Antiseptics and disinfectants for the treatment of bacterial vaginosis: A systematic review

Abstract

Background The study objective was to assess the available data on efficacy and tolerability of antiseptics and disinfectants in treating bacterial vaginosis (BV). Methods A systematic search was conducted by consulting PubMed (1966-2010), CINAHL (1982-2010), IPA (1970-2010), and the Cochrane CENTRAL databases. Clinical trials were searched for by the generic names of all antiseptics and disinfectants listed in the Anatomical Therapeutic Chemical (ATC) Classification System under the code D08A. Clinical trials were considered eligible if the efficacy of antiseptics and disinfectants in the treatment of BV was assessed in comparison to placebo or standard antibiotic treatment with metronidazole or clindamycin and if diagnosis of BV relied on standard criteria such as Amsel’s and Nugent’s criteria. Results A total of 262 articles were found, of which 15 reports on clinical trials were assessed. Of these, four randomised controlled trials (RCTs) were withheld from analysis. Reasons for exclusion were primarily the lack of standard criteria to diagnose BV or to assess cure, and control treatment not involving placebo or standard antibiotic treatment. Risk of bias for the included studies was assessed with the Cochrane Collaboration’s tool for assessing risk of bias. Three studies showed non-inferiority of chlorhexidine and polyhexamethylene biguanide compared to metronidazole or clindamycin. One RCT found that a single vaginal douche with hydrogen peroxide was slightly, though significantly less effective than a single oral dose of metronidazole. Conclusion The use of antiseptics and disinfectants for the treatment of BV has been poorly studied and most studies are somehow methodologically flawed. There is insufficient evidence at present to advocate the use of these agents, although some studies suggest that some antiseptics may have equal efficacy compared to clindamycin or metronidazole. Further study is warranted with special regard to the long-term efficacy and safety of antiseptics and disinfectants for vaginal use.

Sexually transmitted infections: challenges ahead

“…13,79,92,93 314 Overall, the trial results suggest that PID incidence was lower in intervention than control 315 groups (summary risk ratio, RR 0·68, 95% CI 0·49 to 0·94, I 2 8%). 89 However, when 316 stratified by risk of bias, the summary effect was smaller in the two trials at low risk of bias 317 (RR 0·80, 95% CI 0·55 to 1·17) 79,92 than in those at high or unclear risk of bias (RR 0·42,…”

New strategies for local treatment of vaginal infections

“…Some of these compounds, such as dequalinium chloride, nifuratel and chlorhexidine have been tested in clinical trials for effectiveness compared to traditional therapies, showing positive results [114,135,187] .…”

“…Due to their broad spectrum activity and wide availability, antiseptics and disinfectants have been studied for the treatment of vaginal infections, especially in cases where the first-line recommended therapeutic regimens fail to prevent recurrences [135,136]. Benzydamine and chlorhexidine, in particular, have been widely used in bacterial and fungal infections, as irrigation solutions and have been formulated as bioadhesive systems (Table 2).…”

Diagnosis and Treatment of Abnormal Vaginal Discharge

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