Comparison of the efficacy of metronidazole and metronidazole plus probiotics capsule in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary hospital: A single blind randomized controlled trial / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginitis. In the Philippines, prevalence of BV is at 28.16%. The mainstay for the treatment of BV is Metronidazole. Although antibiotic therapy has been shown to eliminate BV associated organisms, there is extremely high recurrence rate.OBJECTIVE: To compare the efficacy of metronidazole and metronidazole plus lactobacilli tablet in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary medical center.METHODOLOGY: The population included non-pregnant women ages 15 t0 44 years old, with bacterial vaginosis diagnosed by Amsel's criteria and Nugent's scoring. The participants were randomly assigned to their treatment group, one is Metronidazole only and other received Metronidazole plus Lactobacillus tablet. All participants followed up on day 8,15,22 and 56 from initiation of treatment resolution or persistence of symptoms and collection of vaginal specimen for gram stain and inquire on adverse effects.RESULTS: On day 8 treatment, there were significantly more participant in the metronidazole plus probiotic arm with an estimated lactobacilli count of more than 30/hpf as comapred to metronidazole alone. On day 15 post treatment, there was no statistically significant difference with the estimated Gardnerella vaginalis count, lactobacilli count, presence or absence of malodorous vaginal discharge between the metronidazole plus probiotic and the metronidazole alone arm. With metronidazole plus probiotic group, the proportion of women with less than 30 per hpf Gardnella vaginalis count and absent foul smelling vaginal discharge were accounted among 100% of the participants from day 8 to 56 post treatment. The early reduction in the causative agent and symptoms can be attributed to an increase in the estimated lactobacilli count sustained until 56 days post treatment metronidazole plus probiotic. However, from day 15 to 22 and 56 post- treatment, the proportion of participants who had a nugent's score of less than 4 were greater for both the metronidazole plus probiotic (100%) and metronidazole alone (95%) arm, when compared to day 8 post-treatment. This finding for the metronidazole plus probiotic group is due to sustained reduction in the Gardnella vaginalis count and increase in lactobacilli counts. Potentially , the metronidazole plus probiotic treatment was found to be more favorable in sustaining the normal flora and probiotic can be used as an adjunct may enhance the efficacy of metronidazole in the treatment of BV.CONCLUSION: Metronidazole plus probiotic and metronidazole only treatment are comparable in treating bacterial vaginosis. In terms of restoring and maintaining the normal flora, metronidazole plus probiotic appears to be more significantly efficacious. Probiotic in the form of lactobacilli is a promising adjunct to enhance the efficacy of metronidazole in the treatment of bacterial vaginosis.

Comparison of the operative and post operative outcome between episiorrhaphy with and without application of policresulen solution / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Episiotomy is a surgical incision of the perineum performed to widen the vaginal opening to facilitate the delivery of an infant. Bleeding is its common complication. A certain technique must be followed so as not to incur either dyspareunia, dehiscence or infection. Hence the application of policresulen solution during repair may minimize bleeding and facilitate better wound healing. OBJECTIVE: To compare the operative and post-operative outcome between episiorraphy with and without application of policresulen solution during repair among puerperal patients admitted in a tertiary hospital. METHODOLOGY: One hundred participants were randomized to two treatment groups. Those assigned to treatment A (n=50) underwent episiorrhaphy with policresulen solution application while those in treatment B (n=50) served as the control group. The main outcome measures were estimated blood loss, operative time and duration of wound healing. RESULTS: There was a significantly shorter mean operative time with the participants in the Policresulen group (20.92 ± 0.90 minutes) as compared to the Control group (53.8 ± 1.79 minutes) with a P-value of CONCLUSION: Policresulen solution application has a good hemostatic effect on the episiotomy wound hence shortened the operative time. It also has a good wound healing effect reflected by a shortened duration of wound healing of the episiotomy wound.

Efficacy of dequalinium vaginal suppository in the treatment of bacterial vaginosis compared with standard Metronidazole oral regimen: A randomized controlled trial / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: The standard treatment for bacterial vaginosis is metronidazole. Side effects are not well tolerated by some patients and some develop resistance. Hence, the search for treatment with less side effects and less resistance. OBJECTIVES: To determine the efficacy of vaginal dequalinium chloride compared to oral metronidazole in the treatment of bacterial vaginosis among non; pregnant women. METHOD: Fourty non-pregnant women and non lactating women, 18-50 years old diagnosed with bacterial vaginosis by presence of vaginal discharge and malodor, Nugent's score of 4 and above, and clue cells seen in Gram stain, were randomly allocated to treatment groups. Group A received dequalinium chloride 10mg/vaginal tablet for 6 days at HS while Group B received metronidazole tablet, 500mg/tablet, 1 tablet per orem BID for 7 days. Microbiologic, clinical and complete cure rate as well as adverse effects of treatment were then assessed. Data entry and encoding was done using Epi info version 6. Analysis was done using stata version 9. Univariate analysis such as mean, median, mode and range were used to describe the characteristics of the subjects. Frequency distribution was used to describe the proportion of patients with microbiologic, clinical and complete cure. This was also used in describing proportion of the participants' acceptability in this study. Chi square was used for comparison of dequalinium chloride and metronidazole between treatment-arms. RESULTS: Ninety five percent (19/20) of those in the dequalinium arm had gram-negative coccobacilli count of less than 10/hpf as compared to 80% (16/20) among those in the control (P < 0.30). Lactobacilli was only restored among 25% of those in the metronidazole and in 75% of the control group (P = 0.002). Reduced amount of discharge was observed in all paricipants in both groups. Malodor of the discharge disappeared in 95% (19/20) of the H2O2 and 85% (17/20) of the control group (P=0.30). CONCLUSION: Dequalinium is comparable with the standard treatment. It is at par with the standard treatment in alleviating symptoms of bacterial vaginosis and reducing estimated coccobacilli. It is more effacious in restoring the normal flora.