PEARLS 233, February 2010, written by Brian R McAvoy

Clinical question

How effective are probiotics in the treatment of bacterial vaginosis?

Bottom line

The results do not provide sufficient evidence for or against recommending probiotics for the treatment of bacterial vaginosis. In addition, there is no conclusive evidence to recommend the use of probiotics either before, during or after antibiotic treatment as a means of ensuring successful treatment or reducing recurrence. An analysis of odds ratios and confidence intervals for individual studies for the outcomes of microbiological cure was suggestive of a beneficial effect only for the augmentation of oral metronidazole with an oral probiotics regimen and for the probiotic/oestriol regimen; however, well designed randomised controlled trials with standardised methodologies and larger patient numbers are needed.  

Caveat

It was not possible to perform a meta-analysis due to significant differences in the probiotic preparations and trial methodologies. Methodological quality was inadequate in 2 studies.  

Context

Bacterial vaginosis is one of the most common causes of genital discomfort in women of reproductive age. This condition occurs when there is an imbalance in the population of normal vaginal microorganisms, with depletion of the dominant lactobacilli and overgrowth of other types of bacteria. Treatment of this condition using recommended antibiotics is often associated with failure and high rates of recurrence. This has led to the concept of replacing the depleted lactobacilli using probiotics, defined as live microorganisms which, when administered in adequate amounts, confer a beneficial health effect on the host.  

Cochrane Systematic Review

Senok AC et al. Probiotics for treatment of bacterial vaginosis. Cochrane Reviews 2009, Issue 4. Article No. CD6289. DOI: 10.1002/14651858.CD006289.pub2. This review contains 4 studies involving 452 participants.