Living Preparation of Lactobacillus versus Metronidazole for Bacterial Vaginosis in Pregnancy: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHAO Tengfei ,  ZHONG Ling , LUO Dan

Department of Gynecology and Obstetrics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China;

Corresponding author：

ZHONG Ling, Email: zhong9ling@hotmail.com

Keywords：

Living preparation of lactobacillus; Metronidazole; Pregnancy; Bacterial vaginosis; Systematic review

DOI：

10.7507/1672-2531.20100592

Video：

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Objective 　To analyze the effectiveness and effect on pregnant outcome about living preparation of lactobacillus versus metronidazole in the treatment of bacterial vaginosis in pregnancy.
Methods 　We searched PubMed, The Cochrane Library, VIP, CNKI, Wangfang, CBM, FMJS, and FEBMT to identify randomized controlled trials (RCT) of living preparation of lactobacillus versus metronidazole for bacterial vaginosis in pregnancy. The quality of the included trials was assessed. RevMan 5.0.24 software was used for meta-analysis.
Results 　Eight trials involving 1 687 patients were included. The results of meta-analysis showed: no significant difference was found in the effectiveness between the two groups (RR=1.04, 95%CI 1.00 to 1.08, P=0.08); living preparation of lactobacillus had lower recurrence rate and lower premature delivery rate compared with metronidazole (RR=0.16, 95%CI 0.06 to 0.43, P=0.0004; RR=0.56, 95%CI 0.33 to 0.94, P=0.03); no significant differences were found in premature rupture of membrane, puerperal infection, infant of low-birth weight, infant infection, and infant jaundice between the two groups.
Conclusion 　The effectiveness about living preparation of lactobacillus versus metronidazole for bacterial vaginosis in pregnancy is similar, but living preparation of lactobacillus has lower recurrence rate and lower premature delivery rate, the others of effect on pregnant outcome are similar.

Citation： ZHAO Tengfei,ZHONG Ling,LUO Dan. Living Preparation of Lactobacillus versus Metronidazole for Bacterial Vaginosis in Pregnancy: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(11): 1338-1344. doi: 10.7507/1672-2531.20100592 Copy

1.	Guise JM, Mahon SM, Aickin M, et al. Screening for bacterial vaginosis in pregnancy. American Journal of Preventive Medicine, 2001, 20(3 Suppl): 62-72.
2.	McDonald HM, Brocklehurst P, Gordon A. Antibiotics for treating bacterial vaginosis in pregnancy. The Cochrane Library, 2007, 24(1): CD000262.
3.	Darwish A, Elnshar EM, Hamadeh SM, et al. Treatment options for bacterial vaginosis in patients at high risk of preterm labor and premature rupture of membranes. The Journal of Obstetrics and Gynaecology Research, 2007, 33(6): 781.
4.	Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002, MMWR Recomm Rep, 51(RR-6): 1-78.
5.	Mitchell C, Balkus J, Agnew K, et al. Changes in the vaginal microenvironment with metronidazole treatment for bacterial vaginosis in early pregnancy. BJOG, 2009, 116(10): 1315-1324.
6.	Marcone V, Calzolari E, Bertini M, et al. Effectiveness of vaginal administration of Lactobacillus rhamnosus following conventional metronidazole therapy: how to lower the rate of bacterial vaginosis recurrences. New Microbiological, 31(3): 429-433.
7.	马延琴, 康雪萍. 乳酸菌胶囊在治疗妊娠合并细菌性阴道病中的应用. 陕西医学杂志, 2008, 37(2): 253-254.
8.	刘冬梅, 孟瑞雪, 高淑丽, 等. 活性乳酸杆菌制剂治疗妊娠期细菌性阴道病疗效观察及其对妊娠结局的影响. 华中科技大学学报（医学版）, 2006, 35(4): 555-558.
9.	田志红, 黄醒华. 妊娠期细菌性阴道病的研究. 中国妇幼保健, 2007, 22(4): 437-440.
10.	李煜, 冯建文, 刘玲, 等. 乳酸杆菌治疗妊娠合并细菌性阴道病临床观察. 海南医学, 2006, 17(2): 18, 49.
11.	乔丽雅, 田可歌, 宋平, 等. 乳杆菌活菌胶囊治疗妊娠期细菌性阴道病的临床观察. 中国优生与遗传杂志, 2006, 14(9): 27-28.
12.	卫爱民, 叶春萍, 哈宝书, 等. 3种方法治疗妊娠期细菌性阴道病及预防不良妊娠结局的效果比较. 中国妇幼保健, 2008, 23(31): 4445-4446.
13.	张力, 乔丽雅. 定君生胶囊用于妊娠期细菌性阴道病的临床观察. 中国优生与遗传杂志, 2007, 15(9): 77-78.
14.	陈萍英, 刘淮, 陈宁宁, 等. 临床干预对妊娠晚期细菌性阴道病不良妊娠结局的预防效果研究. 中国妇幼保健, 2008, 23(29): 4117-4118.
15.	McGregor JA, French JI. French, CNM, MS. Bacterial vaginosis in pregnancy. Obstetrical and Gynecological Survey, 2000, 55(50) (supplement 1).
16.	曹泽毅, 等. 中华妇产科学临床版. 第1版. 北京: 人民卫生出版社, 2010, 21: 232-233.
17.	Thorsen P, Vogel I, Molsted K, et al. Risk factors for bacterial vaginosis in pregnancy: a population-based study on Danish women. Acta Obstetricia and Gynecologica Scandinavica, 2006, 8(85): 906-911.
18.	Caro-Patón T , Carvajal A, de Diego IM, et al. Is metronidazole teratogenic? A meta-analysis. British Journal of Clinical Pharmacology, 2003, 44(2): 179-182.
19.	Ugwumadu AH, Hay P, et al. Bacterial vaginosis: sequelae and management. Current Opinion in infectious Diseases, 1999, 12(1): 53-59.
20.	Hendler I, Andrews WW, et al. The relationship between resolution of asymptomatic bacterial vaginosis and spontaneous preterm birth in fetal fibronectin-positive women. American Journal of Obstetrics and Gynecology, 2007, 197(5): 488.e1-488.e5.
21.	Camargo RP, Simoes JA, et al. Impact of treatment for bacterial vaginosis on prematurity among Brazilian pregnant women: a retrospective cohort study. Sao Paulo Medical Journal, 2005, 123(3): 108-120.
22.	Shennan A, Crawshaw S, Briley A, et al. A randomized controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET Study. BIOG: An International Journal of Obstetrics and Gynaecology, 2005, 113(1): 65-74.
23.	Carey JC, Klebanoff MA, et al. Is a change in the vaginal flora associated with an increased risk of preterm birth? American Journal of Obstetrics and Gynecology, 2005, 192(4): 1341-1346.
24.	Varma R, Gupta JK, et al. Antibiotic treatment of bacterial vaginosis in pregnancy: multiple meta-analyses and dilemmas in interpretation. Eur J Obstet Gynecol Reprod Biol, 2006, 124(1): 10-14.
25.	Marcone V, Calzolari E, et al. Effectiveness of vaginal administration of Lactobacillus rhamnosus following conventional metronidazole therapy: how to lower the rate of bacterial vaginosis recurrences. New Microbiol, 2008, 31(3): 429-433.
26.	Mastromarino P, Macchia S, et al. Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis. Clinical Microbiology and Infection, 2008, 15(1): 67-74.
27.	Tsvetkov K, Vasileva P, et al. Probiotics in the treatment and prevention of bacterial vaginosis relapses. Akush Ginekol(Sofiia), 2007, 46(2): 41.

1. Guise JM, Mahon SM, Aickin M, et al. Screening for bacterial vaginosis in pregnancy. American Journal of Preventive Medicine, 2001, 20(3 Suppl): 62-72.
2. McDonald HM, Brocklehurst P, Gordon A. Antibiotics for treating bacterial vaginosis in pregnancy. The Cochrane Library, 2007, 24(1): CD000262.
3. Darwish A, Elnshar EM, Hamadeh SM, et al. Treatment options for bacterial vaginosis in patients at high risk of preterm labor and premature rupture of membranes. The Journal of Obstetrics and Gynaecology Research, 2007, 33(6): 781.
4. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002, MMWR Recomm Rep, 51(RR-6): 1-78.
5. Mitchell C, Balkus J, Agnew K, et al. Changes in the vaginal microenvironment with metronidazole treatment for bacterial vaginosis in early pregnancy. BJOG, 2009, 116(10): 1315-1324.
6. Marcone V, Calzolari E, Bertini M, et al. Effectiveness of vaginal administration of Lactobacillus rhamnosus following conventional metronidazole therapy: how to lower the rate of bacterial vaginosis recurrences. New Microbiological, 31(3): 429-433.
7. 马延琴, 康雪萍. 乳酸菌胶囊在治疗妊娠合并细菌性阴道病中的应用. 陕西医学杂志, 2008, 37(2): 253-254.
8. 刘冬梅, 孟瑞雪, 高淑丽, 等. 活性乳酸杆菌制剂治疗妊娠期细菌性阴道病疗效观察及其对妊娠结局的影响. 华中科技大学学报（医学版）, 2006, 35(4): 555-558.
9. 田志红, 黄醒华. 妊娠期细菌性阴道病的研究. 中国妇幼保健, 2007, 22(4): 437-440.
10. 李煜, 冯建文, 刘玲, 等. 乳酸杆菌治疗妊娠合并细菌性阴道病临床观察. 海南医学, 2006, 17(2): 18, 49.
11. 乔丽雅, 田可歌, 宋平, 等. 乳杆菌活菌胶囊治疗妊娠期细菌性阴道病的临床观察. 中国优生与遗传杂志, 2006, 14(9): 27-28.
12. 卫爱民, 叶春萍, 哈宝书, 等. 3种方法治疗妊娠期细菌性阴道病及预防不良妊娠结局的效果比较. 中国妇幼保健, 2008, 23(31): 4445-4446.
13. 张力, 乔丽雅. 定君生胶囊用于妊娠期细菌性阴道病的临床观察. 中国优生与遗传杂志, 2007, 15(9): 77-78.
14. 陈萍英, 刘淮, 陈宁宁, 等. 临床干预对妊娠晚期细菌性阴道病不良妊娠结局的预防效果研究. 中国妇幼保健, 2008, 23(29): 4117-4118.
15. McGregor JA, French JI. French, CNM, MS. Bacterial vaginosis in pregnancy. Obstetrical and Gynecological Survey, 2000, 55(50) (supplement 1).
16. 曹泽毅, 等. 中华妇产科学临床版. 第1版. 北京: 人民卫生出版社, 2010, 21: 232-233.
17. Thorsen P, Vogel I, Molsted K, et al. Risk factors for bacterial vaginosis in pregnancy: a population-based study on Danish women. Acta Obstetricia and Gynecologica Scandinavica, 2006, 8(85): 906-911.
18. Caro-Patón T , Carvajal A, de Diego IM, et al. Is metronidazole teratogenic? A meta-analysis. British Journal of Clinical Pharmacology, 2003, 44(2): 179-182.
19. Ugwumadu AH, Hay P, et al. Bacterial vaginosis: sequelae and management. Current Opinion in infectious Diseases, 1999, 12(1): 53-59.
20. Hendler I, Andrews WW, et al. The relationship between resolution of asymptomatic bacterial vaginosis and spontaneous preterm birth in fetal fibronectin-positive women. American Journal of Obstetrics and Gynecology, 2007, 197(5): 488.e1-488.e5.
21. Camargo RP, Simoes JA, et al. Impact of treatment for bacterial vaginosis on prematurity among Brazilian pregnant women: a retrospective cohort study. Sao Paulo Medical Journal, 2005, 123(3): 108-120.
22. Shennan A, Crawshaw S, Briley A, et al. A randomized controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET Study. BIOG: An International Journal of Obstetrics and Gynaecology, 2005, 113(1): 65-74.
23. Carey JC, Klebanoff MA, et al. Is a change in the vaginal flora associated with an increased risk of preterm birth? American Journal of Obstetrics and Gynecology, 2005, 192(4): 1341-1346.
24. Varma R, Gupta JK, et al. Antibiotic treatment of bacterial vaginosis in pregnancy: multiple meta-analyses and dilemmas in interpretation. Eur J Obstet Gynecol Reprod Biol, 2006, 124(1): 10-14.
25. Marcone V, Calzolari E, et al. Effectiveness of vaginal administration of Lactobacillus rhamnosus following conventional metronidazole therapy: how to lower the rate of bacterial vaginosis recurrences. New Microbiol, 2008, 31(3): 429-433.
26. Mastromarino P, Macchia S, et al. Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis. Clinical Microbiology and Infection, 2008, 15(1): 67-74.
27. Tsvetkov K, Vasileva P, et al. Probiotics in the treatment and prevention of bacterial vaginosis relapses. Akush Ginekol(Sofiia), 2007, 46(2): 41.

Chinese Journal of Evidence-Based Medicine

Living Preparation of Lactobacillus versus Metronidazole for Bacterial Vaginosis in Pregnancy: A Systematic Review

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