| Abstract [eng] |
Novelty: Bacterial vaginosis (BV) affects ~1/3 of reproductive‑age women; >50% recur within 6–12 months despite standard metronidazole or clindamycin. Recent evidence on probiotics, biofilm disruptors, and male partner treatment has not been translated into actionable community pharmacy guidance. This thesis aligns the newest primary evidence with explicit counselling actions. Aim: To evaluate evidence‑based vaginal microbiome modulation strategies after BV treatment and their relevance for community pharmacist consultation. Objectives: (1) Synthesize evidence on post‑BV microbiome interventions (probiotics, biofilm disruptors). (2) Evaluate their effectiveness and safety for preventing recurrence and restoring Lactobacillus‑dominant microbiota. (3) Identify literature gaps and limitations. (4) Translate findings into practical, evidence‑based counselling recommendations. Methods: A PRISMA 2020‑guided systematic narrative review. PubMed/MEDLINE and Scopus were searched (1990–April 2026). Studies were selected via PICOS criteria: reproductive‑age women, microbiome modulation interventions after BV. The Cochrane RoB 2 tool assessed RCT quality. To support translation, a qualitative document analysis of 23 vaginal health products available in Lithuanian community pharmacies was performed and compared with the clinical evidence. Results: 24 primary studies (20 RCTs, 1 clinical cohort, 1 pilot, 2 retrospective). Six intervention categories: probiotics, synbiotics, biofilm disruptors/non‑antibiotic antimicrobials, acidifying agents, combination suppressive regimens, and male partner treatment. Vaginal L. crispatus IP 174178 and specific multi‑strain regimens significantly reduced recurrence and promoted Lactobacillus‑dominant microbiota restoration. Dequalinium chloride achieved 80–93% short‑term cure, non‑inferior to antibiotics, with favorable tolerability. Astodrimer 1% gel offered modest recurrence prevention. Concurrent male partner treatment (oral metronidazole + topical clindamycin) lowered 12‑week recurrence from 63% to 35% in monogamous couples. All interventions were well tolerated; no treatment‑related serious adverse events. RoB 2: 4 RCTs low risk, 10 “some concerns,” 6 high risk. Key gaps: short follow‑up (rarely >6 months), heterogeneous diagnostic criteria, geographic concentration, and absence of data on pregnant, adolescent, or post‑menopausal women. Product analysis revealed frequent mismatch between claims and evidence; only a minority were supported by high‑ or moderate‑level data. Conclusions: Post‑BV microbiome modulation is an expanding but heterogeneous field. Strain‑specific Lactobacillus probiotics, dequalinium chloride, astodrimer gel, and male partner treatment offer the most clinical benefit—reducing recurrence, restoring protective microbiota, and showing good tolerability. Reliability is limited by inconsistent outcomes, short follow‑up, methodological bias, and population gaps. Community pharmacists should translate this evidence into cautious, patient‑specific counselling: prioritize evidence‑based, strain‑specific options; manage expectations regarding symptom relief versus microbiological cure; and refer patients outside the scope of uncomplicated recurrent BV for medical evaluation. |
