Probiotics for the Treatment of Bacterial Vaginosis: A Meta-Analysis

Ziyue Wang, Yining He, Yingjie Zheng, Ziyue Wang, Yining He, Yingjie Zheng

Abstract

Background: The effect of probiotic therapy on bacterial vaginosis (BV) is controversial. We conducted a meta-analysis of the efficacy and safety associated with probiotic treatment for BV.

Methods: We searched multiple databases covering up to 1 March 2018. Studies published as blinded randomized controlled trials (RCTs), comparing treatment using probiotic versus active or placebo control in BV patients were included, with at least one-month follow-up. Random effects model and trial sequential analysis (TSA) were applied.

Results: Ten studies (n = 2321) were included. Compared with placebo, the probiotics-only therapy resulted in a beneficial outcome both in clinical cure rate at the 30th day (risk ratio, RR = 2.57; 95% confidential interval, 95% CI: 1.96 to 3.37), and Nugent score (mean difference, MD = -2.71; 95% CI: 3.41 to -2.00). This effect decreased but remained significant after eight weeks. Probiotics-post-antibiotics therapy had a decreased effect only for a short term and possibly among studies with a mostly black study population. No extra adverse events were observed. The TSA suggested a larger sample size for effective evaluation of the probiotics as a supplementary remedy.

Conclusions: Probiotic regimes are safe and may exhibit a short-term and long-term beneficial effect for BV treatment. The ethnic-specific result for the probiotic used after antibiotics is worthy of further study.

Keywords: bacterial vaginosis; meta-analysis; probiotic therapy.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow diagram. Abbreviations: RCTs = randomized controlled trials; BV = bacterial vaginosis.
Figure 2
Figure 2
Forest plot: the efficacy of probiotics vs. placebo for BV after a normal menstrual cycle (around the 30th day after intervention, divided by ethnic groups). Abbreviations: APT = antibiotic + probiotic treatment; POT = probiotic only treatment; NA = no data available.
Figure 3
Figure 3
Forest plot: Nugent scores of probiotics vs. placebo for BV after a normal menstrual cycle (around the 30th day after intervention, divided by ethnic groups). Abbreviations: APT = antibiotic + probiotic treatment; POT = probiotic only treatment; NA = no data available.

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