References

medsovet

Медицинский Совет

Meditsinskiy sovet = Medical Council

2079-701X2658-5790

REMEDIUM GROUP Ltd.

10.21518/2079-701X-2020-13-148-154

medsovet-5799

Research Article

ИНФЕКЦИИ

INFECTIONS

Пробиотики в лечении вагинальных инфекций: эффективность с позиции доказательной медицины

Probiotics in the treatment of vaginal infections: efficacy from the perspective of evidence-based medicine

https://orcid.org/0000-0001-8228-1114

Леонова

М. В.

Leonova

M. V.

Леонова Марина Васильевна - чл.-корр. РАЕН, доктор медицинских наук, профессор, клинический фармаколог.

400131, Волгоград, площадь Павших Борцов, д. 1

Marina V. Leonova - Corresponding Member of the Russian Academy of Natural Sciences, Dr. of Sci. (Med.), Professor.

anti23@mail.ru

Ассоциация клинических фармакологов РоссииРоссияAssociation of Clinical Pharmacologists of RussiaRussian Federation

2020

13102020

013148154

2020

Леонова М.В.

Leonova M.V.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.med-sovet.pro/jour/article/view/5799

Проблема вагинальных инфекций у женщин (БВ и ВВК) остается актуальной как в связи с высокой распространенностью, так и в связи с недостаточной эффективностью противомикробной терапии и риском рецидивирования. Одним из путей решения является применение пробиотиков, в частности пробиотических лактобактерий, выполняющих защиту вагинальной среды против патогенов. В группе вагинальных лактобактерий доминирующими являются L. crispatus, L. iners, L. jensenii, L. gasseri. Лактобактерии во влагалищной среде обеспечивают важные защитные функции против патогенов благодаря продукции молочной и других органических кислот, поддерживающих рН < 4,5, высокой способности к адгезии эпителия и агрегации, с образованием биопленки и биосурфактантов, ингибированию связывания и адгезии патогенных бактерий, а также продукции антимикробных веществ, таких как H2O2, бактериоцины, и регуляции локального эпителиального иммунитета. Пробиотические лактобактерии могут применяться как вагинально, так и орально, эффективно колонизируя вагинальную среду. Проведено несколько метаанализов рандомизированных клинических исследований (РКИ) по оценке эффективности пробиотиков как в комбинации с антибиотиками, так и в монотерапии. Эффективность пробиотиков при БВ была подтверждена в 4 метаанализах, показавших значимое увеличение частоты излечения (ОР более 1,53), в том числе в режиме монотерапии без применения антибиотиков (ОР более 2,57). Эффективность пробиотиков при оральном применении превосходила вагинальные формы. В одном метаанализе РКИ была подтверждена эффективность пробиотических лактобактерий при ВВК как в достижении более высокой частоты излечения при оральном и вагинальном применении (ОР 1,41 и ОР 1,11 соответственно), так и в снижении частоты рецидивирования (ОР 0,34). Пробиотики включены в клинические рекомендации США, Канады с уровнем доказательности I-II, а также в отечественные рекомендации в качестве второго этапа лечения после курса противомикробной терапии. Таким образом, применение пробиотиков представляет альтернативную стратегию и способствует улучшению результатов лечения благодаря восстановлению экосистемы влагалища.

The problem of vaginal infections in women (BV and VVC) remains relevant due to both the high prevalence and the lack of effectiveness of antimicrobial therapy and the risk of recurrence. One solution is to use probiotics, in particular probiotic lactobacilli that protect the vaginal environment from pathogens. The group of vaginal lactobacteria is dominated by L. crispatus, L. iners, L. jensenii, L. gasseri. Lactobacteria in the vaginal environment provide important protective functions against pathogens due to the production of lactic and other organic acids that maintain pH < 4.5, high ability to adhere to epithelium and aggregation, with the formation of biofilm and biosurfactants, inhibition of binding and adhesion of pathogenic bacteria, as well as products of antimicrobial substances such as H2O2, bacteriocins, and regulation of local epithelial immunity. Probiotic lactobacteria can be used both vaginally and orally, effectively colonizing the vaginal environment. Several meta-analyses of randomized clinical trials (RCTs) were performed to evaluate the efficacy of probiotics in combination with antibiotics and in monotherapy. The efficacy of probiotics in BV was confirmed in 4 meta-analyses, which showed a significant increase in the frequency of treatment (RR more than 1.53), including in monotherapy without antibiotics (RR more than 2.57). The efficiency of probiotics in oral use exceeded vaginal forms. In one meta-analysis of RCTs the efficacy of probiotic lactobacteria in VVC was confirmed both in achieving a higher cure rate in oral and vaginal use (RR 1,41 and RR 1,11 respectively), and in reducing the frequency of relapse (RR 0,34). Probiotics are included in clinical recommendations of the USA, Canada with the level of evidence I-II, as well as in domestic recommendations as the second stage of treatment after antimicrobial therapy.

Thus, the use of probiotics represents an alternative strategy and helps to improve treatment results through the restoration of the vaginal ecosystem.

пробиотикилактобактериибактериальный вагинозвульвовагинальный кандидозметаанализ

probioticslactobacteriabacterial vaginosisvulvovaginal candidiasismeta-analysis

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The authors declare that there are no conflicts of interest present.