Efficacy and safety of different drugs for the treatment of bacterial vaginosis: a systematic review and network meta-analysis.

IF 4.6 2区医学 Q2 IMMUNOLOGY Frontiers in Cellular and Infection Microbiology Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI:10.3389/fcimb.2024.1402346

Yuxin Fan, Yanhong Gu, Yi Xian, Qinya Li, Youli He, Kaiyang Chen, Hui Yu, Huan Deng, Li Xiong, Zhiwei Cui, Yang Yang, Yin Xiang

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Abstract

Objective: Bacterial vaginosis is a disease caused by vaginal microecology disorder, which seriously affects female health. At present, there are many drugs to treat BV, and this study aims to compare the efficacy and safety of multiple drugs for BV through a network meta-analysis (NMA).

Methods: All studies were sourced from PubMed and Embase databases from the establishment date to April 13, 2023. We evaluated the clinical cure success rate and adverse effects (abnormal increase in vaginal discharge, external genital irritation, and vulvar itching) and performed subgroup analyses of the clinical cure success rate for different modes of administration. All statistical analyses were performed using R and STATA 14.0 software for network meta-analysis.

Results: We included 42 studies that met the criteria, involving a total of 8382 patients. Network meta-analysis results showed that metronidazole and secnidazole had a higher rate of adverse reactions than placebo (RR 7.06; 95%-CI 2.61-19.10, RR 4.03; 95%-CI 1.63-9.98), the adverse reaction rate of probiotics group was lower than that of metronidazole group (RR 0.44; 95%-CI 0.21-0.93). The clinical cure rate of oral ornidazole was better than clindamycin (RR 16.08; 95%-CI 1.72-150.47), Secnidazole (RR 8.17; 95%-CI 1.66-40.25) and probiotics. Direct meta-analysis results showed that ornidazole had a better clinical cure rate than Secnidazole (RR 1.22; 95%-CI 1.10-1.34), oral ornidazole had a better clinical cure rate than Secnidazole (RR 1.23; 95%-CI 1.11-1.36). The clinical cure rate of vaginal application of sucrose was better than metronidazole (RR 1.12; 95%-CI 1.03-1.21) and metronidazole had a lower clinical cure rate than probiotics (RR 0.68; 95%-CI 0.52-0.88).

Conclusions: The results of this systematic review and network meta-analysis suggest that ornidazole may be an effective alternative for the treatment of BV, and that sucrose and probiotics are potential BV treatments that need to be validated by more high-quality clinical studies in the future.

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不同药物治疗细菌性阴道病的疗效和安全性：系统综述和网络荟萃分析。

目的细菌性阴道炎是由阴道微生态失调引起的疾病，严重影响女性健康。目前，治疗细菌性阴道炎的药物很多，本研究旨在通过网络荟萃分析（NMA）比较多种药物治疗细菌性阴道炎的疗效和安全性：方法：所有研究均来自PubMed和Embase数据库，研究时间自建立之日起至2023年4月13日。我们评估了临床治愈成功率和不良反应（阴道分泌物异常增多、外生殖器刺激和外阴瘙痒），并对不同给药方式的临床治愈成功率进行了亚组分析。所有统计分析均使用 R 和 STATA 14.0 软件进行网络荟萃分析：我们纳入了 42 项符合标准的研究，共涉及 8382 名患者。网络荟萃分析结果显示，甲硝唑和塞克硝唑的不良反应率高于安慰剂（RR 7.06; 95%-CI 2.61-19.10，RR 4.03; 95%-CI 1.63-9.98），益生菌组的不良反应率低于甲硝唑组（RR 0.44; 95%-CI 0.21-0.93）。口服奥硝唑的临床治愈率优于克林霉素（RR 16.08；95%-CI 1.72-150.47）、塞克硝唑（RR 8.17；95%-CI 1.66-40.25）和益生菌。直接荟萃分析结果显示，奥硝唑的临床治愈率优于塞克硝唑（RR 1.22；95%-CI 1.10-1.34），口服奥硝唑的临床治愈率优于塞克硝唑（RR 1.23；95%-CI 1.11-1.36）。阴道应用蔗糖的临床治愈率优于甲硝唑（RR 1.12；95%-CI 1.03-1.21），而甲硝唑的临床治愈率低于益生菌（RR 0.68；95%-CI 0.52-0.88）：本系统综述和网络荟萃分析的结果表明，奥硝唑可能是治疗BV的有效替代药物，而蔗糖和益生菌是潜在的BV治疗药物，未来需要更多高质量的临床研究来验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Cellular and Infection Microbiology IMMUNOLOGY-MICROBIOLOGY

CiteScore

7.90

自引率

7.00%

发文量

1817

审稿时长

14 weeks

期刊介绍： Frontiers in Cellular and Infection Microbiology is a leading specialty journal, publishing rigorously peer-reviewed research across all pathogenic microorganisms and their interaction with their hosts. Chief Editor Yousef Abu Kwaik, University of Louisville is supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Cellular and Infection Microbiology includes research on bacteria, fungi, parasites, viruses, endosymbionts, prions and all microbial pathogens as well as the microbiota and its effect on health and disease in various hosts. The research approaches include molecular microbiology, cellular microbiology, gene regulation, proteomics, signal transduction, pathogenic evolution, genomics, structural biology, and virulence factors as well as model hosts. Areas of research to counteract infectious agents by the host include the host innate and adaptive immune responses as well as metabolic restrictions to various pathogenic microorganisms, vaccine design and development against various pathogenic microorganisms, and the mechanisms of antibiotic resistance and its countermeasures.