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Archives of Gynecology and Obstetrics

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01.06.2014 | General Gynecology

Effects of probiotics for the treatment of bacterial vaginosis in adult women: a meta-analysis of randomized clinical trials

verfasst von: Haohai Huang, Lijun Song, Wenchang Zhao

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 6/2014

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Abstract

Purpose

The aim of this study was to evaluate the evidence for probiotic use in the treatment of bacterial vaginosis (BV) in adult women.

Methods

The Cochrane Library, PubMed, CINAHL and EMBASE databases were searched to identify the relevant randomized controlled trials that investigated the effects of probiotics for the treatment of BV. Two independent authors used an Excel file to extract data and assessed trial quality. The primary outcome measure was the cure rate of BV. The meta-analysis was performed with the fixed-effects model or random-effects model according to heterogeneity.

Results

A total of 1,304 patients from 12 trials were subjected to meta-analysis. The pooled result showed that probiotics supplementation can significantly improve the cure rate in adult BV patients [risk ratio (RR) 1.53; 95 % confidence interval (CI) 1.19–1.97]. Findings were slightly different when analyses were restricted to nine high-quality studies (RR 1.60; 95 % CI 1.16–2.22). In a subgroup meta-analysis, a statistically significant beneficial effect of probiotics was observed in Europe populations and short-term follow-up days.

Conclusion

Compared with the control arm, the limited evidence suggests that probiotics show a beneficial effect in patients who are suffering from BV. However, the results should be interpreted cautiously because of the heterogeneity among study designs. Further large-scale, well-designed RCTs on this topic are urgently needed.

Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, Markowitz LE (2007) The prevalence of bacterial vaginosis in the United States, 2001–2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis 34(11):864–869. doi:10.1097/OLQ.0b013e318074e565 PubMedCrossRef

Kenyon C, Colebunders R, Crucitti T (2013) The global epidemiology of bacterial vaginosis: a systematic review. Am J Obstet Gynecol. doi:10.1016/j.ajog.2013.05.006 PubMed

Ness RB, Kip KE, Hillier SL, Soper DE, Stamm CA, Sweet RL, Rice P, Richter HE (2005) A cluster analysis of bacterial vaginosis-associated microflora and pelvic inflammatory disease. Am J Epidemiol 162(6):585–590. doi:10.1093/aje/kwi243 PubMedCrossRef

Larsson PG, Bergstrom M, Forsum U, Jacobsson B, Strand A, Wolner-Hanssen P (2005) Bacterial vaginosis. Transmission, role in genital tract infection and pregnancy outcome: an enigma. APMIS 113(4):233–245. doi:10.1111/j.1600-0463.2005.apm_01.x PubMedCrossRef

Hillier SL, Nugent RP, Eschenbach DA, Krohn MA, Gibbs RS, Martin DH, Cotch MF, Edelman R, Pastorek JG 2nd, Rao AV et al (1995) Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The vaginal infections and prematurity study group. N Engl J Med 333(26):1737–1742. doi:10.1056/nejm199512283332604 PubMedCrossRef

Cherpes TL, Hillier SL, Meyn LA, Busch JL, Krohn MA (2008) A delicate balance: risk factors for acquisition of bacterial vaginosis include sexual activity, absence of hydrogen peroxide-producing lactobacilli, black race, and positive herpes simplex virus type 2 serology. Sex Transm Dis 35(1):78–83. doi:10.1097/OLQ.0b013e318156a5d0 PubMedCrossRef

Atashili J, Poole C, Ndumbe PM, Adimora AA, Smith JS (2008) Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies. AIDS (London, England) 22(12):1493–1501. doi:10.1097/QAD.0b013e3283021a37 CrossRef

Wiesenfeld HC, Hillier SL, Krohn MA, Landers DV, Sweet RL (2003) Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis 36(5):663–668. doi:10.1086/367658 PubMedCrossRef

Gillet E, Meys JF, Verstraelen H, Bosire C, De Sutter P, Temmerman M, Broeck DV (2011) Bacterial vaginosis is associated with uterine cervical human papillomavirus infection: a meta-analysis. BMC Infect Dis 11:10. doi:10.1186/1471-2334-11-10 PubMedCentralPubMedCrossRef

10.

Bradshaw CS, Morton AN, Hocking J, Garland SM, Morris MB, Moss LM, Horvath LB, Kuzevska I, Fairley CK (2006) High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis 193(11):1478–1486. doi:10.1086/503780 PubMedCrossRef

11.

Oduyebo OO, Anorlu RI, Ogunsola FT (2009) The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women. Cochrane Database Syst Rev 3:CD006055. doi:10.1002/14651858.CD006055.pub2 PubMed

12.

Joesoef MR, Schmid GP, Hillier SL (1999) Bacterial vaginosis: review of treatment options and potential clinical indications for therapy. Clin Infect Dis 28(Suppl 1):S57–S65. doi:10.1086/514725 PubMedCrossRef

13.

Swidsinski A, Mendling W, Loening-Baucke V, Ladhoff A, Swidsinski S, Hale LP, Lochs H (2005) Adherent biofilms in bacterial vaginosis. Obstet Gynecol 106(5 Pt 1):1013–1023. doi:10.1097/01.AOG.0000183594.45524.d2 PubMedCrossRef

14.

Costerton W, Veeh R, Shirtliff M, Pasmore M, Post C, Ehrlich G (2003) The application of biofilm science to the study and control of chronic bacterial infections. J Clin Investig 112(10):1466–1477. doi:10.1172/jci20365 PubMedCentralPubMedCrossRef

15.

Reid G, Burton J (2002) Use of Lactobacillus to prevent infection by pathogenic bacteria. Microbes Infect 4(3):319–324PubMedCrossRef

16.

Reid G, Burton J, Devillard E (2004) The rationale for probiotics in female urogenital healthcare. MedGenMed 6(1):49PubMedCentralPubMed

17.

Saunders S, Bocking A, Challis J, Reid G (2007) Effect of Lactobacillus challenge on Gardnerella vaginalis biofilms. Colloids Surf B 55(2):138–142. doi:10.1016/j.colsurfb.2006.11.040 CrossRef

18.

McMillan A, Dell M, Zellar MP, Cribby S, Martz S, Hong E, Fu J, Abbas A, Dang T, Miller W, Reid G (2011) Disruption of urogenital biofilms by lactobacilli. Colloids Surf B 86(1):58–64. doi:10.1016/j.colsurfb.2011.03.016 CrossRef

19.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. doi:10.1371/journal.pmed.1000100 PubMedCentralPubMedCrossRef

20.

Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK (1983) Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 74(1):14–22PubMedCrossRef

21.

Nugent RP, Krohn MA, Hillier SL (1991) Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 29(2):297–301PubMedCentralPubMed

22.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12PubMedCrossRef

23.

Kjaergard LL, Villumsen J, Gluud C (2001) Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 135(11):982–989PubMedCrossRef

24.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ (Clinical research ed) 327(7414):557–560. doi:10.1136/bmj.327.7414.557 CrossRef

25.

Hallen A, Jarstrand C, Pahlson C (1992) Treatment of bacterial vaginosis with lactobacilli. Sex Transm Dis 19(3):146–148PubMedCrossRef

26.

Parent D, Bossens M, Bayot D, Kirkpatrick C, Graf F, Wilkinson FE, Kaiser RR (1996) Therapy of bacterial vaginosis using exogenously-applied Lactobacilli acidophili and a low dose of estriol: a placebo-controlled multicentric clinical trial. Arzneimittelforschung 46(1):68–73PubMed

27.

Eriksson K, Carlsson B, Forsum U, Larsson PG (2005) A double-blind treatment study of bacterial vaginosis with normal vaginal lactobacilli after an open treatment with vaginal clindamycin ovules. Acta Derm Venereo 85(1):42–46. doi:10.1080/00015550410022249 CrossRef

28.

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, double-blind, placebo controlled trial. Microbes Infect 8(6):1450–1454. doi:10.1016/j.micinf.2006.01.003 PubMedCrossRef

29.

Petricevic L, Witt A (2008) The role of Lactobacillus casei rhamnosus Lcr35 in restoring the normal vaginal flora after antibiotic treatment of bacterial vaginosis. BJOG 115(11):1369–1374. doi:10.1111/j.1471-0528.2008.01882.x PubMedCrossRef

30.

Marcone V, Calzolari E, Bertini M (2008) Effectiveness of vaginal administration of Lactobacillus rhamnosus following conventional metronidazole therapy: how to lower the rate of bacterial vaginosis recurrences. New Microbiol 31(3):429–433PubMed

31.

Larsson PG, Stray-Pedersen B, Ryttig KR, Larsen S (2008) Human lactobacilli as supplementation of clindamycin to patients with bacterial vaginosis reduce the recurrence rate; a 6-month, double-blind, randomized, placebo-controlled study. BMC Womens Health 8:3. doi:10.1186/1472-6874-8-3 PubMedCentralPubMedCrossRef

32.

Mastromarino P, Macchia S, Meggiorini L, Trinchieri V, Mosca L, Perluigi M, Midulla C (2009) Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis. Clin Microbiol Infect 15(1):67–74. doi:10.1111/j.1469-0691.2008.02112.x PubMedCrossRef

33.

Martinez RC, Franceschini SA, Patta MC, Quintana SM, Gomes BC, De Martinis EC, Reid G (2009) Improved cure of bacterial vaginosis with single dose of tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomized, double-blind, placebo-controlled trial. Can J Microbiol 55(2):133–138. doi:10.1139/w08-102 PubMedCrossRef

34.

Ya W, Reifer C, LE Miller (2010) Efficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a double-blind, randomized, placebo-controlled study. Am J Obstet Gynecol 203(2):120 e121–120 e126. doi:10.1016/j.ajog.2010.05.023 CrossRef

35.

Marcone V, Rocca G, Lichtner M, Calzolari E (2010) Long-term vaginal administration of Lactobacillus rhamnosus as a complementary approach to management of bacterial vaginosis. Int J Gynaecol Obstet 110(3):223–226. doi:10.1016/j.ijgo.2010.04.025 PubMedCrossRef

36.

Bradshaw CS, Pirotta M, De Guingand D, Hocking JS, Morton AN, Garland SM, Fehler G, Morrow A, Walker S, Vodstrcil LA, Fairley CK (2012) Efficacy of oral metronidazole with vaginal clindamycin or vaginal probiotic for bacterial vaginosis: randomised placebo-controlled double-blind trial. PLoS One 7(4):e34540. doi:10.1371/journal.pone.0034540 PubMedCentralPubMedCrossRef

37.

Reid G, Dols J, Miller W (2009) Targeting the vaginal microbiota with probiotics as a means to counteract infections. Curr Opin Clin Nutr Metab Care 12(6):583–587. doi:10.1097/MCO.0b013e328331b611 PubMedCrossRef

38.

Reid G (2008) Probiotic Lactobacilli for urogenital health in women. J Clin Gastroenterol 42(Suppl 3 Pt 2):S234–S236. doi:10.1097/MCG.0b013e31817f1298 PubMedCrossRef

39.

Falagas M, Betsi GI, Athanasiou S (2007) Probiotics for the treatment of women with bacterial vaginosis. Clin Microbiol Infect 13(7):657–664PubMedCrossRef

40.

Matu MN, Orinda GO, Njagi EN, Cohen CR, Bukusi EA (2010) In vitro inhibitory activity of human vaginal lactobacilli against pathogenic bacteria associated with bacterial vaginosis in Kenyan women. Anaerobe 16(3):210–215. doi:10.1016/j.anaerobe.2009.11.002 PubMedCrossRef

41.

Senok AC, Verstraelen H, Temmerman M, Botta GA (2009) Probiotics for the treatment of bacterial vaginosis. Cochrane Database Syst Rev 4:CD006289. doi:10.1002/14651858.CD006289.pub2 PubMed

42.

Anukam KC, Osazuwa E, Osemene GI, Ehigiagbe F, Bruce AW, Reid G (2006) Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes Infect 8(12–13):2772–2776. doi:10.1016/j.micinf.2006.08.008 PubMedCrossRef

43.

MacPhee RA, Hummelen R, Bisanz JE, Miller WL, Reid G (2010) Probiotic strategies for the treatment and prevention of bacterial vaginosis. Expert Opin Pharmacother 11(18):2985–2995. doi:10.1517/14656566.2010.512004 PubMedCrossRef

44.

Mastromarino P, Vitali B, Mosca L (2013) Bacterial vaginosis: a review on clinical trials with probiotics. New Microbiol 36(3):229–238PubMed

45.

Barrons R, Tassone D (2008) Use of Lactobacillus probiotics for bacterial genitourinary infections in women: a review. Clin Ther 30(3):453–468. doi:10.1016/j.clinthera.2008.03.013 PubMedCrossRef

46.

Shalev E, Battino S, Weiner E, Colodner R, Keness Y (1996) Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent candidal vaginitis and bacterial vaginosis. Arch Fam Med 5(10):593–596PubMedCrossRef

47.

Strus M, Chmielarczyk A, Kochan P, Adamski P, Chelmicki Z, Chelmicki A, Palucha A, Heczko PB (2012) Studies on the effects of probiotic Lactobacillus mixture given orally on vaginal and rectal colonization and on parameters of vaginal health in women with intermediate vaginal flora. Eur J Obstet Gynecol Reprod Biol 163(2):210–215. doi:10.1016/j.ejogrb.2012.05.001 PubMedCrossRef

Titel: Effects of probiotics for the treatment of bacterial vaginosis in adult women: a meta-analysis of randomized clinical trials
verfasst von: Haohai Huang
Lijun Song
Wenchang Zhao
Publikationsdatum: 01.06.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 6/2014
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-013-3117-0

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Effects of probiotics for the treatment of bacterial vaginosis in adult women: a meta-analysis of randomized clinical trials

Abstract

Purpose

Methods

Results

Conclusion

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Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

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