Efficacy of metronidazole and lactobacillus in the treatment of bacterial vaginosis- A comparative study

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Author Details : Bhaskara Narayana*

Volume : 5, Issue : 1, Year : 2019

Article Page : 16-19

https://doi.org/10.18231/2581-4729.2019.0004

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Abstract

Abstract

Introduction: Bacterial vaginosis (BV) is a well-known lower reproductive tract disorder occurred due to the replacement of normal vaginal flora such as lactobacillus species with another anaerobic microbial flora. Metronidazole is the primary therapeutic choice with 70% recovery rate.

Aim: To assess the efficacy of Metronidazole and lactobacillus in the management of bacterial vaginosis.

Materials and Methods: A total 140 cases diagnosed with bacterial vaginosis, following Nugent’s scoring system and Amsel’s criteria were recruited. Based on the drug administered, cases were divided in to 2 groups i.e. group 1 medicated with lactobacillus 1 bd capsule for one month then 1 od for preceding month and group 2 medicated orally with metronidazole 400mg bd for one week.

Results: Vaginal pH was recorded <5> 5.5 in 22 cases. Saline mount examination showed clue cells in 88.5% cases, complete absence of clue cells in 7.8% cases and clue cells in combination with pus cells in 3.5% cases. Positive whiff-amine test was observed in 95.7% cases.

Conclusion: Comparison based on Amsel criteria showed good therapeutic benefits was noted at the end of 1^st week, 1^st month. At the end of 3^rd month and 6^th month benefits were gradually decreased. Comparison by Nugent’s scoring system showed good response rate was gradually decreased at the end of 1^st week, 1^st month and 3^rd month in both the study groups. Whereas at the end of 6^th month, therapeutic response was gradually decreased in both groups. Recurrence was seen in 8.5% cases of group 1 at the end of 6^th month, no recurrence was seen in group2.

Keywords: Bacterial vaginosis (BV), Metronidazole, Lactobacillus, Amsel criteria, Nugent’s scoring system.

Introduction

Table 1: Obstetric history of the participants in both groups.

Table 3: Values of Amsel’s criteria among two study groups.

Discussion

Bacterial vaginosis is a common cause of vaginal discharge in reproductive age women. BV is associated with the loss of the lactobacilli colonies with a subsequent overgrowth of anaerobic polymicrobials consisting of anaerobes and Gardnerella vaginalis, and an increase in the vaginal pH over 4.5 within the vaginal lumen. The present study was designed to assess the management of bacterial vaginosis with metronidazole and lactobacillus. A total 140 cases between age group 21-50 years with mean age of 34.1 years were included. Morris et al, in his study stated that incidence of bacterial vaginosis is more in sexually active reproductive age people.^[10] Among the total cases, 98 cases had complaint of genital discharge, 24 cases had complaints of genital itching, 5 cases had complaint of severe genital odour and 13 cases did not specified any complaints.

Vaginal discharge with a drop of 10% KOH produced rotten fishy odour which is positive whiff-amine test was observed in 95.7% cases (Table 2). Amines like putrescine and cadaverine composed in the secretion of bacterial vaginosis leads to the rotten fishy odor and decreases candida albicans existence.^[11] Vaginal pH was recorded <5> 5.5 in 22 cases. pH>4.5 in bacterial vaginosis is considered as abnormal.^[7] Saline mount examination showed clue cells in 88.5% cases, complete absence of clue cells in 7.8% cases and clue cells in combination with pus cells in 3.5% cases.

Efficacy of medication was assessed based on Amsel’s criteria and Nugent’s scoring system and was observed at the end of 1^st week, 1^st month, 3^rd month and 6^th month of after treatment. In this study, the comparison based on Amsel’s criteria observed therapeutic benefits at the end of 1^st week and 1^st month, but at end of 3^rd month slight difference between the response group 1 (87.1%) and group 2 (98.5%). Whereas at the end of 6^th month observed much difference between both groups i.e. group 1 showed good response in 77.1% cases and group 2 showed good response in all 100% cases (Table 3). Results of Selvaraj N et al., showed results were compatible between both groups at end of 1^st week, 1^st, 2^nd month whereas at 6^th months metronidazole group showed good response in 76.2% cases and Lactobacillus group showed good response in 94% cases.^[12]        

Therapeutic effect assessment based on Nugent’s scoring system between both groups showed that in
group 1, at the end of 1^st week (51.4%), 1^st month (67.1%) high response rate was gradually increased thereafter response rate was gradually decreased at the end of 3^rd month (44.2%) and 6^th month (25.7%). In group 2, at the end of 1^st week (72.8%), 1^st month (81.4%) and 3^rd month
(92.8%) high response rate was gradually increased thereafter response rate was slightly decreased at the end of

and 6^th month (85.7%) (Table 4). The results of this study was compatible with the study of Selvaraj N et al.^[12]

Study by Kingsley C et al., stated that at the end of 1^st month good response was seen in 90% cases of lactobacillus group and in 55 % cases of metronidazole group.^[13] Study by Reid G et al., on comparison between lactobacillus and placebo found reappearance of lactobacillus colonies in 37% lactobacillus group cases and 13% in placebo group cases.^[14] Nausea and fatty changes in the liver was observed in few cases.

Conclusion

The results of this study concludes that, Metronidazole is effective in the management of bacterial vaginosis than lactobacillus. The comparison based on Amsel criteria observed therapeutic benefits at the end of 1^st week and 1^st month, while at end of 3^rd month slight difference was observed between group 1 (87.1%) and group 2 (98.5%). Whereas at the end of 6^th month, good response was seen in 77.1% of group 1 cases and 100% of group 2 cases. Comparison by Nugent’s scoring system showed good response rate was gradually decreased at the end of 1^st week, 1^st month and 3^rd month in both the study groups. Whereas at the end of 6^th month, therapeutic response was gradually decreased in both groups. Recurrence was seen in 8.5% cases of group 1 at the end of 6^th month, no recurrence was seen in group 2. Further studies are required to assess efficacy of study drugs on fungal isolates and with more sample size.

Conflicts of Interest: None.

References

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How to cite : Narayana B, Efficacy of metronidazole and lactobacillus in the treatment of bacterial vaginosis- A comparative study. IP Indian J Clin Exp Dermatol 2019;5(1):16-19

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