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Probiotics effective to prevent recurrent BV

Clinical Question:
Does intravaginal treatment with probiotics reduce recurrences of bacterial vaginosis in women with a history of recurrent bacterial vaginosis?

Bottom Line:
Intravaginal administration of probiotic capsules for 2 weeks reduces episodes of symptomatic bacterial vaginosis (BV) in women with a history of recurrent BV. (LOE = 1b-)

Reference:
Ya W, Reifer C, Miller LE. Efficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a double-blind, randomized placebo-controlled study. Am J Obstet Gynecol 2010;203:120.e1-6.  [PMID:20659602]

Study Design:
Randomized controlled trial (double-blinded)

Funding:
Industry

Allocation:
Concealed

Setting:
Outpatient (any)

Synopsis:
This randomized controlled trial enrolled 120 healthy women, aged 18 years to 55 years, who were free of BV at enrollment, but had at least 2 episodes within the preceding year. Exclusion criteria were the presence of vulvovaginitis, antibiotic or antifungal treatment in the week prior to enrollment, pregnancy or lactation, daily fermented milk/yogurt consumption, immunosuppression, and cervical dysplasia or carcinoma. Women were randomized to receive a daily intravaginal probiotic capsule (Probaclac, which contains Lactobacillus ramnosis, Lactobacillus acidophilus, Streptococcus thermophilus, and lactose) or placebo capsules. The probiotic dose was 8 billion cfu, which is 80 times greater than the lactobacillus volume recommended to restore and maintain normal urogenital flora. Women were instructed to refrain from using other intravaginal products. Treatment was 1 capsule daily for 2 one-week cycles, with a week in between: 1 week on, 1 week off, 1 week on. Women were evaluated at 30 days and 60 days after treatment, including assessment of vaginal flora. Women were contacted by telephone 11 months after treatment to inquire about further episodes of BV. Reported diagnoses of BV were confirmed by contact with the treating physician. Episodes of BV were treated with antibiotics at the physicians' discretion. Study retention did not differ between groups (91% vs 90% at 60 days, and 81% vs 76% at 11 months). Recurrences of BV occurred in 16% of treated patients and in 45% of control patients by 60 days (number needed to treat [NNT] = 3.4; 95% CI, 2.3-8.0). Between 60 days and 11 months following treatment, confirmed episodes of BV remained lower in the treated group (11% vs 28%; NNT = 5.9; 3.2-31.0).

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