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An exploratory pilot study evaluating the supplementation of standard antibiotic therapy with probiotic lactobacilli in south African women with bacterial vaginosis
Karolinska Inst, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Skaraborg Hosp, Sweden.
Karolinska Inst, Sweden.
Karolinska Inst, Sweden.
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2019 (English)In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, BMC INFECTIOUS DISEASES, Vol. 19, no 1, article id 824Article in journal (Refereed) Published
Abstract [en]

Background

To reduce acquisition and relapse of bacterial vaginosis (BV), lactobacilli must be maintained in the vaginal microbiome. Probiotic lactobacilli may aid this purpose. We investigated whether vaginal probiotics (containing Lactobacillus rhamnosus DSM 14870 and Lactobacillus gasseri DSM 14869) would result in vaginal colonisation with lactobacilli in women with and without BV.

Methods

This prospective, partially randomised, exploratory pilot study was conducted in Soweto, South Africa. Thirty-nine sexually-active, HIV negative women were enrolled from October 2014 to May 2016 into three arms. Women who did not have BV (Group 1, n = 13) self-administered probiotic capsules vaginally once daily for 30 days, then once a week until Day 190. Women diagnosed with BV were randomized into Group 2 (n = 12) or Group 3 (n = 14) and treated with the triple oral antibiotic combination for vaginal discharge syndrome per South African guidelines (cefixime 400 mg stat, doxycycline 100 mg BD for 7 days and metronidazole 2 g stat). Immediately after antibiotic treatment, women in Group 2 self-administered probiotic capsules vaginally once daily for 30 days then vaginally once a week until Day 190. Women in Group 3 were not given lactobacilli.

Results

During the study, L. rhamnosus DSM 14870 or L. gasseri DSM 14869, were isolated in 5/13 (38.5%) women in Group 1 compared to 10/12 (83.3%) women in Group 2 (p = 0.041). The 1-month and 6-month BV cure rates were similar (P >  0.05) between Group 2 (42 and 25%) compared to Group 3 (36 and 25%). In Group 2, no correlation was observed between the frequency of isolation of the two Lactobacillus strains and the 1-month or 6-month cure rate.

Conclusions

Supplementation with vaginal probiotic capsules resulted in colonisation of the vagina by the Lactobacillus strains (L. rhamnosus DSM 14870 and L. gasseri DSM 14869) contained in the capsules. We observed low initial cure rates of BV after a stat dose of metronidazole and that the probiotic did not improve BV cure rates or alleviate recurrence which could be due to treatment failure or very limited power of the study.

Place, publisher, year, edition, pages
BioMed Central, 2019. Vol. 19, no 1, article id 824
Keywords [en]
Lactobacillus; Bacterial vaginosis; Probiotics; Lactobacillus rhamnosus DSM 14870; Lactobacillus gasseri DSM 14869
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-161145DOI: 10.1186/s12879-019-4425-1ISI: 000487083100009PubMedID: 31533663Scopus ID: 2-s2.0-85072400215OAI: oai:DiVA.org:liu-161145DiVA, id: diva2:1365782
Note

Funding Agencies|Swedish Research Council (Vetenskapsradet)Swedish Research Council [348-2013-6609]; Stiftelsen Lakare mot AIDS Forskningsfond [Fob2016-0008]; National Research Foundation in South AfricaNational Research Foundation - South Africa [UID 70878]

Available from: 2019-10-25 Created: 2019-10-25 Last updated: 2019-12-11Bibliographically approved

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