Long-term vaginal administration of Lactobacillus rhamnosus as a complementary approach to management of bacterial vaginosis

Objective: To investigate the advantages of long-term vaginal administration of Lactobacillus rhamnosus after oral treatment with metronidazole to prevent the recurrence of bacterial vaginosis (BV). Methods: A total of 49 women with a diagnosis of BV were randomized into 2 groups. Group A was treated with a twice daily dose of 500 mg oral metronidazole for 7 days. Group B was treated with the same schedule followed by a once-weekly vaginal application of 40 mg of Lactobacillus rhamnosus for 6 months. A non-parametric analysis of variance for repeated measures was used to test whether there were significant changes in the vaginal ecosystems in the 2 groups. Results: During the first 6 months of follow-up, a constant percentage (96%) of patients in group B had a balanced vaginal ecosystem. Follow-up over 12 months showed no statistically significant difference among vaginal ecosystems in patients in group B (P=0.40), whereas in group A there was a significant increase in the number of women with abnormal flora over time (P=0.01). Conclusion: The vaginal administration of the probiotic Lactobacillus rhamnosus allows stabilization of the vaginal ecosystem and reduces the recurrence of BV. (C) 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.