Current Infectious Disease Reports

, Volume 11, Issue 6, pp 471–475

Antibiotic consideration in bacterial vaginosis

Article

Abstract

Bacterial vaginosis (BV) is a syndrome characterized by the loss of indigenous vaginal lactobacilli and massive polymicrobial anaerobic vaginal overgrowth of elusive etiology. Although progress has occurred in defining the composition of the vaginal microbiome using DNA amplifications, rapidly accumulating data have not resulted in therapeutic advantage. Treatment options remain limited and outcome often unsatisfactory, particularly regarding the frequent recurrence of symptomatic disease, leading to enormous frustration among patients and practitioners. This review does not address the important issues of transmission, diagnosis, and complications of BV, but focuses on antimicrobial activity of current drugs and their limitations in vitro and in vivo. Recognizing these limitations should allow for either development of new antibiotics or for innovative use of currently available drugs in new study protocols.

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References and Recommended Reading

  1. 1.
    Sobel JD: Bacterial vaginosis. Annu Rev Med 2000, 51:349–356.CrossRefPubMedGoogle Scholar
  2. 2.
    Koumans EH, Sternberg M, Bruce C, et al.: The prevalence of bacterial vaginosis in the United States, 2001–2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis 2007, 34:864–869.CrossRefPubMedGoogle Scholar
  3. 3.
    Fredricks DN, Fiedler TL, Marrazzo JM: Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med 2005, 353:1899–1911.CrossRefPubMedGoogle Scholar
  4. 4.
    Ferris MJ, Masztal A, Aldridge KE, et al.: Association of Atopobium vaginae, a recently described metronidazole resistant anaerobe, with bacterial vaginosis. BMC Infect Dis 2004, 13:4–5.Google Scholar
  5. 5.
    Verhelst R, Verstraelen H, Claeys G, et al.: Cloning of 16S rRNA genes amplified from normal and disturbed vaginal microflora suggests a strong association between Atopobium vaginae, Gardnerella vaginalis and bacterial vaginosis. BMC Microbiol 2004, 4:16.CrossRefPubMedGoogle Scholar
  6. 6.
    Amsel R, Totten PA, Spiegel CA, et al.: Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983, 74:14–22.CrossRefPubMedGoogle Scholar
  7. 7.
    Piot P, Van Dyck E, Godts P, Vanderheyden J: A placebo-controlled, double-blind comparison of tinidazole and triple sulfonamide cream for the treatment of nonspecific vaginitis. Am J Obstet Gynecol 1983, 147:85–89.PubMedGoogle Scholar
  8. 8.
    Centers for Disease Control and Prevention, Workowski KA, Berman SM: Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006, 55(RR-11):1–94.Google Scholar
  9. 9.
    Oduyebo OO, Anorlu RI, Ogunsola FT: The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women. Cochrane Database Syst Rev 2009, 8:CD006055.Google Scholar
  10. 10.
    Greaves WL, Chungafung J, Morris B, et al.: Clindamycin versus metronidazole in the treatment of bacterial vaginosis. Obstet Gynecol 1988 72:799–802.PubMedGoogle Scholar
  11. 11.
    Bradshaw CS, Morton AN, Hocking J, et al.: High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis 2006, 193:1478–1486.CrossRefPubMedGoogle Scholar
  12. 12.
    Hay P: Recurrent bacterial vaginosis. Curr Infect Dis Rep 2000, 2:506–512.CrossRefPubMedGoogle Scholar
  13. 13.
    Senok A, Verstraebrn H, Temmerman M, Botta G: Probiotics for the treatment of bacterial vaginosis. Cochrane Database Syst Rev 2006, 4:CD006289.Google Scholar
  14. 14.
    Lamp KC, Freeman CD, Klutman NE, Lacy MK: Pharmacokinetics and pharmacodynamics of the nitroimidazole antimicrobials. Clin Pharmacokinet 1999, 36:353–373.CrossRefPubMedGoogle Scholar
  15. 15.
    Davis B, Glover DD, Larsen B: Analysis of metronidazole penetration into vaginal fluid by reversed-phase high-performance liquid chromatography. Am J Obstet Gynecol 1984, 149:802–803.PubMedGoogle Scholar
  16. 16.
    Fredricsson B, Hagström B, Nord CE, Rane A: Systemic concentrations of metronidazole and its main metabolites after intravenous oral and vaginal administration. Gynecol Obstet Invest 1987, 24:200–207.PubMedCrossRefGoogle Scholar
  17. 17.
    Mattila J, Männistö PT, Mäntylä R, et al.: Comparative pharmacokinetics of metronidazole and tinidazole as influenced by administration route. Antimicrob Agents Chemother 1983, 23:721–725.PubMedGoogle Scholar
  18. 18.
    Alper MM, Barwin BN, McLean WM, et al.: Systemic absorption of metronidazole by the vaginal route. Obstet Gynecol 1985, 65:781–784.PubMedGoogle Scholar
  19. 19.
    Manthei RW, Feo LG, Stambaugh JE: Identification of the metabolites of metronidazole in the human vagina. Wiad Parazytol 1969, 15:403–405.PubMedGoogle Scholar
  20. 20.
    Jones BM, Geary I, Alawattegama AB, et al.: In-vitro and in-vivo activity of metronidazole against Gardnerella vaginalis, Bacteroides spp. and Mobiluncus spp. in bacterial vaginosis. J Antimicrob Chemother 1985, 16:189–197.CrossRefPubMedGoogle Scholar
  21. 21.
    Nagaraja P: Antibiotic resistance of Gardnerella vaginalis in recurrent bacterial vaginosis. Indian J Med Microbiol 2008, 26:155–157.CrossRefPubMedGoogle Scholar
  22. 22.
    Easmon CS, Ison CA, Kaye CM, et al.: Pharmacokinetics of metronidazole and its principal metabolites and their activity against Gardnerella vaginalis. Br J Vener Dis 1982, 58:246–249.PubMedGoogle Scholar
  23. 23.
    Onderdonk AB, Louie TJ, Tally FP, Bartlett JG: Activity of metronidazole against Escherichia coli in experimental intra-abdominal sepsis. J Antimicrob Chemother 1979, 5:201–210.CrossRefPubMedGoogle Scholar
  24. 24.
    De Backer E, Verhelst R, Verstraelen H, et al.: Antibiotic susceptibility of Atopobium vaginae. BMC Infect Dis 2006, 6:51.CrossRefPubMedGoogle Scholar
  25. 25.
    De Backer E, Dubreuil L, Brauman M, et al.: In vitro activity of secnidazole against Atopobium vaginae, an anaerobic pathogen involved in bacterial vaginosis. Clin Microbiol Infect 2009 (Epub ahead of print).Google Scholar
  26. 26.
    Swidsinski A, Mendling W, Loening-Baucke V, et al.: Adherent biofilms in bacterial vaginosis. Obstet Gynecol 2005, 106:1013–1023.PubMedGoogle Scholar
  27. 27.
    Bradshaw CS, Tabrizi SN, Fairley CK, et al.: The association of Atopobium vaginae and Gardnerella vaginalis with bacterial vaginosis and recurrence after oral metronidazole therapy. J Infect Dis 2006, 194:828–836.CrossRefPubMedGoogle Scholar
  28. 28.
    Menard JP, Fenollar F, Henry M, et al.: Molecular quantification of Gardnerella vaginalis and Atopobium vaginae loads to predict bacterial vaginosis. Clin Infect Dis 2008, 47:33–43.CrossRefPubMedGoogle Scholar
  29. 29.
    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.CrossRefPubMedGoogle Scholar
  30. 30.
    Beigi RH, Austin MN, Meyn LA, et al.: Antimicrobial resistance associated with the treatment of bacterial vaginosis. Am J Obstet Gynecol 2004, 191:1124–1129.CrossRefPubMedGoogle Scholar
  31. 31.
    Liu CY, Huang YT, Liao CH, et al.: Increasing trends in antimicrobial resistance among clinically important anaerobes and Bacteroides fragilis isolates causing nosocomial infections: emerging resistance to carbapenems. Antimicrob Agents Chemother 2008, 52:3161–3168.CrossRefPubMedGoogle Scholar
  32. 32.
    Theron MM, Janse Van Rensburg MN, Chalkley LJ: Nitroimidazole resistance genes (nimB) in anaerobic Gram-positive cocci (previously Peptostreptococcus spp.). J Antimicrob Chemother 2004, 54:240–242.CrossRefPubMedGoogle Scholar
  33. 33.
    Puapermpoonsiri S, Watanabe K, Kato N, Ueno K: In vitro activities of 10 antimicrobial agents against bacterial vaginosis-associated anaerobic isolates from pregnant Japanese and Thai women. Antimicrob Agents Chemother 1997, 41:2297–2299.PubMedGoogle Scholar
  34. 34.
    Ferris DG, Litaker MS, Woodward L, et al.: Treatment of bacterial vaginosis: a comparison of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream. J Fam Pract 1995, 41:443–449.PubMedGoogle Scholar
  35. 35.
    Sobel JD, Ferris D, Schwebke J, et al.: Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol 2006, 194:1283–1289.CrossRefPubMedGoogle Scholar
  36. 36.
    Reichman O, Akins R, Sobel JD: Boric acid addition to suppressive antimicrobial therapy for recurrent bacterial vaginosis. Sex Transm Dis 2009 (Epub ahead of print).Google Scholar
  37. 37.
    Sanchez S, Garcia PJ, Thomas KK, et al.: Intravaginal metronidazole gel versus metronidazole plus nystatin ovules for bacterial vaginosis: a randomized controlled trial. Am J Obstet Gynecol 2004, 191:1898–1906.CrossRefPubMedGoogle Scholar
  38. 38.
    Jones BM, Geary I, Lee ME, Duerden BI: Comparison of the in vitro activities of fenticonazole, other imidazoles, metronidazole, and tetracycline against organisms associated with bacterial vaginosis and skin infections. Antimicrob Agents Chemother 1989, 33:970–972.PubMedGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.Division of Infectious DiseasesHarper University HospitalDetroitUSA

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