Current Approaches to Antimicrobial Therapy of Bacterial Vaginosis

Клиническая Микробиология и Антимикробная Химиотерапия. 2009; 11(3):196-210

​ Reshetko O.V., Lucevich K.A.
bacterial vaginosis recurrence pregnancy preterm birth antimicrobial therapy
Section
Diseases and Pathogens
Type
Journal article
Publication
Клиническая Микробиология и Антимикробная Химиотерапия. 2009; 11(3):196-210

Abstract

Efficacy of antimicrobial treatment regimens in pregnant or non-pregnant women with bacterial vaginosis (BV) is difficult to evaluate. It’s due to variability of the diagnosis and cure criteria currently used in clinical studies. This paper reviews studies of different topical and systemic antimicrobial treatment regimens in women with BV. Antimicrobial therapy in women with BV was shown to significantly reduce the risk of persistence compared to placebo. Specific treatment regimens and efficacy of probiotics for recurrent episodes of BV are discussed. Relationships between BV and pregnancy outcomes or gynecological disorders as well as a need for treatment in asymptomatic women with BV are also considered. However, efficacy of antimicrobial therapy in pregnant women with BV in reducing the risk of preterm birth remains controversial.

  • 1. Sweet R.L. Gynecologic conditions and bacterial vaginosis: implications for the non-pregnant patient. Infect Dis Obstet Gynecol 2000; 8:184–90.
  • 2. Allen-Davis J.T., Beck A., Parker R., et al. Assessment of vulvovaginal complaints: accuracy of telephone triage and in-office diagnosis. Obstet Gynecol 2002; 99:18-22.
  • 3. O’Dowd T.C., Parker S., Kelly A. Women’s experiences of general practitioner management of their vaginal symptoms. Br J Gen Pract 1996; 46: 415-8.
  • 4. Langsford M.J., Dobbs F.F., Morrison G.M., Dance D.A.B. The effect of introduction of a guideline oh the management of vaginal discharge and in particular bacterial vaginosis in primary care. Fam Pract 2001; 18:253-7.
  • 5. Ferris M.J., Masztal A., Martin D. H. Use of speciesdirected 16S rRNA gene PCR primers for detection of Atopobium vaginae in patients with bacterial vaginosis. J Clin Microbiol 2004; 42:5892-4.
  • 6. Amsel R., Totten P.A., Spiegel C.A., et al. Nonspecific vaginitis: diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74:14-22.
  • 7. Schwebke J.R., Hillier S.L., Sobel J.D., et al. Validity of the vaginal Gram stain for the diagnosis of bacterial vaginosis. Obstet Gynecol 1996; 88:573-6.
  • 8. Nugent R.P., Krohn M.A., Hillier S.L. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation. J Clin Microbiol 1991; 29:297-301.
  • 9. Forsum U., Jakobsson T., Larsson P.G., et al. An international study of the interobserver variation between interpretations of vaginal smear criteria of bacterial vaginosis. APIMIS 2002; 110:811-8.
  • 10. Thomas K.K., Sanchez S., Garcia P.J., Holmes K.K. Why do different criteria for “cure” yield different conclusions in comparing two treatments for bacterial vaginosis? Sex Transm Dis 2005; 32:526-30.
  • 11. Livengood C.H., Ferris D.G., Wiesenfeld H.C., et al. Effectiveness of two tinidazole regimens in treatment of bacterial vaginosis: a randomized controlled trial. Obstet Gynecol 2007; 110:302-9.
  • 12. Hay P.E., Lamont R.F., Taylor-Robinson D., et al. Abnormal bacterial colonization of the genital tract and subsequent preterm delivery and late miscarriage. Br Med J 1994; 308:295-8.
  • 13. Schwebke J.R., Desmond R.A. A randomized trial of the duration of therapy with metronidazole plus or minus azithromycin for treatment of symptomatic bacterial vaginosis. Clin Infect Dis 2007; 44:213-9.
  • 14. Rosenstein I.J., Morgan D.J., Sheehan M., et al. Bacterial vaginosis in pregnancy: distribution of bacterial species in different Gram-stain categories of the vaginal flora. J Med Microbiol 1996; 45:120-6.
  • 15. Larsson P.G., Platz-Christensen J.J., Dalaker K., et al. Treatment with 2% clindamycin vaginal cream prior to first trimester surgical abortion to reduce signs of postoperative infection: a prospective, double-blinded, placebo-controlled, multicenter study. Acta Obstet Gynecol Scand 2000; 79:390-6.
  • 16. Yudin M.H., Landers D.V., Meyn L., Hillier S.L. Clinical and cervical cytokine response to treatment with oral or vaginal metronidazole for bacterial vaginosis during pregnancy: a randomized trial. Obstet Gynecol 2003; 102:527-34.
  • 17. Joesoef M.R., Schmid G.P., Hillier S.L. Bacterial vaginosis: review of treatment options and potential clinical indications for therapy. Clin Infect Dis 1999; 28 (Suppl.1):S57–S65.
  • 18. Hay P.E. Recurrent bacterial vaginosis. Curr Infect Dis Rep 2000; 2:506-12.
  • 19. Hanson J.M., McGregor J.A., Hillier S.L., et al. Metronidazole for bacterial vaginosis: a comparison of vaginal gel vs. oral therapy. J Reprod Med 2000; 45:889- 96.
  • 20. Livengood C.H., Soper D.E., Sheehan K.L., et al. Comparison of once-daily and twice-daily dosing of 0.75% metronidazole gel in the treatment of bacterial vaginosis. Sex Transm Dis 1999; 26:137–42.
  • 21. Sobel J.D., Peipert J.F., McGregor J.A., et al. Efficacy of clindamycin vaginal ovule (3-day treatment) vs. clindamycin vaginal cream (7-day treatment) in bacterial vaginosis. Infect Dis Obstet Gynecol 2001; 9:9-15.
  • 22. Greaves W.L., Chungafung J., Morris B., et al. Clindamycin versus metronidazole in the treatment of bacterial vaginosis. Obstet Gynecol 1988; 72:799-802.
  • 23. Paavonen J., Mangioni C., Martin M.A., Wajszcuk C.P. Vaginal clindamycin and oral metronidazole for bacterial vaginosis: a randomized trial. Obstet Gynecol 2000; 96:256-60.
  • 24. Faro S., Skokos C.K. The efficacy and safety of a single dose of Clindesse™ vaginal cream versus a seven-dose regimen of Cleocin® vaginal cream in patients with bacterial vaginosis. Infect Dis Obstet Gynecol 2005; 13:155-60.
  • 25. Okun N., Gronau K. A., Hannah M. E. Antibiotics for bacterial vaginosis or trichomonas vaginalis in pregnancy: a systematic review. Obstet Gynecol 2005; 105: 857-68.
  • 26. McDonald H.M., O’Loughlin J.A., Vigneswaran R., et al. Bacterial vaginosis in pregnancy and efficacy of short-course oral metronidazole treatment: a randomized placebo controlled trial. Obstet Gynecol 1994; 84:343-8.
  • 27. Carey J.C., Klebanoff K., Hauth J., et al. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. N Engl J Med 2000; 342:534-40.
  • 28. Hauth J.C., Goldenberg R.L., Andrews W.W., et al. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995; 333:1732-6.
  • 29. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines. MMWR Morb MortalWkly Rep 1997; 46:72-3.
  • 30. Burtin P., Taddio A., Ariburnu O., et al. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol 1995; 172:525-9.
  • 31. Thapa P.B., Whitlock J.A., Brockman W.K.G., et al. Prenatal exposure to metronidazole and risk of childhood cancer: a retrospective cohort study of children younger than 5 years. Cancer 1998; 83:1461-8.
  • 32. McGregor J.A., French J.I., Parker R., et al. Prevention of premature birth by screening and treatment of common genital tract infections: results of a prospective controlled evaluation. Am J Obstet Gynecol 1995; 173:157-67.
  • 33. Ugwumadu A., Reid F., Hay P., Manyonda I. Natural history of bacterial vaginosis and intermediate flora in pregnancy and effect of oral clindamycin. Obstet Gynecol 2004; 104:114-9.
  • 34. Kekki M., Kurki T., Pelkonen J., et al. Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial. Obstet Gynecol 2001; 97:643-8.
  • 35. Vermeulen G.M., van Zwet A.A., Bruinse H.W. Changes in the vaginal flora after two percent clindamycin vaginal cream in women at high risk of spontaneous preterm birth. Br J Obstet Gynaecol 2001; 108:697-700.
  • 36. Joesoef M.R., Hillier S.L., Wiknjosastro G. et al. Intravaginal clindamycin treatment for bacterial vaginosis: effects on preterm delivery and low birth weight. Am J Obstet Gynecol 1995; 173:1527-31.
  • 37. Smart S., Singal A., Mindel A. Social and sexual risk factors for bacterial vaginosis. Sex Transm Infect 2004; 80:58-62.
  • 38. Bradshaw C. S., Morton A. N., Garland S. M., et al. Evaluation of a point-of-care test, BVBlue, and clinical and laboratory criteria for diagnosis of bacteria vaginosis. J Clin Microbiol 2005; 43:1304-8.
  • 39. Wilson J. Managing recurrent bacterial vaginosis. Sex Transm Infect 2004; 80:8-11.
  • 40. Colli E., Landoni M., Parazzini F., et al. Treatment of male partners and recurrence of bacterial vaginosis: a randomised trial. Genitourin Med 1997; 73:267-70.
  • 41. Alfonsi G.A., Shlay J.C., Parker S. What is the best approach for managing recurrent bacterial vaginosis? J Fam Pract 2004; 53:650-2.
  • 42. Sanchez S., Garcia P.J., Thomas K.K., et al. Intravaginal metronidazole gel versus metronidazole plus nystatin ovules for bacterial vaginosis: a randomized controlled trial. Am J Obstet Gynecol 2004; 191:1898-906.
  • 43. Bradshaw C. S., Morton A. N., Hocking J., et al. High recurrence rates of bacteria vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis 2006; 193:1475- 7.
  • 44. Koumans E.H., Markowitz L.E., Hogan V. Indications for therapy and treatment recommendations for bacterial vaginosis in nonpregnant women: a synthesis of data. Clin Infect Dis 2002; 35 (Suppl.2):S152-72.
  • 45. Sobel J.D., Ferris D., Schwebke J., et al. Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol 2006; 194:1283–9.
  • 46. Edwards L. The diagnosis and treatment of infectious vaginitis. Dermatol Ther 2004; 17:102-10.
  • 47. Simoes J.A., Aroutcheva A.A., Shott S., et al. Effect of metronidazole on the growth of vaginal Lactobacillus in vitro. Infect Dis Obstet Gynecol 2001; 9:41-5.
  • 48. Swidsinski A., Mendling W., Loening-Baucke V., et al. Adherent biofilms in bacterial vaginosis. Obstet Gynecol 2005; 106:1013-23.
  • 49. Гомберг М.А., Плахова К.И., Анискова И.Н. Стандартная и нестандартная диагностика и терапия при выделениях из влагалища. Фарматека 2006; (2):45-50.
  • 50. Nailor M.D., Sobel J.D. Tinidazole for the treatment of vaginal infections. Expert Opin Investig Drugs 2007; 16:743-51.
  • 51. Austin M.N., Meyn L.A., Hillier S.L. Susceptibility of vaginal bacteria to metronidazole and tinidazole. Anaerobe 2006; 12:227-30.
  • 52. Baylson F.A., Nyirjesy P., Weitz M.V. Treatment of recurrent bacterial vaginosis with tinidazole. Obstet Gynecol 2004; 104:931-2.
  • 53. Milani M., Barcellona E., Agnello A. Efficacy of the combination of 2 g oral tinidazole and acidic buffering vaginal gel in comparison with vaginal clindamycin alone in bacterial vaginosis: a randomized, investigatorblinded, controlled trial. Eur J Obstet Gynecol Reprod Biol 2003; 109:67-71.
  • 54. Анкирская А.С., Прилепская В.Н., Байрамова Г.Р., Муравьева В.В. Бактериальный вагиноз: особенности клинического течения, диагностика и лечение. РМЖ 1998; (5):276-82.
  • 55. Reid G. Probiotic agents to protect the urogenital tract against infection. Am J Clin Nutr 2001; 73(Suppl):S437- 43.
  • 56. Boeke A.J., Dekker J.H., van-Eijk J.T., et al. Effect of lactic acid suppositories compared with oral metronidazole and placebo in bacterial vaginosis: a randomised clinical trial. Genitourin Med 1993; 69:388-92.
  • 57. McLean N.W., Rosenstein I.J. Characterization and selection of a Lactobacillus species to re-colonize the vagina of women with recurrent bacterial vaginosis. J Med Microbiol 2000; 49:543-52.
  • 58. Wilks M., Wiggins R., Whiley A., et al. Identification and Н2О2 production of vaginal lactobacilli from pregnant women at high risk of preterm birth and relation with outcome. J Clin Microbiol 2004; 42:713-7.
  • 59. Reid G. In vitro testing of Lactobacillus acidophilus NCFMTM as a possible probiotic for the urogenital tract. Int Dairy J 2000; 10:415–9.
  • 60. Reid G., Bruce A.W. Selection of Lactobacillus for urogenital probiotic applications. J Infect Dis 2001; 183 (Suppl.):S77–80.
  • 61. Gardiner G.E., Heinemann C., Bruce A.W., et al. Persistence of Lactobacillus fermentum RC-14 and Lactobacillus rhamnosus GR-1 but not L. rhamnosus GG in the human vagina as demonstrated by randomly amplified polymorphic DNA. Clin Diagn Lab Immunol 2002; 9:92-6.
  • 62. Reid G., Bruce A.W., Taylor M. Instillation of Lactobacillus and stimulation of indigenous organisms to prevent recurrence of urinary tract infections. Microecol Ther 1995; 23:32-45.
  • 63. Marrazzo J.M., Wiesenfeld H.C., Murray P.J., et al. Risk factors for cervicitis among women with bacterial vaginosis. J Infect Dis 2006; 193:617-24.
  • 64. Larsson P.G., Bergstrom M., Forsum U., et al. Bacterial vaginosis. Transmission, role in genital tract infection and pregnancy outcome: An enigma. Review article III. APMIS 2005; 113:233-45.
  • 65. Crowley T., Low N., Turner A., et al. Antibiotic prophylaxis to prevent post-abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial. Br J Obstet Gynaecol 2001; 108:396- 402.
  • 66. Darj E., Stralin E.B., Nilsson S. The prophylactic effect of doxycycline on postoperative infection rate after firsttrimester abortion. Obstet Gynecol 1987; 70:755-7.
  • 67. Miller L., Thomas K., Hughes J.P., et al. Randomised treatment trial of bacterial vaginosis to prevent postabortion complication. Br J Obstet Gynaecol 2004; 111:982-8.
  • 68. Hemsell D.L., Heard M.C., Nobles B.J., et al. Single-dose prophylaxis for vaginal and abdominal hysterectomy. Am J Obstet Gynecol 1987; 157:498-501.
  • 69. Mittendorf R., Aronson M.P., Berry R.E., et al. Avoiding serious infections associated with abdominal hysterectomy: a meta-analysis of antibiotic prophylaxis. Am J Obstet Gynecol 1993; 169:1119-24.
  • 70. Larsson P.G., Carlsson B. Does pre- and postoperative metronidazole treatment lower vaginal cuff infection rate after abdominal hysterectomy among women with bacterial vaginosis? Infect Dis Obstet Gynecol 2002; 10:133-40.
  • 71. Lin L., Song J., Kimber N., et al. The role of bacterial vaginosis in infection after major gynecologic surgery. Infect Dis Obstet Gynecol 1999; 7:169-74.
  • 72. Taha T.E., Kumwenda N.I., Kafulafula G., et al. Intermittent intravaginal antibiotic treatment of bacterial vaginosis in HIV-uninfected and -infected women: a randomized clinical trial. PLoS Clin Trials 2007; 2:e10.
  • 73. Sobel J.D. What is new in bacterial vaginosis and trichomoniasis? Infect Dis Clin North Am 2005; 19:387- 406.
  • 74. Mеrdh P.A., Tchoudomirova K., Elshibly S., Hellberg D. Symptoms and signs in single and mixed genital infections. Int J Gynecol Obstet 1998; 63:145-52.
  • 75. Wijgert J. Van de, Fullem A., Kelly C., et al. Phase I trial of the topical microbicide BufferGel: safety results from four international sites. J AIDS 2001; 26:21-7.
  • 76. Цzyurt E., Toykulieva V.B., Danilyians L.L., et al. Efficacy of 7-day treatment with metronidazole + miconazole (Neo-Penotran®) - a triple-active pessary for the treatment of single and mixed vaginal infections. Int J Gynecol Obstet 2001; 74:35-43.
  • 77. Побединский Н.М., Аксенова О.А., Аксенова М.Г., Молочков В.А. Клинико-бактериологическое обоснование комплексного лечения бактериального вагиноза у женщин репродуктивного возраста. Акуш и гинек 2006; №6:24-27.
  • 78. Leitich H., Bodner-Adler B., Brunbauer M., et al. Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol 2003; 189:139-47.
  • 79. Odendaal H.J., Popov I., Schoeman J., et al. Preterm labour – is bacterial vaginosis involved? S Afr Med J 2002; 92:231-4.
  • 80. Andrews W. W., Sibai B. M., Thom, E. A., et al. Randomized clinical trial of metronidazole plus erythromycin to prevent spontaneous preterm delivery in fetal fibronectin-positive women. Obstet Gynecol 2003; 101:847-55.
  • 81. Shennan A., Crawshaw S., Briley A., et al. A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET Study. Br J Obstet Gynaecol 2006; 113:65-74.
  • 82. Guise J.M., Mahon S.M., Aickin M., et al. Screening for bacterial vaginosis in pregnancy. Am J Prev Med 2001; 20 (Suppl.1):62-72.
  • 83. Leitich H., Brunbauer M., Bodner-Adler B., et al. Antibiotic treatment of bacterial vaginosis in pregnancy: a meta-analysis. Am J Obstet Gynecol 2003; 188:752-8.
  • 84. Varma R., Gupta J.K. Antibiotic treatment of bacterial vaginosis in pregnancy: multiple meta-analyses and dilemmas in interpretation. Eur J Obstet Gynecol Reprod Biol 2006; 124:10-4.
  • 85. Kurkinen-Rдty M., Vuopala S., Koskela M., et al. A randomized, controlled trial of vaginal clindamycin for early pregnancy bacterial vaginosis. Br J Obstet Gynaecol 2000; 107:1427-32.
  • 86. Lamont R.F., Duncan S.L.B., Mandal D., Bassett P. Intravaginal clindamycin to reduce preterm birth in women with abnormal genital tract flora. Obstet Gynecol 2003; 101:516-22.
  • 87. Ugwumadu A., Manyonda I., Reid F., Hay P. Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trial. Lancet 2003; 361:983-8.
  • 88. Kiss H., Petricevic L., Husslein P. Prospective randomised controlled trial of an infection screening programme to reduce the rate of preterm delivery. Br Med J 2004; 329:371-5.
  • 89. Larsson P.G., Fahraeus L., Carlsson B., et al. Late miscarriage and preterm birth after treatment with clindamycin: a randomized consent design study according to Zelen. Br J Obstet Gynaecol 2006; 113:629- 37.
  • 90. Morgan D.J., Taylor-Robinson D. Late miscarriage and preterm birth after treatment with clindamycin: a randomised consent design study according to Zelen. Br J Obstet Gynaecol 2006; 113:1483.
  • 91. Morency A.M., Bujold E. The effect of second-trimester antibiotic therapy on the rate of preterm birth. J Obstet Gynaecol Can 2007; 29:35-44.
  • 92. McDonald H., Brocklehurst P., Gordon A. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2007; Issue 1:CD000262.
Views
0 Abstract
0 PDF
0 Crossref citations
Shared