Probiotics are a good choice for the treatment of Bacterial Vaginosis: a meta-analysis of randomized controlled trial

Abstract

Background: Bacterial vaginosis is one of the most common vaginal infectious diseases in female reproductive period. Although the existing view is that probiotic treatment may be one of the feasible methods for the treatment of bacterial vaginosis, different intervention methods lead to different treatment results. Therefore, up-to-date and comprehensive evidence in this regard is essential for the development of intervention strategies.Objective: This meta-analysis aims to systematically evaluate the role of probiotics in the treatment of Bacterial Vaginosis (BV) in adult women. Methods: We searched the databases of Embase, Cochrane Library, PubMed, Web of Science and ClinicalTrials.gov for Randomized Controlled Trials published until November 7, 2021.Meta-analysis was performed by Revman5.3 software to systematically evaluate the clinical efficacy of probiotics adjunctive therapy in the treatment of BV. The literatures were screened and evaluated according to the inclusion and exclusion criteria. Chi-square test was used to test the heterogeneity between trials. Random or Fixed effect models were used to analyze the cure rate of BV. Results: Fourteen randomized controlled trials compared the efficacy of probiotics with antibiotic therapy (probiotics + antibiotics group) versus antibiotics alone or plus placebo (antibiotics (+placebo) group) for BV [RR = 1.23, 95% CI (1.05, 1.43), P = 0.009]. Three compared the efficacy of probiotics regimen (probiotics group) and antibiotics (antibiotics group) in the treatment of BV [RR = 1.12, 95% CI (0.60, 2.07), P =0.72]. Another Three compared the efficacy of probiotics regimen (probiotics group) with placebo (placebo group) [risk ratios (RR) = 15.20, 95% CI (3.87, 59.64), P < 0.0001]. Conclusion: Our meta-analysis suggests probiotics may play a positive role in the treatment of BV, but more strong evidence is needed.

Probiotics, a promising therapy to reduce the recurrence of bacterial vaginosis in women? a systematic review and meta-analysis of randomized controlled trials

“…Similar to our results, a probiotic administration for a 10-day duration resulted in a significant reduction of pathogenic microbiota in vagina and the maintenance of vaginal eubiosis up to 30 days after the end of treatment, regardless of the route of administration (48). In contrast, a recent systematic review found that Lacticaseibacillus rhamnosus administered orally was more efficacious than intravaginal application for the treatment of BV (49), which was again likely to be due to unstandardized methodology mentioned above. A narrative review had concluded that the administration of selective probiotic strains resulted in enhanced host's ability to fight existing infection, restoration of normal vaginal flora and prevention of further BV recurrence when given at a dosage of over 100 million CFU for 2 months (50).…”

“…A recent pilot clinical study that investigated the probiotic potential of Lacticaseibacillus 10.3389/fnut.2022.938838 rhamnosus had exhibited the strain to have broad adverse activities against vaginal pathogens, in vitro capability to adhere to VK2/E67 vaginal epithelial cells, and antioxidant properties as demonstrated by the strain's ability to resist linoleic acid peroxidation. Furthermore, the strain was also shown to have anti-inflammatory properties in which gene expressions of COX-2 and the proinflammatory interleukin-8 were downregulated, whereas the expression of the anti-inflammatory interleukin-10 was upregulated (49).…”