Insufficient evidence for effectiveness of probiotics for bacterial vaginosis

January 01, 0001

Insufficient evidence for effectiveness of probiotics for bacterial vaginosis

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.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 233, February 2010.
Written by Brian R McAvoy. Published by the Cochrane Primary Care Group

Category: X. Female Genital System, Breast. Keywords: bacterial vaginosis, treatment, probiotics
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 29 June 2010

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Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.