Abstract
An optimal host–microbiota interaction in the human vagina governs the reproductive health status of a woman. The marked depletion in the beneficial Lactobacillus sp. increases the risk of infection with sexually transmitted pathogens, resulting in gynaecological issues. Vaginal infections that are becoming increasingly prevalent, especially among women of reproductive age, require an effective concentration of antimicrobial drugs at the infectious sites for complete disease eradication. Thus, topical treatment is recommended as it allows direct therapeutic action, reduced drug doses and side effects, and self-insertion. However, the alterations in the physiological conditions of the vagina affect the effectiveness of vaginal drug delivery considerably. Conventional vaginal dosage forms are often linked to low retention time in the vagina and discomfort which significantly reduces patient compliance. The lack of optimal prevention and treatment approaches have contributed to the unacceptably high rate of recurrence for vaginal diseases. To combat these limitations, several novel approaches including nano-systems, mucoadhesive polymeric systems, and stimuli-responsive systems have been developed in recent years. This review discusses and summarises the recent research progress of these novel approaches for vaginal drug delivery against various vaginal diseases. An overview of the concept and challenges of vaginal infections, anatomy and physiology of the vagina, and barriers to vaginal drug delivery are also addressed.
Highlights
Vaginal infection is a global health issue commonly seen in women at reproductive age
The minimum inhibitory concentration (MIC) values against C. albicans of both chitosan nanocapsules were comparable with the drug solutions, suggested that the activity of both drugs was maintained throughout the nano-encapsulation process
This study demonstrated that the combination of a thermosensitive gel and pH-sensitive liposome using poloxamers and mPEG-Hz-CHEMS as polymers had a potential to reduce the toxicity of arctigenin during vaginal delivery while providing constant drug release [159]
Summary
Vaginal infection is a global health issue commonly seen in women at reproductive age It generally includes bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis [1,2]. This study found that the prevalence of vaginal infections was comparatively higher in non-pregnant women than pregnant women They found that women at the age of 40 and above were more susceptible to BV due to the reduction of oestrogen altering the living environment of the Lactobacillus sp. The objectives of this review are to demonstrate advantages and challenges associated with the formulations, to critically appraise different optimization parameters based on their physicochemical properties, the in vitro release pattern, the in vivo efficacy and safety profile, and to critically appraise the regulatory perspective of the formulations of different novel approaches for local delivery of antimicrobials for vaginal infection
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