Clinical and cervical cytokine response to treatment with oral or vaginal metronidazole for bacterial vaginosis during pregnancy: A randomized trial

被引:74
作者
Yudin, MH
Landers, DV
Meyn, L
Hillier, SL
机构
[1] Magee Womens Hosp, Dept Obstet Gynecol & Reprod Sci, Pittsburgh, PA 15213 USA
[2] Univ Pittsburgh, Sch Med, Dept Obstet Gynecol & Reprod Sci, Pittsburgh, PA 15213 USA
[3] St Michaels Hosp, Toronto, ON M5B 1W8, Canada
[4] Univ Minnesota, Minneapolis, MN USA
基金
美国国家卫生研究院;
关键词
D O I
10.1016/S0029-7844(03)00566-0
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: To compare the efficacy of oral versus vaginal metronidazole treatment in pregnant women with bacterial vaginosis, and to compare cytokine profiles (interleukin-1beta, -6, and -8) in the cervical secretions of these women before and after treatment. METHODS: Pregnant women with bacterial vaginosis diagnosed both by Gram stain and clinical criteria were randomized to receive oral (n = 52) or vaginal (n = 50) metronidazole therapy. Cervical specimens for cytokine analysis and vaginal fluid for evaluation of bacterial vaginosis were obtained at baseline and 4 weeks after treatment. RESULTS: There was no significant difference in therapeutic cure rates (defined as a Gram stain score of 0-3 and the absence of all four clinical signs of bacterial vaginosis) between the two groups (71% and 70% for the oral and vaginal groups, respectively, P = 1.0). Cervical levels of interleukin-1beta, -6, and -8 were significantly lower after treatment among the 72 women cured of bacterial vaginosis (P < .001, P = .001, and P = .02, respectively) but not among women who failed to respond to therapy. For interleukin-1beta and -6, a significant decrease in cytokine level was observed in both the oral and vaginal treatment groups. CONCLUSION: One week of oral metronidazole and 5 days of intravaginal. metronidazole are equally efficacious for treatment of bacterial vaginosis during pregnancy. The. decrease in cervical interleukin-1beta, -6, and -8 levels among women who established a normal flora after treatment butnot among those with persistent bacterial vaginosis suggests a direct linkage between vaginal flora abnormalities and elevated cervical levels of interleukin-1beta, -6, and -8. (C) 2003 by The American College of Obstetricians and Gynecologists.
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页码:527 / 534
页数:8
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