Background and Objectives: Upper respiratory tract infections are one of the most common reasons for outpatient admission. Acute pharyngitis is typically caused by viruses and is self-limiting but in up to 30% of cases, secondary bacterial infection may occur, requiring antibacterial treatment. In the face of growing antibacterial resistance due to inappropriate systemic antibiotic use, different topical therapy would have benefits. The objective of this study was to compare changes in throat and tonsillar mucous membrane bacterial density in patients with acute pharyngitis after a single exposure to a local antibacterial agent presented in different pharmaceutical forms—medicated lozenge, throat spray, or a solution for gargling. Materials and Methods: This was a non-interventional observational study that involved 90 adult outpatients with acute pharyngitis. Patients were prescribed to one of three options: medicated lozenges (containing dequalinium chloride and cinchocaine hydrochloride)—Treatment A; throat spray (containing streptocide soluble and norsulfazol-sodium)—Treatment B; or a powder, Furasol® 100 mg (containing furagin soluble), for use as an external gargling solution—Treatment C. Throat swab culture was collected before and 20 min after the single exposure to the medication. Microbial testing was performed using a semi-quantitative quadrant streak plate method to assess bacterial density before and after exposure. Results: Four pathogenic agents were isolated from the swabs, with Staphylococcus aureus being the most prevalent. Overall, a reduction in post-exposure bacterial growth intensity was observed in 84.6% of the samples after Treatment C exposure, with a statistically significant difference from both Treatment B (57.1%, p < 0.05) and Treatment A (10%, p < 0.05). The difference was also significant between Treatment A and Treatment B. Conclusions: The findings showed that the throat gargling solution had more impact on mucous bacterial load compared to the throat spray and medicated lozenges in the patients with acute pharyngitis. Further research should address the effects of different pharmaceutical forms of the same antibacterial agent, where available.

Abstract The crystal structure of Form A of dequalinium chloride has been solved and refined using synchrotron X-ray powder diffraction data, and optimized using density functional theory techniques. Dequalinium chloride Form A crystallizes in space group P4 2 2 1 2 (#94) with a = 26.2671(8), c = 9.1119(4) Å, V = 6,286.9(4) Å 3 , and Z = 8 at 298 K. Despite the conventional representation of the cation, the ring N atoms are not positively charged. The positive charges are distributed on the ring carbon atoms ortho and para to these N atoms. The central decyl chain conformation is more kinked than the all- trans that might be expected in the solid state, but contains only one unusual torsion angle. The crystal structure consists of an array of dequalinium cations, with chloride anions located in regions between the cations. There are short stacks of roughly parallel rings in multiple directions. There is only one classical hydrogen bond in the structure, N–H···Cl between one of the amino groups and one of the chloride anions. Several C–H···Cl hydrogen bonds are prominent, involving ring, chain, and methyl hydrogen atoms as donors. Particularly noteworthy are the hydrogen bonds from the first and second C atoms at each end of the decyl chain. The powder pattern has been submitted to the International Centre for Diffraction Data (ICDD) for inclusion in the Powder Diffraction File ™ (PDF ® ).

Background: Vulvovaginal candidiasis (VVC) is a Candida infection on vulva and vagina region. The most common etiology is C. albicans. Besides being the risk factor for developing VVC, pregnancy also limits the possible medication. This report presents the efficacy of Dequalinium Chloride (DQC) on VVC during pregnancy due to C. albicans. Case: A third-trimester primigravidae, 27-year-old, complained first odorless thick curd-like consistency vaginal discharge accompanied with pruritus (VAS 9/10) and pain since 3 months prior to admission. Venerology examination showed erythema on the labia majora and a great amount of thick vaginal discharge on the labia minora, vaginal, and cervix area. Vaginal discharge examination using KOH 10% showed pseudohyphae. Gram examination found pseudohyphae and polymorphonuclear (PMN) cells &gt;30 in the vagina, and pseudohyphae on the cervix’s discharge. VITEK-2 culture showed fluconazole-sensitive C. albicans. The patient was given DQC intravaginal tablets for 10 days and showed remarkable clinical and microscopic examination improvement. Conclusion: Intravaginal DQC is effective in treating pregnant patients with VVC. VVC in pregnancy should be treated appropriately to prevent perinatal adverse effects. Keywords: Vulvovaginal Candidiasis, dequalinium chloride, pregnancy, C. albicans

Given limited treatment options for Trichomonas vaginalis (TV) in patients with metronidazole allergy and waiting times for desensitization leaving patients in significant discomfort, it is imperative to find alternative options. This case study highlights an example of cure of TV using 24 nightly dequalinium chloride pessaries in a patient with metronidazole allergy, thus presenting a potential treatment option for further study.

Bacterial vaginosis is one of the most prevalent sexually transmitted infections (STI) of women of reproductive age with an incidence of 20-30% in women with complaints of discharge1. As per the criteria for diagnosis of bacterial vaginoses (BV), Amsel’s criteria include which include, a) vaginal discharge, b) fishy odour, c) clue cells on histo-pathology and d) alkaline vaginal pH of 4.5 and greater. Additional diagnosing techniques include gram-staining and Nugent score2. Metronidazole and clindamycin are the first line for treating bacterial vaginosis and their cure rate is between 55 to 90%3, However, due to growing resistance against anti-microbials, another alternative dequalinium chloride, a broad-spectrum antiseptic, has demonstrated efficacy against bacterial vaginosis (BV) in multiple clinical trials4. Dequalinium chloride works by absorbing into the cell surface membrane and permanently distorting its permeability, it disrupts the cell protein synthesising mechanism thus hindering its replication and it also causes denaturation and precipitation of cell nucleic material. This multimodal action minimises the risk of bacterial resistance and it was also seen that it damages bacterial biofilm and impairs bacterial metabolism4. Clinical trials have reported over 90% resolution of BV with dequalinium chloride by using dequalinium chloride and it was also seen that Women using dequalinium chloride reported fewer vulvovaginal complaints compared to metronidazole and clindamycin5. In conclusion, dequalinium chloride appears to be a superior alternative to conventional antibiotics for BV, offering higher efficacy, better tolerability, and fewer adverse effects. Its broad-spectrum activity against both Gram-positive and Gram-negative bacteria further reduces the likelihood of antimicrobial resistance, making it a promising non-antibiotic option for BV treatment.

BACKGROUND: Bacterial vaginosis is an imbalance of the vaginal microbiome that is characterized by a decrease in lactobacilli and an overgrowth of opportunistic anaerobic bacteria. Given the high prevalence of bacterial vaginosis and the problem of antibiotic resistance, there is a need to develop new treatment methods and optimize the use of existing drugs. AIM: The aim of this study was to evaluate the efficacy and tolerability of the sequential use of lactic acid with clindamycin or dequalinium chloride in the treatment of bacterial vaginosis in women of reproductive age. METHODS: This study involved 127 women aged 18 to 45 years and diagnosed with bacterial vaginosis based on the Amsel criteria. The patients were randomly divided into four groups: Group 1 (34 women) received lactic acid; Group 2 (31 women) received clindamycin and lactic acid; Group 3 (32 women) received dequalinium chloride and lactic acid; and Group 4 (30 women) received clindamycin only. The effectiveness of treatment was assessed after 14 days based on the Amsel criteria. Three months post-treatment, complaints, vaginal discharge pH, amine tests and smears were analyzed if two or more Amsel criteria were present. RESULTS: Two weeks after treatment, bacterial vaginosis symptoms persisted in 14.7% of women in Group 1, 3.2% of women in Group 2, and 13.3% of women in Group 4. Additionally, two weeks after therapy, vulvovaginal candidiasis was diagnosed in one woman (3.2%) in Group 3. Bacterial vaginosis recurrences three months after treatment were recorded in 6.9% of patients in Group 1, 3.3% of patients in Group 2, 6.5% of patients in Group 3, and 11.5% of patients in Group 4. In Group 2, one case of vulvovaginal candidiasis (3.3%) was also documented. The efficacy of lactic acid was 85.3% after 14 days and 93.1% after three months, while clindamycin demonstrated an efficacy of 86.7% after 14 days and 88.5% after three months. Combination therapy with clindamycin and lactic acid demonstrated an efficacy of 96.8% after 14 days and 96.7% after three months. Treatment with dequalinium chloride and lactic acid demonstrated an efficacy of 100% after 14 days and 93.5% after three months. CONCLUSION: The data obtained confirm the high efficacy of the two-stage therapy using clindamycin with lactic acid and dequalinium chloride with lactic acid. This treatment method provides superior outcomes in terms of both cure rates and tolerability compared to traditional treatments. Given the growing resistance of microorganisms to antibiotics, the introduction of safe alternatives is particularly important, while offering new prospects for improving the treatment of bacterial vaginosis and enhancing the quality of life for patients.

Dequalinium chloride (DQC) is a potent antimicrobial agent; however, its therapeutic application is limited due to poor solubility, rapid degradation, and short half-life. In this study, we developed a nanogel-based delivery system to provide stability, bioavailability, and controlled release of DQC, subsequently improving antimicrobial impact. Carbopol 940 and PEG 6000 were used for the synthesis of the nanogel, which was characterized for physicochemical properties, drug entrapment, and release kinetics. Differential Scanning Calorimetry (DSC), and X-ray Diffraction (XRD) confirmed the successful encapsulation and amorphous nature, whereas Thermogravimetric Analysis (TGA) validated improved thermal stability. The nanogel showed a high entrapment efficiency of 90%, and the drug was released sustained according to a non-Fickian diffusion mechanism with 86.23% cumulative release in 24h. As per antimicrobial activity, it was observed that the developed formulation showed better inhibition against Escherichia coli and Staphylococcus aureus than free drug solutions. Thus, the findings indicate that the developed nanogel formulation can be considered a worthy advanced antimicrobial delivery system with controlled drug release.

Chemodynamic therapy (CDT) holds great promise in cancer treatment, whereas its efficacy is severely compromised by the low concentration of endogenous hydrogen peroxide(H2O2), insufficient exogenous catalytic ions, and the presence of high levels of cellular glutathione (GSH). Herein, a dissociable, tumor cell membrane-camouflaged carrier-free nanoparticle is developed through the molecular interaction of copper ions (Cu2+), dequalinium (DQ), and β-Lapachone (β-Lap). Upon homotypic tumor targeting, the system releases Cu2+ (exogenous catalytic ions), β-Lap (H2O2 donor), and DQ (GSH scavenger), achieving triple amplification of CDT efficacy. Concurrently, the intracellular accumulation of Cu2+ induces cuproptosis, thereby synergistically augmenting CDT efficacy and strikingly restraining tumor growth. Overall, the integration of Cu2+ supplementation, H2O2 self-supplying, and GSH depletion offers a promising avenue for improving cancer treatment outcomes and paves a new way for multimodal cancer therapy.

Mitochondria-targeted nanotherapeutics: A new frontier in neurodegenerative disease treatment.

BACKGROUND: Bacterial vaginosis is a common infectious non-inflammatory vaginal condition that increases susceptibility to sexually transmitted diseases, negatively impacts perinatal outcomes, and reduces overall quality of life. Considering the low long-term effectiveness of antibiotic therapy, the high recurrence rates, and the frequent side effects associated with its use, there is a growing need to explore alternative approaches for bacterial vaginosis treatment. AIM: To evaluate the efficacy and tolerability of a two-step treatment approach for bacterial vaginosis, which includes clindamycin or dequalinium chloride and lactic acid, in women of reproductive age. MATERIALS AND METHODS: An open-label randomized clinical trial was conducted, including 93 women aged 18–45 years diagnosed with bacterial vaginosis according to Amsel’s criteria. Participants were randomly assigned to three groups: 31 women in the first group received lactic acid monotherapy, 31 in the second group received a combination of clindamycin and lactic acid, and 31 in the third group were treated with dequalinium chloride and lactic acid. Treatment efficacy was assessed after 14 days using Amsel’s criteria. Three months post-treatment, patient-reported symptoms and vaginal pH levels were evaluated. RESULTS: Two weeks post-treatment, bacterial vaginosis symptoms persisted in 3 (9.7%) patients from the first group and in 1 (3.2%) patient from the second group. A positive trend in vaginal pH normalization was observed in all groups both at the two-week and three-month follow-ups. At the three-month follow-up, vaginal discharge complaints persisted in one patient from the first group, one from the second, and two from the third. The efficacy of lactic acid monotherapy at day 14 was 90.3%, increasing to 96.4% at three months. The two-step therapy combining clindamycin and lactic acid demonstrated an efficacy of 96.8% and 96.7%, respectively. The two-step therapy with dequalinium chloride and lactic acid demonstrated 100% efficacy after 14 days and 93.3% at the three-month follow-up. A case of vulvovaginal candidiasis was reported in the second group three months after treatment. CONCLUSION: This study demonstrated the sustained high efficacy of the two-step treatment approach in both short-term and long-term perspectives. Whereas monotherapy initially showed lower efficacy, its long-term outcomes became comparable, highlighting the importance of lactic acid in combination therapy.

Introduction: Vulvovaginitis affects pregnancy outcomes and managing it involves the use of metronidazole or nystatin, which can cause local or systemic side effects. Dequalinium chloride (DQC) is suggested as a new treatment option for vulvovaginitis during pregnancy with minimal side effects. Objective: To compare the effectiveness of dequalinium chloride (DQC) versus metronidazole + nystatin (MN) in treating vulvovaginitis in pregnant women during their second and third trimesters. Method: A single-blind randomized controlled trial was conducted at the Andalas Public Health Center, Padang, from January to May 2024. Pregnant women in their second and third trimesters, meeting the inclusion and exclusion criteria, were enrolled. The participants were randomly assigned to either the DQC or MN group. Vaginal swabs were taken before and after a 6-day treatment, and PCR analysis was performed. Results: Eighteen patients were treated with DQC and MN. Most participants had bacterial vaginosis (DQC 78%, MN 83%), with half having candidiasis (DQC and MN 50%) and fewer cases of trichomoniasis (28% in both groups). Significant improvements were seen in the DQC group for symptoms (p=0.000), Gardnerella vaginalis (p=0.035), and Candida albicans (p=0.021). In the MN group, significant improvements were noted for symptoms (p=0.000) and Gardnerella vaginalis (p=0.002). No significant differences were observed between the groups for symptom resolution or microbial reduction. Conclusion: DQC is as effective as metronidazole + nystatin in treating bacterial vaginosis and candidiasis in pregnancy. Keywords: Vulvovaginitis, pregnancy, dequalinium chloride, metronidazole, nystatin

В настоящее время вопрос сохранения здоровья нации является актуальным и приоритетным для Российской Федерации. Огромное значение для охраны здоровья имеет продукция отечественной фармацевтической промышленности, которая является важнейшей социально значимой отраслью экономики. Обеспечение граждан лекарственными препаратами – базовая составляющая национальной безопасности государства. По данным Минпромторга на 2015 г., в России степень зависимости фармацевтической промышленности от импорта составила 73%, медицинской промышленности – 81%. Критическая зависимость от импорта, по мнению экспертов, создает потенциальную угрозу национальной безопасности, может привести к возможному дефициту лекарственных препаратов и дальнейшему кратному удорожанию лекарств и медицинских услуг. В современных экономических и геополитических условиях импортозамещение, особенно в сегменте таких товаров, как медикаменты, – стратегически значимая цель. Программой «Фарма‑2030», принятой в 2023 г., поставлена цель увеличить экспорт фармацевтической продукции в четыре раза – до 2,8 млрд долл. Это возможно только при выпуске конкурентоспособной на внешних рынках инновационной продукции, что соответствует модели фарминдустрии внешнеориентированного импортозамещения. Для реализации такой политики требуется комплексная поддержка государства, в том числе инвестиционная, инфраструктурная, научно-­исследовательская. Разработка оригинальных лекарственных средств – сложный, длительный, трудоемкий, затратный и рискованный процесс. Создание дженериков требует существенно меньших затрат, чем разработка оригинального препарата, поскольку стоимость не включает расходы, связанные с длительными экспериментальными и клиническими испытаниями. Дженерики, или, согласно российскому законодательству, воспроизведенные лекарственные препараты, нашли широкое применение на отечественном фармацевтическом рынке. Государственная система, регулирующая обращение лекарственных средств на территории страны, обеспечивает то, что отечественный дженерик уступает оригинальному препарату только ценой, но не качеством. Септофемин – первый отечественный дженерик деквалиния хлорида на фармацевтическом рынке РФ. Экономическая доступность лекарственного средства открывает перспективу расширения его медицинского применения, что обеспечит высокую эффективность и хорошую безопасность, приведет к сокращению применения антибиотиков в фармакотерапии вульвовагинальных инфекций и, соответственно, снижению антибиотикорезистентности. Currently, the issue of preserving the health of the nation is relevant and priority for the Russian Federation. The products of the domestic pharmaceutical industry, which is the most important socially significant sector of the economy, are of great importance for health protection. Providing citizens with medicines is a basic component of ensuring the national security of the state. In Russia, according to the Ministry of Industry and Trade for 2015, the degree of dependence of the pharmaceutical industry on imports was 73%, the medical industry – 81%. Critical dependence on imports, according to experts, creates a potential threat to national security and can lead to a possible shortage of medicines and a further increase in the cost of medicines and medical services. Import substitution, especially in the segment of goods such as medicines, is currently a strategically significant goal, given the current economic and geopolitical conditions. The Pharma2030 program, adopted in 2023, sets goals to increase the export of pharmaceutical products fourfold–to $2.8 billion. This is only possible with the release of innovative products that are competitive in foreign markets, which corresponds to the pharmaceutical industry model of externally oriented import substitution. To implement such a policy, comprehensive state support is required, including investment, infrastructure, and research. The development of original medicines is a complex, lengthy, labor-­intensive, costly and risky process. The creation of generic drugs is significantly less expensive than the development of an original drug, since the cost does not include the costs associated with lengthy experimental and clinical trials. Generics, or according to Russian legislation, reproduced drugs have found widespread use in the domestic pharmaceutical market. The state system regulating the circulation of medicines in the country ensures that the domestic generic is inferior to the original drug only in price, and not in quality. Septofemin is the first domestic generic of dequalinium chloride on the Russian market. The economic availability of the drug opens up the prospect of expanding medical use, which will ensure high efficiency and good safety, leading to a decrease in the use of antibiotics in the pharmacotherapy of vulvovaginal infections and, accordingly, to a decrease in antibiotic resistance.

Treatment options for recalcitrant Trichomonas vaginalis (TV), when very high dose systemic 5-nitroimidazole plus intravaginal therapy for over 14days has failed, are very limited. They have poor efficacy, unpleasant side effects, and are difficult and expensive to acquire. We report successful treatment with 24weeks of daily dequalinium chloride vaginal tablets. Dequalinium is licensed in Europe where it is readily available and cheap. It offers a safe and pragmatic alternative for recalcitrant TV.

Bacterial vaginosis (BV) is a common cause of vaginal infection. First-line treatments of BV are metronidazole and clindamycin. Due to the increase in antibiotic resistance, effective nonantibiotic treatments for BV are needed. To examine whether dequalinium chloride, a broad-spectrum antiseptic, is noninferior to oral metronidazole for the treatment of BV. This phase 4, multicenter, triple-blind, double-dummy, parallel, noninferiority randomized clinical trial was conducted from July 29, 2021, to August 25, 2022, with a 1-month follow-up. Participants were premenopausal women 18 years or older with BV from 11 gynecologic practices and 1 hospital in Poland, Slovakia, and the Czech. Patients were randomized to treatment with dequalinium chloride vaginal tablets (10 mg once daily for 6 days) or oral metronidazole (500 mg twice daily for 7 days). Double-dummy medication kits contained vaginal and oral tablets with placebo and active medication. The main outcome was the noninferiority margin (of 15 percentage points) in the absolute difference in clinical cure rates between dequalinium chloride and metronidazole 7 to 11 days after start of treatment (visit 1). Noninferiority was met if the lower 95% CI for the difference in clinical cure rate was less than 15 percentage points at visit 1. A total of 147 women (mean [SD] age, 36.7 [9.0] years) were treated with dequalinium chloride (n = 72) or metronidazole (n = 75). The clinical cure rates at visit 1 were 64 of 69 (92.8%) for dequalinium chloride vs 69 of 74 (93.2%) for metronidazole in the intention-to-treat population, whereas in the per-protocol population, cure rates were 54 of 58 (93.1%) for dequalinium chloride vs 48 of 53 (90.6%) for metronidazole. The treatment differences of -0.5 percentage points (95% CI, -10.8 to 9.8 percentage points; P = .002) in the intention-to-treat population and 2.5 percentage points (95% CI, -9.4 to 14.4 percentage points; P = .001) in the per-protocol population confirmed the noninferiority of dequalinium chloride. The tolerability of dequalinium chloride was rated as very good by 30 of 50 patients (60.0%) but only by 21 of 54 (38.9%) for metronidazole. Three patients in the metronidazole group suspended treatment due to an adverse event. This randomized clinical trial showed that dequalinium chloride was not inferior to metronidazole for the treatment of BV. Dequalinium chloride had a similarly high cure rate but with better tolerability and fewer adverse events. With a similar efficacy to metronidazole and clindamycin, dequalinium chloride warrants consideration as first-line treatment for BV to help reduce antibiotic consumption. EudraCT: 2020-002489-15.

The relevance of diseases accompanied by pathological secretions from the genital tract is undeniable. This is the leading reason for women to go to a gynecologist. Despite the routine nature of diseases associated with pathological secretions from the genital tract – bacterial vaginosis, aerobic vaginitis, candidiasis vulvovaginitis, mixed vaginitis – the issues of their diagnosis and treatment remain unresolved. In the treatment of vaginosis and vaginitis, we are increasingly faced with the formation of biofilms and, accordingly, a refractory response to treatment or a relapse of the disease. Research shows that refractory response and relapse of the disease are different conditions that require different therapeutic and preventive approaches, but in both cases their cause is often the formation of biofilm. Biofilm vaginitis is a problem of the new century. Biofilms are a difficult task in the treatment of bacterial infections and are one of the main causes of infection persistence. Currently, more than 80% of bacterial infections are caused by the formation of bacterial biofilms. Due to the biofilm, increased tolerance to antimicrobials is maintained for a number of reasons. The article discusses available methods of overcoming antibiotic resistance in bacterial vaginosis and vaginitis, the possibility of avoiding recurrence of the disease without causing significant harm to the vaginal microbiota. Special attention is paid to such an antiseptic as dequalinium chloride. Unlike antibiotics, dequalinium chloride is less toxic to lactobacilli and does not increase the risk of developing candidiasis vulvovaginitis. It works well both on the causes of bacterial vaginosis and on flora unrelated to bacterial vaginosis, which makes it a potentially effective drug for aerobic and mixed vaginitis.

Purpose of the study. To evaluate the clinical and laboratory effectiveness and long-term results of the two-stage therapy for nonspecific vulvovaginitis in pregnant women in the third trimester using the antiseptic dequalinium chloride (Fluomizin) and the probiotic (Gynoflor E). Material and methods. There were sixty-nine pregnant women in the third trimester of gestation observed in the outpatient setting. The treatment was carried out in two sequent stages. Patients of the main and the control groups (n=69) received local treatment with an antiseptic: dequalinium chloride (Fluomizin) containing 10 mg in a vaginal tablet for six days, one tablet intravaginally per day in the first stage. Topical probiotics were used to restore the vaginal normocenosis state in the second stage. Patients in the main group (n=36) used a drug containing L. acidophilus lyophilisate 50.00 mg (at least 108 viable bacteria) and an ultra-low dose of estriol — 0.03 mg (Gynoflor E) for six days, one tablet intravaginally per day. Patients in the control group (n=33) received a course of treatment using intravaginal capsules containing a lyophilized culture of lactobacilli L. casei rhamnosus Doderleini (at least 108 CFU), one capsule twice per day for seven days. Evaluation of the effectiveness of the therapy included primary results such as dynamics of complaints, findings on vaginal speculum examination and microscopic examination of vaginal smears. Secondary results of the assessment included the overall duration and dynamics of the labor (vaginal or surgical intervention), birth trauma (rupture of the cervix or vagina), the development of signs of chorioamnionitis and intra-amniotic infection of the fetus, the condition of newborns and the postpartum period. Results. The improvement in the condition was noted such as a relief of clinical manifestations in 97.2% (35/36) (p&lt;0.05) of patients in the main group and in 93.9% (31/33) (p&lt;0.05) of patients control group in the absence of statistical significance of differences between groups (p = 0.51) during the threatment. Microscopy assessment showed that laboratory cure included in the normalization of leukocyte number in 94.4% (34/36, p&lt;0.05) of patients in the main group and in 93.9% (31/33, p&lt;0.05) control groups. The use of the complex two-stage therapy: an antiseptic (Fluomizin) and a probiotic with a microdose of estriol (Ginoflor E), contributed to a decrease in the concentration of small gram-variable cocci towards the predominance of single (1—10 per p/z) and moderate amounts (11—100 p/z) microorganisms with a simultaneous increase in the content of lactobacilli and their prevalence (moderate and large numbers) over other microflora in 91.7% (33/36) compared to the initial data (p&lt;0.05). Conclusion. The data showed the high effectiveness of the complex two-stage therapy by using the antiseptic dequalinium chloride and the probiotic Ginoflor E in the treatment of nonspecific vulvovaginitis in pregnant women in the third trimester with the frequency of achieving a general therapeutic effect in 95.8% of patients (p&lt;0.05), the absence of serious adverse events and the high satisfaction from using the drug in 97.2% of pregnant women.

Dequalinium chloride for the treatment of vulvovaginal infections: A systematic review and meta-analysis

This article considers the issues of antibiotic resistance prevention using dequalinium chloride (DQC) as an example. Antimicrobial resistance is a serious threat to global health due to natural adaptation mechanisms of microorganisms; it is complicated by irrational use of antimicrobial agents. DQC, which is a quaternary ammonium compound, has a broad spectrum of antimicrobial activity and is effective against gram-positive and gram-negative bacteria, fungi and protozoa. The absence of registered cases of resistance to DQC makes it a promising tool for the treatment of infections, including those resistant to conventional antibiotic therapy. The article presents the results of clinical trials confirming the high efficacy and safety of DQC in the treatment of vaginal infections and recurrence prevention. Special attention is paid to the need for further research to support these findings and to develop comprehensive strategies for the use of antiseptics in clinical practice. Key words: dequalinium chloride, antibiotic resistance, bacterial vaginosis, antiseptics, pharmacotherapy

Objective/PurposeWomen at reproductive age frequently experience vulvovaginal infections and vaginitis. The most common etiologies are vulvovaginal candidiasis (VVC), bacterial vaginosis (BV), desquamative inflammatory vaginitis/aerobic vaginitis, and trichomoniasis. Various treatment options are available for these infections, such as specific antimicrobial or antiseptic agents. Dequalinium chloride (DQC) is a local antiseptic agent with a broad antimicrobial and antifungal spectrum. Multiple studies suggest that DQC is an efficient treatment for vaginal infections; however, it is not widely recommended as a first-line treatment. This systematic review and meta-analysis aims to evaluate the efficacy of DQC compared with that of standard treatment.MethodsOur systematic review was conducted according to the PRISMA guidelines. PubMed/MEDLINE, EMBASE, CENTRAL, and clinicaltrials.org were searched to retrieve relevant reports up to October 2022.ResultsFour randomized controlled studies and 1 observational study were included in this review. Overall, DQC showed noninferiority to the reference treatments for BV and VVC, and to the evaluated treatment options for desquamative inflammatory vaginitis/aerobic vaginitis. For BV and VVC, this could also be confirmed in a meta-analysis including 3 randomized controlled studies. No serious adverse events were reported in any of these studies.ConclusionsDequalinium chloride offers a safe, well-tolerated, and efficient treatment option for vulvovaginal infections of different etiologies. However, further studies are needed to confirm our findings and allow inclusion of DQC as a first-line treatment into guidelines.

Evolution of antibiotic resistance is a world health crisis, fueled by new mutations. Drugs to slow mutagenesis could, as cotherapies, prolong the shelf-life of antibiotics, yet evolution-slowing drugs and drug targets have been underexplored and ineffective. Here, we used a network-based strategy to identify drugs that block hubs of fluoroquinolone antibiotic-induced mutagenesis. We identify a U.S. Food and Drug Administration– and European Medicines Agency–approved drug, dequalinium chloride (DEQ), that inhibits activation of the Escherichia coli general stress response, which promotes ciprofloxacin-induced (stress-induced) mutagenic DNA break repair. We uncover the step in the pathway inhibited: activation of the upstream “stringent” starvation stress response, and find that DEQ slows evolution without favoring proliferation of DEQ-resistant mutants. Furthermore, we demonstrate stress-induced mutagenesis during mouse infections and its inhibition by DEQ. Our work provides a proof-of-concept strategy for drugs to slow evolution in bacteria and generally.