: A systematic review was conducted by searching the following databases: PubMed, Science Direct, Web of Science, Springer Link and the Cochrane. The review included randomized controlled trials (RCTs) conducted in primary hospitals and private clinics. The Amsel criteria and Nugent score were used for diagnosis appraisal of bacterial vaginosis. were included in this systematic review consisting of the two types of bacterial vaginosis treatment.  All pooled data analyses were based on random-effects models and intention to treat (ITT). Data were analyzed using Rev Man 5 software.

Results: The review included 5 RCTs involving 692 women on reproductive age underwent treatment of BV for 5 days or more.The studies showed that combination of probiotic and antimicrobial treatment reduced the risk of bacterial vaginosis recurrence a half time compared to antimicrobial treatment alone(RR= 0.49; 95% CI= 0.17 to 1.44).

Conclusion: Adding probiotic to antimicrobial regimens is more effective than antimicrobial regimens alone for treating bacterial vaginosis recurrence.

Keywords: probiotic, antimicrobial, bacterial vaginosis recurrence, randomized controlled trial

Correspondence: Aquartuti Tri Darmayanti. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: tutiaquar@gmail.com. Mobile: +6281329380114.

Indonesian Journal of Medicine (2017), 2(3): 161-168
https://doi.org/10.26911/theijmed.2017.02.03.03 

References

Akobeng AK (2005). Understanding systematic reviews and metaanalysis. Archives of Disease in Childhood, 90 (8): 845–848.

Alioua S, Abdi A, Fhoula I, Bringel F, Boudabous A, Ouzari IH. (2016). Diversity of vaginal lactic acid bacterial microbiota in 15 Algerian pregnant women with and without bacterial vaginosis by using culture independent method. Journal of Clinical and Diagnostic Research, 10(9).

Anukam K, Osazuwa E, Ahonkhai I, Ngwu M, Osemene G, Bruce AW, Reid G (2006). Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC 14: randomized, doubleblind, placebo controlled trial.Microbes and Infection, 8(6): 1450–1454.

Bautista CT, Wurapa E, Sateren WB, Morris S, Hollingswprth B, Sanchez JL (2016). Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections.Military Medical Research, 3 (1): 4.

Beigi R, Autin M, Meyn L, Kroohn M, Hiller S. et al. (2004). Antimicrobial resistance associated with the treatment of bacterial vaginosis.American Journal of Obstetrics and Gynecology, 191(4): 1124–1129.

Bohbot JM, Cardot JM (2012). Vaginal impact of the oral administration of total freezedried culture of LCR 35 in healthy women. Infectious Diseases in Obstetrics and Gynecology.

Bradshaw CS, Morton AN, Hocking J, Garland SM, Morris MB, Lona MM, Horvat LB, et al. (2006). High Recurrence Rates of Bacterial Vaginosis over the Course of 12 Months after Oral Metronidazole Therapy and Factors Associated with Recurrence.The Journal of Infectious Diseases, 193 (11): 1478–1486.

Bradshaw CS, Pirotta M, Guingand DD, Hocking JS, MMorton AN, Garland SM, Fehler G (2012). Efficacy of oral metronidazole with vaginal clindamycin or vaginal probiotic for bacterial vaginosis: Randomised placebocontrolled doubleblind trial. PLoS ONE, 7(4): 1–10.

Cribby S, Taylor M, Reid G (2008). Vaginal Microbiota and the Use of Probiotics. Interdisciplinary Perspectives on Infectious Diseases, 2008: 1–9.

Falagas, M. E., Betsi, G. I. and Athanasiou, S (2007). Probiotics for the treatment of women with bacterial vaginosis. Clinical Microbiology and Infection. European Society of Clinical Infectious Diseases, 13(7):657–664.

Haggerty CL, Hiller S, Bass D, Ness R (2004). Bacterial vaginosis and anaerobic bacteria are associated with endometritis. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 39(7).

Heczko PB, Tomusiak A, Adaski P, Jakimiuk AJ, Stefański G, Cichońska AM, Szczurek MS, et al. (2015). Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, doubleblind, placebocontrolled trial. BMC Women’s Health, 15(1): 115.

Karim A, Barakbah (2016). Studi Retrospektif: Vaginosis Bakterial (Retrospective Study: Bacterial Vaginosis). 5-6.

Krauss Silva L, Moreira MEL, Alves MB, Braga A, Caacho KG, Batista MRR, Horta AA, et al. (2011). A randomised controlled trial of probiotics for the prevention of spontaneous preterm delivery associated with bacterial vaginosis: preliminary results. Trials. BioMed Central Ltd, 12(1): 239.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, John PA, Clarke M, et al. (2009). The PRISMA statement for reporting systematic reviews and metaanalyses of studies that evaluate healthcare interventions: explanation and elaboration.Bmj, 339(j1): b2700–b2700.

Ling Z, Liu X, Chen W, Luo Y, Yuan L, Xia Y, Nelson KE, et al. (2013). The Restoration of the Vaginal Microbiota After Treatment for Bacterial Vaginosis with Metronidazole or Probiotics. Microbial Ecology, 65(3): 773–780.

Marcone V, Rocca G, Lichtner M, Calzolari E, et al. (2010). Longterm vaginal administration of Lactobacillus rhamnosus as a complementary approach to management of bacterial vaginosis. International Journal of Gynecology and Obstetrics. International Federation of Gynecology and Obstetrics, 110(3): 223–226.

Marrazzo JM, Martin DH (2007). Management of women with cervicitis. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, pp. S102–S110.

Martinez RCR, Silvio A, Patta MC, Quintaa SM, Gomes BC, Martinis ECP, et al. (2009). Improved cure of bacterial vaginosis with single dose of tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomized, doubleblind, placebocontrolled trial. Canadian Journal of Microbiology, 55(2): 133–138.

Mastromarino P, Vitali B, Mosca L (2013). Bacterial vaginosis: a review on clinical trials with probiotics.The new microbiologica, 36: 229–38.

Pendharkar S, Brandsborg E, Hammarström L, Marcott H, Larsson PG, et al. (2015). Vaginal colonisation by probiotic lactobacilli and clinical outcome in women conventionally treated for bacterial vaginosis and yeast infection. BMC Infectious Diseases. BMC Infectious Diseases, 15(1): 255.

Reid G, Beuerman D, Heinemann C, Bruce AW, et al. (2001). Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora.FEMS Immunology and Medical Microbiology, 32(1): 37–41.

Stojanović N, Plećaš D. and Plešinac S. (2012). Normal vaginal flora, disorders and application of probiotics in pregnancy.Archives of Gynecology and Obstetrics, 286(2): 325–332.

Vicariotto F, Mogna L,and Piano MD (2014). Effectiveness of the Two Microorganisms Lactobacillus fermentum LF15 and Lactobacillus plantarum LP01, Formulated in Slowrelease Vaginal Tablets, in Women Affected by Bacterial Vaginosis. Journal of Clinical Gastroenterology, S106–S112.

Downloads

Published

2018-01-13

Issue

Section

Articles