Stepped therapy of vaginal dysbiosis: mosaic of evidences

И. В. Лахно, О. В. Грищенко

Abstract


Bacterial vaginosis is the most common cause of pathological discharges in women of reproductive age. The known coexistence of Garnerella vaginalis, Atopobium vaginae and anaerobic microorganisms in biofilms reduces the bioavailability of the antibacterial drugs.

The aim of the work was to study the efficacy of stepped prescription of hexicon and livarol in patients with bacterial vaginosis . There were examined 125 women of reproductive age. In group I, under the supervision were 30 healthy women. In group II, 47 patients were examined with bacterial vaginosis, whom was administered metronidazole vaginal suppositories 1 suppository daily for 7 days and fluconazole 150 mg once. In group III, 48 women with bacterial vaginosis used stepped approach to the treatment by intravaginal hexicon 1 suppository twice a day for 5 days and then livarol 1 suppository once daily for 5 days.

The number of episodes of itching and burning sensation in the vagina in patients of group II for 2–5 days of vaginal sanitation were 7.1 ± 1.4 while in group III – 19.8 ± 6.7 (p < 0.05). It can be assumed that the appearance of clinical and laboratory signs of acute inflammation in women of group III was associated with an effective impact of hexicon on Gardnerella vaginalis and anaerobes. Apparently, the biofilm removal in this group was accompanied by the restoration of immune protection at the level of the vaginal mucosa. After 1 month the total recovery was observed in 76.6% of patients in group II and 95.9% of women in group III. The recurrence rate

in the 12 months of observation in group II was 31.9% and in group III – only 6.25%. Odds ratio of the recurrence of bacterial vaginosis in case of traditional treatment were 13.6 and in case of stepped approach – 1.9.

Stepped therapy of patients with bacterial vaginosis with vaginal suppositories hexicon and livarol increased the efficacy of the conventional treatment and reduced the rate of recurrence.


Keywords


bacterial vaginosis; stepped treatment; hexicon; livarol

References


Bertran, Th., Brachet, P., Vareille-Delarbre, M., et al. “Slight Pro-Inflammatory Immunomodulation Properties of Dendritic Cells by Gardnerella vaginalis: The “Invisible Man” of Bacterial Vaginosis?” Journal of Immunology Research Volume 2016 (2016). DOI: http://dx.doi.org/10.1155/2016/9747480

Machado, D., Castro, J., Palmeira-de-Oliveira A., et al. “Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions.” Front Microbiol (2016). DOI: http://dx.doi.org/10.3389/fmicb.2015.01528

Bradshaw, С.S., Tabrizi, S.N., Fairley, С.К., et al. “The association of Atopobium vaginae and Gardnerella vaginalis with bacterial vaginosis and recurrence after oral metronidazole therapy.” The Journal of infectious diseases 194.6 (2006): 828–36.

Shaaban, O.M., Youssef, A.E., Khodry, M.M., et al. “Vaginal douching by women with vulvovaginitis and relation to reproductive health hazards.” BMC Women’s Health 13 (2013): 231–6.

Sherrard, J., Donders, G., White, D., et al. “European (IUSTI/WH) guideline on the management of vaginal discharge.” Int J STD AIDS 22.8 (2011): 421–9.

Sivaranjini, R., Jaisankar, T., Thappa, D.M., et al. “Spectrum of vaginal discharge in a tertiary care setting.” Trop Parasitol 3 (2013): 135–9.

Tokmak, A., Özer, I., Erkilinc, S., et al. “Vaginal washing fluid C-reactive protein levels in women with recurrent or treatment resistant vaginitis.” Journal of Clinical and Experimental Investigations 6.1 (2015): 5–9.


GOST Style Citations


1. Bertran, Th., Brachet, P., Vareille-Delarbre, M., et al. “Slight Pro-Inflammatory Immunomodulation Properties of Dendritic Cells by Gardnerella vaginalis: The “Invisible Man” of Bacterial Vaginosis?” Journal of Immunology Research Volume 2016 (2016). DOI: http://dx.doi.org/10.1155/2016/9747480

2. Machado, D., Castro, J., Palmeira-de-Oliveira A., et al. “Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions.” Front Microbiol (2016). DOI: http://dx.doi.org/10.3389/fmicb.2015.01528

3. Bradshaw, С.S., Tabrizi, S.N., Fairley, С.К., et al. “The association of Atopobium vaginae and Gardnerella vaginalis with bacterial vaginosis and recurrence after oral metronidazole therapy.” The Journal of infectious diseases 194.6 (2006): 828–36.

4. Shaaban, O.M., Youssef, A.E., Khodry, M.M., et al. “Vaginal douching by women with vulvovaginitis and relation to reproductive health hazards.” BMC Women’s Health 13 (2013): 231–6.

5. Sherrard, J., Donders, G., White, D., et al. “European (IUSTI/WH) guideline on the management of vaginal discharge.” Int J STD AIDS 22.8 (2011): 421–9.

6. Sivaranjini, R., Jaisankar, T., Thappa, D.M., et al. “Spectrum of vaginal discharge in a tertiary care setting.” Trop Parasitol 3 (2013): 135–9.

7. Tokmak, A., Özer, I., Erkilinc, S., et al. “Vaginal washing fluid C-reactive protein levels in women with recurrent or treatment resistant vaginitis.” Journal of Clinical and Experimental Investigations 6.1 (2015): 5–9.





DOI: http://dx.doi.org/10.18370/2309-4117.2016.28.58-59

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ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)