Antibiotics or Antiseptics: What to Choose for the Treatment of Bacterial Vaginosis?

BACKGROUND: Bacterial vaginosis is an imbalance of the vaginal microbiome that is characterized by a decrease in lactobacilli and an overgrowth of opportunistic anaerobic bacteria. Given the high prevalence of bacterial vaginosis and the problem of antibiotic resistance, there is a need to develop new treatment methods and optimize the use of existing drugs. AIM: The aim of this study was to evaluate the efficacy and tolerability of the sequential use of lactic acid with clindamycin or dequalinium chloride in the treatment of bacterial vaginosis in women of reproductive age. METHODS: This study involved 127 women aged 18 to 45 years and diagnosed with bacterial vaginosis based on the Amsel criteria. The patients were randomly divided into four groups: Group 1 (34 women) received lactic acid; Group 2 (31 women) received clindamycin and lactic acid; Group 3 (32 women) received dequalinium chloride and lactic acid; and Group 4 (30 women) received clindamycin only. The effectiveness of treatment was assessed after 14 days based on the Amsel criteria. Three months post-treatment, complaints, vaginal discharge pH, amine tests and smears were analyzed if two or more Amsel criteria were present. RESULTS: Two weeks after treatment, bacterial vaginosis symptoms persisted in 14.7% of women in Group 1, 3.2% of women in Group 2, and 13.3% of women in Group 4. Additionally, two weeks after therapy, vulvovaginal candidiasis was diagnosed in one woman (3.2%) in Group 3. Bacterial vaginosis recurrences three months after treatment were recorded in 6.9% of patients in Group 1, 3.3% of patients in Group 2, 6.5% of patients in Group 3, and 11.5% of patients in Group 4. In Group 2, one case of vulvovaginal candidiasis (3.3%) was also documented. The efficacy of lactic acid was 85.3% after 14 days and 93.1% after three months, while clindamycin demonstrated an efficacy of 86.7% after 14 days and 88.5% after three months. Combination therapy with clindamycin and lactic acid demonstrated an efficacy of 96.8% after 14 days and 96.7% after three months. Treatment with dequalinium chloride and lactic acid demonstrated an efficacy of 100% after 14 days and 93.5% after three months. CONCLUSION: The data obtained confirm the high efficacy of the two-stage therapy using clindamycin with lactic acid and dequalinium chloride with lactic acid. This treatment method provides superior outcomes in terms of both cure rates and tolerability compared to traditional treatments. Given the growing resistance of microorganisms to antibiotics, the introduction of safe alternatives is particularly important, while offering new prospects for improving the treatment of bacterial vaginosis and enhancing the quality of life for patients.