Effects of Pro/Prebiotics Alone over Pro/Prebiotics Combined with Conventional Antibiotic Therapy to Treat Bacterial Vaginosis: A Systematic Review

Abstract

Background. Bacterial vaginosis (BV), caused by an imbalance in the vaginal microbiota, can be treated and prevented by probiotics. Pregnant women with BV can experience premature labor and spontaneous abortions. Probiotics and prebiotics promote the proliferation of beneficial microorganisms, alter the composition of the vaginal microbiota, and prevent intravaginal infections in postmenopausal women. In addition to reducing infection symptoms, pre/probiotics can also help prevent vaginal infections. Materials and Methods. A systematic review was conducted on studies from 2010 to 2020 to determine the efficacy of pre/probiotics on the treatment of BV in pregnant and nonpregnant women. The databases Medline, Scopus, Embase, and Google Scholar were systematically searched using the following keywords: “bacterial vaginosis,” “probiotics,” “prebiotics,” and “synbiotics.” Results. A total of 1,871 articles were found in the initial search, and 24 clinical trials were considered eligible. In studies comparing the effects of pre/probiotics and placebos with or without antibiotic therapy in patients with BV, significant differences in clinical outcomes were observed. Probiotics reduced the levels of IL-1β and IL-6, as well as the overall Nugent score and Amsel’s criteria for restitution of a balanced vaginal microbiota. In addition, probiotics can reduce the vaginal colonization of Group B streptococci among pregnant women. In subjects treated with probiotics, BV cure rates were higher than those in subjects treated with antibiotics. There were no additional adverse events. Conclusion. Pre/probiotic regimens, when used for BV treatment, are usually safe and can exhibit long-term and short-term benefits. In order to prove the benefits of pre/probiotics in BV treatment, additional high-quality research is required.

Mechanisms and Clinical Implications of Human Gut Microbiota-Drug Interactions in the Precision Medicine Era

“…Furthermore, they can alleviate some of the side effects associated with cancer treatment, such as diarrhea, mucositis, infections, and inflammation. In the case of diabetes, probiotics or prebiotics can improve glycemic control, enhance insulin sensitivity, and positively affect lipid profiles by influencing the gut microbiota and its metabolites, thus reducing the risk of diabetic complications, including nephropathy, neuropathy, and cardiovascular diseases [104].…”

The Use of Prebiotics from Pregnancy and Its Complications: Health for Mother and Offspring—A Narrative Review

“…In the case of bacterial vaginosis, they suggest that a combination of probiotics and prebiotics should be applied instead of using antibiotics, which is risky for a pregnant woman. Systematic reviews found that pre/probiotic regimens have even higher cure rates than antibiotics [ 36 ]. This would also provide greater protection to the mother and the fetus.…”

Fighting polymicrobial biofilms in bacterial vaginosis

“…A group of patients with BV was treated with metronidazole (250 mg tablets, 3 per day) plus a prebiotic vaginal gel (5 mg vaginal gel daily) for 7 days, and the study showed that in the treatment group the symptoms of infection were lower than in the group that did not receive the prebiotic gel (Hakimi et al, 2018 ). A very recent review analysed the studies using probiotics/prebiotics in combination with antibiotics for BV treatment and concluded that the combined therapy is more effective in reducing BV recurrence than the antibiotics alone (Afifirad et al, 2022 ).…”