Comparing the efficacy of probiotic plus antibiotic with the Antibiotic Therapy alone on the recurrence of Bacterial Vaginosis

Objective: To compare the efficacy of a probiotic plus antibiotic with antibiotic therapy alone for the prevention of the recurrence of bacterial vaginosis. Method: A Randomized control trial was conducted in the Gynecological Department of Nishtar Hospital, Multan, between July 2022 and June 2023. One hundred and twenty (N=120) women with bacterial vaginosis, all cured with metronidazole, were enrolled and randomized. In Group-A, Probiotics were administered once a day for 14 days following antibiotic treatment (Tab Metronidazole 400mg, three times a day for seven days). In Group-B, only oral antibiotics were given. The patients were followed up in four visits for five months for bacterial vaginosis recurrence (responders, partial responders, non-responders, and drop-outs) using Amsel criteria by vaginal swabs. All the data was collected on a structured Performa. Results: The mean age of enrolled 120 women was 32.28 +/- 2.58, and 111(92.5%) were married. Of 120 enrolled women, 8 (6.7%) were dropped out. Evaluating the recurrence rate, the probiotic group (n=57) had fewer recurrences than the placebo (n=55) (8.9% vs 21.4%, p-value <0.05). Group-A had a better responder rate at five months of follow-up than the placebo group (39.2% vs. 25.8%) (RR 0.31, 95%CI: 0.1450-0.7998, p-Value <0.05). Comparing the effect of probiotics on the components of the Amsel criteria, only vaginal discharge had a statistically significant reduction by using probiotics plus antibiotics (p-value <= 0.05). Conclusion: This trial showed that probiotics plus antibiotics significantly reduced bacterial vaginosis recurrences than antibiotics alone.