Сравнение эффективности распространенных схем лечения бактериального вагиноза

Abstract

Introduction. Bacterial vaginosis (BV), being one of the most common diseases of the female genital organs, is still of interest to a practitioner. In modern conditions, requiring a short time to make a diagnosis and start treatment, it is often necessary to prescribe treatment empirically. Given the variety of regimens for the treatment of BV, it is advisable to identify the most effective for empirical therapy. Aim. To determine the most effective treatment regimen for BV among those common in the Russian Federation. Materials and methods. The study involved 120 women aged 18 to 45 years who met the inclusion criteria: applying to the antenatal clinic with complaints of abnormal vaginal discharge, the presence of BV, confirmed by the Amsel criteria at the initial admission. The follow-up was carried out during 4 consecutive visits. At the first visit, a clinical investigation was carried out: sampling for bacterioscopic and bacteriological studies, pH-metry of the posterior vaginal vault secretion, the amine whiff test, sampling for the Femoflor 16 real-time polymerase chain reaction (RT-PCR). At the second visit, all women were divided into 4 representative groups depending on the treatment regimen (group 1: metronidazole (gel) + Lactogynal (vaginal capsules); group 2: clindamycin (cream) + Lactogynal; group 3: chlorhexidine gluconate (vaginal tablets) + Lactogynal; group 4: Elzhina (vaginal tablets) + Lactogynal). At the third visit, on the 7th day of treatment, the intermediate efficacy of the studied regimens was evaluated, and side effects were identified. The fourth visit was scheduled 10–14 days after the end of treatment, during which the final result of treatment and treatment complications were assessed. Results. There were no significant differences in the studied groups in terms of the presence of complaints of vaginal abnormal discharge, the results of bacterioscopic examination, a positive amine whiff test, and the pH level (p > 0.05). In using the Femoflor-16 RT-PCR, normal state of vaginal biocenosis was determined in 26.67% of patients of each group (p = 1.0), moderate anaerobic dysbiosis – in 33.33% (p = 1.0), severe anaerobic dysbiosis – from 33.33% (in group 4) to 40% (in groups 1–3) (p > 0.05). The most effective was the treatment regimen with the use of Elzhina, its effectiveness was 80%. Also, according to the results of the Femoflor RT-PCR, the drug Elzhina showed the highest efficacy– 96.67%. Conclusion. The most effective was the treatment regimen with the use of a combined drug with antibacterial, antiprotozoal, antifungal and anti-inflammatory action for topical administration – Elzhina. This drug is highly effective and can be recommended as an empirical treatment for BV.