Abstract
Objectives: The balance of the vaginal ecosystem depends on lactobacilli whose biofilm protectsagainst microorganisms that are not normally present or are subdominant in vaginal flora. Vaginal infection treatments should eliminate pathogens while preserving the Lactobacillus flora to prevent relapse or recurrence. The objective of this study was to determine the sensitivity of lactobacilli to antiseptics, antibiotics and antifungal agents used, alone or in combination, in the topical treatment of infectious vaginitis. Materials and Methods: The minimum inhibitory concentration (MIC) of 15 active ingredients and the minimum inhibitory dilution (MID) of 17 pharmaceuticals products were determined for three main Lactobacillus strains (L. crispatus, L. gasseri and L. jensenii). Results: The MICs of the antibiotics and antifungal agents were above their critical concentrations in the three strains, contrary to the antiseptics. According to their MID, some pharmaceutical products, especially combinations, inhibit the growth of one or more strains at concentrations that can be found in the vaginal mucosa after application at the usual dosage. Conclusions: Certain topical anti-infective drugs may interfere with the growth of lactobacilli, worsening the vaginal flora imbalance. Maintaining vaginal flora balance should be a selection criterion when choosing an anti-infective therapy.
Highlights
Skin and mucous membranes are constantly colonized by microorganisms that form a physiological biofilm
The pharmaceutical products Metronidazole-Miconazole (MM), Ornidazole-Neomycin-Nystatin (ONN) and Clindamycin-Ketoconazole (CK) give minimum inhibitory dilution (MID) below this threshold value for 2 strains, whereas Nifuratel-Nystatin formulation (NN) gives MIDs below 0.8% for the three strains tested. This in vitro study shows the effect of 17 pharmaceutical products indicated in the topical treatment of infectious vaginitis and the effect of their active ingredients on 3 main Lactobacillus vaginal strains
The antiseptic active ingredients could have a destructive effect on lactobacilli in vivo, since their minimum inhibitory concentration (MIC) are lower than the critical concentrations
Summary
Skin and mucous membranes are constantly colonized by microorganisms that form a physiological biofilm. This biofilm protects against colonization by exogenous potential pathogens [1] [2]. Lactate accumulation maintains the vaginal pH between 3.8 and 4.5, where few pathogens are able to develop This protects the vaginal cavity from colonization, by fecal bacteria such as Enterobacteriaceae, Enterococci and Clostridium, and protects against vaginal, uterus or urinary tract infections [3]-[5]. A number of Lactobacillus strains produce hydrogen peroxide [6]-[8] This bactericidal agent plays a key role in regulating vaginal flora by inhibiting pathogens. Lactobacillus gasseri, Lactobacillus jensenii and Lactobacillus crispatus are the strains producing hydrogen peroxide most frequently isolated in normal vaginal flora [9] [10]
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