[Probiotic monotherapy of bacterial vaginosis: a open, randomized trial].

UNLABELLED: The aim of the current research is to establish the clinical and microbiological efficacy of the therapy with local probiotics in the treatment of anaerobic vaginal infections and the therapy's effect upon vaginal flora. STUDY DESIGN/METHODS: 381 (100%) women with bacterial vaginitis are included in the research. They were randomized into three groups. In the first group 143 women who were treated with local (10 applications) probiotics vaginal medicine, containing live lactobacillus types Lactobacillus acidophilus, Lactobacillus rhamnosus. In the second group 126 patients were treated with five days oral administration of Clindamycin (tabl.x 600 mg) BID and local therapy of two vaginal ovules containing each 1000 mg Metronidazole, which were administered intravaginal every other day. In the third group 112 women were treated with the same therapy as the second group and in addition started from the day 5 after it were administered locally probiotic medicine containing Lactobacillus acidophilus u Lactobacillus rhamnosus. The efficacy of the therapeutic scheme was evaluated via comparison of patients' clinical complains in the different groups, of data from clinical examinations (Amsel) and microbiological tests (Nugent) for each patient. RESULTS: Thirty five-forty days after the probiotic therapy, the clinical efficacy in this group (Amsel) is 42.7% and microbiological efficacy (Gram preparation - Nugent)--41.3%. They are lower than the results which we received in the groups where the combine nitroimidazole/incozamide treatment was performed with or without local probiotic. The second group: clinical efficacy--51.6%, microbiological (Nugent)--46.4%. The highest clinical--87.5% and microbiological--80.3% efficacy showed the combine nitroimidazole/lincozamide/probiotic treatment in the third group. CONCLUSIONS: Our results show that the local monotherapy with probiotics has fewer efficacies in comparison to the combine therapeutic schemes for treatment of vaginal disbacteriosis with dominant anaerobic species.

[Effect of Lactobacillus casei var rhamnosus (Gynophilus) in restoring the vaginal flora by female patients with bacterial vaginosis--randomized, open clinical trial].

UNLABELLED: The vaginal probiotics can increase the clinical and microbiological efficacy of the therapeutic regimens used for the treatment of bacterial vaginosis. The Aim of our study was to evaluate the effect of the application of Lactobacillus casei var rhamnosus (Gynophilus--probiotic species Lcr 35) in restoring the vaginal flora and prevention of relapses by female patients with anaerobic vaginal infection undergoing conventional (nitroimidazole) local and main therapy. METHODS: In the study were included 60 women with established Amsel/Nugent bacterial vaginosis who were randomized in two groups. The first group patients (n-30 beginning/n-25 controls) underwent a 5 day treatment with two daily peroral doses of metronidazole 500 mg, with local application of metronidazole ovules 1000 mg at the 1st and the 3rd day (M+M). In the second group (n-30 beginning/n-26 controls) the therapeutic regimen was the same as in the first group, with additional 7 day treatment with Lactobacillus casei var rhamnosus - Lcr 35. (Gynophilus) vaginal ovules, two daily doses (M+M+G). RESULTS: 30% to 40% was the difference/enhance of the clinical efficacy according to the clinical indicators when Lactobacillus casei var rhamnosus - Lcr 35 was added to the standard nitroimidazole therapy. Concerning the main clinical indicator: Amsel criteria, the improvement after the therapy in the first group (M+M) was 60% (n-15) and in the second group (M+M+G) 88.5% (n-23). According to the microbiological indicators the improvement in the first group (M+M) based on the vaginal flora evaluation (Nugent score) was 60% (n-15) and in the second group, after the addition of Lcr 35 it was 88.5% (n-23). CONCLUSIONS: The application of Gynophilus after conventional 5-nitroimidazole treatment for bacterial vaginosis increased the clinical and microbiological efficacy of the therapy by 25% - 30%. The microbial balance in the vaginal ecosystem was restored in the majority of patients (88%), which is a prerequisite for low percentage of bacterial vaginosis relapses.