Abstract
Background: The effect of probiotic therapy on bacterial vaginosis (BV) is controversial. We conducted a meta-analysis of the efficacy and safety associated with probiotic treatment for BV. Methods: We searched multiple databases covering up to 1 March 2018. Studies published as blinded randomized controlled trials (RCTs), comparing treatment using probiotic versus active or placebo control in BV patients were included, with at least one-month follow-up. Random effects model and trial sequential analysis (TSA) were applied. Results: Ten studies (n = 2321) were included. Compared with placebo, the probiotics-only therapy resulted in a beneficial outcome both in clinical cure rate at the 30th day (risk ratio, RR = 2.57; 95% confidential interval, 95% CI: 1.96 to 3.37), and Nugent score (mean difference, MD = −2.71; 95% CI: −3.41 to −2.00). This effect decreased but remained significant after eight weeks. Probiotics-post-antibiotics therapy had a decreased effect only for a short term and possibly among studies with a mostly black study population. No extra adverse events were observed. The TSA suggested a larger sample size for effective evaluation of the probiotics as a supplementary remedy. Conclusions: Probiotic regimes are safe and may exhibit a short-term and long-term beneficial effect for BV treatment. The ethnic-specific result for the probiotic used after antibiotics is worthy of further study.
Highlights
Bacterial vaginosis (BV) is one of the most common diseases in women of reproductive age [1]
Eligibility criteria were based on the PICOS framework [23]: (1) premenopausal nonpregnant women with bacterial vaginosis (BV) were enrolled (BV was defined by one of three diagnostic tests recommended by widely accepted clinical guidelines [24,25], namely Nugent score [26], Amsel criteria [27] or Hay/Ison criteria [28]); (2) probiotic preparations, single or mixed strains with any dosage, route of administration and preparation types; (3) control arm used placebo or active controls; (4) the outcomes of interest were reported; (5) randomized, double- or triple-blind controlled trials with follow-up of at least one menstrual cycle
Participants in seven studies were firstly treated with antibiotics followed with probiotic preparations to reduce the risk of recurrence; the other three studies used probiotics only
Summary
Bacterial vaginosis (BV) is one of the most common diseases in women of reproductive age [1]. The prevalence of BV ranged from 5.9% to 15.4% [2] This number was 16.3%–29.2% in the United States [3], and reached up to 50% in southern and eastern Africa [4]. Despite this being a mild disease, patients with BV may suffer from a higher risk of reproductive tract infections and adverse pregnancy outcomes [5,6,7]. The effect of probiotic therapy on bacterial vaginosis (BV) is controversial. We conducted a meta-analysis of the efficacy and safety associated with probiotic treatment for BV
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