Antiseptics and disinfectants for the treatment of bacterial vaginosis: A systematic review

BMC Infectious Diseases

Marleen Temmerman¹  Kristien Roelens²  Rita Verhelst¹  Hans Verstraelen² 

[1] International Centre or Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium;Department of Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, B-9000, Ghent, Belgium

关键词: Hydrogen peroxide;    Polyhexamethylene biguanide;    Chlorhexidine;    Systematic review;    Therapy;    Disinfectants;    Antiseptics;    Bacterial vaginosis;   

Others  :  1175343
DOI  :  10.1186/1471-2334-12-148

 received in 2011-12-15, accepted in 2012-05-25,  发布年份 2012

【 摘 要 】

Background

The study objective was to assess the available data on efficacy and tolerability of antiseptics and disinfectants in treating bacterial vaginosis (BV).

Methods

A systematic search was conducted by consulting PubMed (1966-2010), CINAHL (1982-2010), IPA (1970-2010), and the Cochrane CENTRAL databases. Clinical trials were searched for by the generic names of all antiseptics and disinfectants listed in the Anatomical Therapeutic Chemical (ATC) Classification System under the code D08A. Clinical trials were considered eligible if the efficacy of antiseptics and disinfectants in the treatment of BV was assessed in comparison to placebo or standard antibiotic treatment with metronidazole or clindamycin and if diagnosis of BV relied on standard criteria such as Amsel’s and Nugent’s criteria.

Results

A total of 262 articles were found, of which 15 reports on clinical trials were assessed. Of these, four randomised controlled trials (RCTs) were withheld from analysis. Reasons for exclusion were primarily the lack of standard criteria to diagnose BV or to assess cure, and control treatment not involving placebo or standard antibiotic treatment. Risk of bias for the included studies was assessed with the Cochrane Collaboration’s tool for assessing risk of bias. Three studies showed non-inferiority of chlorhexidine and polyhexamethylene biguanide compared to metronidazole or clindamycin. One RCT found that a single vaginal douche with hydrogen peroxide was slightly, though significantly less effective than a single oral dose of metronidazole.

Conclusion

The use of antiseptics and disinfectants for the treatment of BV has been poorly studied and most studies are somehow methodologically flawed. There is insufficient evidence at present to advocate the use of these agents, although some studies suggest that some antiseptics may have equal efficacy compared to clindamycin or metronidazole. Further study is warranted with special regard to the long-term efficacy and safety of antiseptics and disinfectants for vaginal use.

【 授权许可】

   
2012 Verstraelen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Nyirjesy P: Vulvovaginal candidiasis and bacterial vaginosis. Infect Dis Clin North Am 2008, 22:637-652.
• [2]Koumans EH, Kendrick JS, CDC Bacterial vaginosis Working Group: Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda. Sex Transm Dis 2001, 28:292-297.
• [3]Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC): Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010, 59:1-110.
• [4]Verstraelen H, Verhelst R: Bacterial vaginosis: an update on diagnosis and treatment. Expert Rev Anti Infect Ther 2009, 7:1109-1124.
• [5]Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, et al.: Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983, 74:14-22.
• [6]Nugent RP, Krohn MA, Hillier SL: Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991, 29:297-301.
• [7]Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, et al.: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009, 339:b2700.
• [8]Julian PT Higgins, Sally Green (Eds): Cochrane Handbook for Systematic Reviews of Interventions. , ; . Available: http://www.cochrane-handbook.org/ webcite. Accessed 10 September 2011
• [9]van der Meijden WI, Piot P, Schmitz PI, Stolz E: Treatment of clue cell-positive discharge with 200 mg povidone-iodine pessaries. A double-blind and placebo-controlled trial. Eur J Obstet Gynecol Reprod Biol 1987, 24:299-307.
• [10]Hay PE, Uthayakumar S, Peddie H, Lister P: A double-blind placebo-controlled trial of topical benzydamine douche twice a day in patients with bacterial vaginosis. Int J STD AIDS 1997, 8(Suppl 1):42.
• [11]Ventolini G, Villa I, Guerra A: A controlled clinical study on the efficacy of benzydamine in the topical treatment of non-specific cervicitis and vaginitis. Int J Tissue React 1987, 9:157-167.
• [12]Ison CA, Taylor RFH, Link C, Buckett P, Harris JRW, et al.: Local treatment for bacterial vaginosis. Br Med J (Clin Res Ed) 1987, 295:886.
• [13]Molteni B, D'Antuono A, Bandini P, Sintini G, Barcellona E, et al.: Efficacy and tolerability of a new chlorhexidine-based vaginal gel in vaginal infections. Curr Med Res Opin 2004, 20:849-853.
• [14]Petersen EE, Weissenbacher ER, Hengst P, Spitzbart H, Weise W, et al.: Local treatment of vaginal infections of varying etiology with dequalinium chloride or povidone iodine. A randomised, double-blind, active-controlled, multicentric clinical study. Arzneimittelforschung 2002, 52:706-715.
• [15]Winceslaus SJ, Calver G: Recurrent bacterial vaginosis–an old approach to a new problem. Int J STD AIDS 1996, 7:284-287.
• [16]Cardone A, Zarcone R, Borrelli A, Di Cunzolo A, Russo A, et al.: Utilisation of hydrogen peroxide in the treatment of recurrent bacterial vaginosis. Minerva Ginecol 2003, 55:483-492.
• [17]Chaithongwongwatthana S, Limpongsanurak S, Sitthi-Amorn C: Single hydrogen peroxide vaginal douching versus single-dose oral metronidazole for the treatment of bacterial vaginosis: a randomised controlled trial. J Med Assoc Thai 2003, 86:S379-S384.
• [18]Novakov Mikic A, Budakov D: Comparison of local metronidazole and a local antiseptic in the treatment of bacterial vaginosis. Arch Gynecol Obstet 2010, 282:43-47.
• [19]Gerli S, Rossetti D, Di Renzo GC: A new approach for the treatment of bacterial vaginosis: use of polyhexamethylene biguanide. A prospective, randomised study. Eur Rev Med Pharmacol Sci 2003, 7:127-130.
• [20]Minozzi M, Gerli S, Di Renzo GC, Papaleo E, Ferrari A: The efficacy and safety of a single dose of polyhexamethylene biguanide gynaecologic solution versus a seven-dose regimen of vaginal clindamycin cream in patients with bacterial vaginosis. Eur Rev Med Pharmacol Sci 2008, 12:59-65.
• [21]Yu H, Tak-Yin M: The efficacy of povidone-iodine pessaries in a short, low-dose treatment regime on candidal, trichomonal and non-specific vaginitis. Postgrad Med J 1993, 69:S58-S61.
• [22]Wewalka G, Stary A, Bosse B, Duerr HE, Reimer K: Efficacy of povidone-iodine vaginal suppositories in the treatment of bacterial vaginosis. Dermatology 2002, 204:79-85.
• [23]Dattani IM, Gerken A, Evans BA: Aetiology and management of non-specific vaginitis. Br J Vener Dis 1982, 58:32-35.
• [24]Beigi RH, Austin MN, Meyn LA, Krohn MA, Hillier SL: Antimicrobial resistance associated with the treatment of bacterial vaginosis. Am J Obstet Gynecol 2004, 191:1124-1129.
• [25]Austin MN, Beigi RH, Meyn LA, Hillier SL: Microbiologic response to treatment of bacterial vaginosis with topical clindamycin or metronidazole. J Clin Microbiol 2005, 43:4492-4497.