The efficacy of the probiotic L. acidophilus for the treatment and prevention of urogenital infections in women
Urogenital infections (UMI) are common in women. The prevalence of IGU is quite high - for example, the prevalence of acute cystitis in United States is estimated to be 26 to 36 million cases per year, 21 to 33% of women of reproductive age suffering from vaginosis bacterial. Secondary complications from these diseases lead to infertility or an increased risk of premature birth. Despite the great importance of these infections, the approaches to their treatment have not undergone significant changes in recent years - for example, antibiotics and antimycotics remain the main drugs in the treatment of UID, however, with the increase in antibiotic resistance, the effectiveness of these drugs decreases and, during pregnancy, their use is not always possible.
The concept of the protective role of normal vaginal microflora (especially lactobacilli) formed the basis for the treatment of urogenital infections with probiotics. This concept was first formulated by Canadian urologist Andrew Bruce in the early 1970s. Last century. It was later shown that strains of lactobacilli can colonize the vagina when using vaginal suppositories and reduce the risk of urinary tract infections and vaginitis of fungal etiology and vaginosis bacterial .
It should be noted that the micro-ecosystem of the vaginal microflora is very sensitive to various factors, such as hormonal status, sexual activity, the use of oral contraceptives, glycogen content, vaginal pH, glucocorticoid therapy, immunosuppressive therapy, etc..
In clinical studies, intravaginal administration of probiotics has been shown to help reduce the growth of pathogenic microorganisms, having a beneficial effect on the progression of bacterial vaginosis and a number of urinary tract infections. Thus, it has been found that intravaginal use of L. acidophilus for 6-12 days or oral administration L. acidophilus or L. rhamnosus GR-1 and L. fermentum RC-14 within 2 months leads to (1) a remedy against bacterial vaginosis, defined as a point 0-1 according to the criteria of R. Amsel and / or (2) a decrease in the incidence of relapse of bacterial vaginosis and / or (3) an increase in the number of lactobacilli in the vagina and the restoration of normal microflora in the vagina is significantly more often compared to the use of 'placebo or no treatment.
The mechanism of action of probiotics on the vaginal mucosa during urogenital infections is probably multifactorial in nature and is due to the production of lactic acid, bactericidal substances (antimicrobial peptides or bacteriocins) and hydrogen peroxide, a modification immune response (synthesis of IgA and anti-inflammatory cytokines), synthesis of specific molecules that can reduce virulence of pathogens and a number of other factors. The main mechanism of action of probiotics in women with UI is thought to be the production of biosurfactants and collagen-binding proteins, which leads to suppression of the adhesion of pathogenic bacteria, namely sensitive uropathogens. to biosurfactants: E. coli 67, E. coli Hu734, E. faecalis 1131, E. faecalis 1396 , P. mirabilis 28cii, P. aeruginosa AK1, S. epidermidis 3059, K. pneumonia 3a.
A unique probiotic preparation for intravaginal administration, containing the probiotic Lactobacillus acidophilus and a nutrient medium for lactobacilli lactose, is Ecofemin (manufactured by the Danish company Pharma-Vinci A / C), registered in United States in 2008.
There are studies showing the efficacy and safety of the local use of lactobacilli, in particular L. acidophilus, in the treatment of bacterial vaginosis.
Thus, the efficacy of the use of L. lyophilized acidophilus for the treatment of bacterial vaginosis was demonstrated in a double-blind placebo-controlled study in 60 patients with bacterial vaginosis. L. acidophilus was administered intravaginally for 6 days (1 capsule 2 times a day). At the end of the use of vaginal capsules with lactobacilli in 57% of women in the L. acidophilus use group there was a restoration of the balance of the vaginal microflora compared to 0 % in the placebo group.
In an open pilot study conducted in Italy and published in 2007, 40 women with a bacterial vaginosis clinic received a douching with a solution containing L. for 6 days. acidophilus. A microscopic examination of vaginal smears was performed at the time of diagnosis, 6 and 20 days after the end of treatment. According to the Nugent criteria, bacterial vaginosis was confirmed in 52.5% of women before treatment and only in 7.5% of patients during the follow-up period (20 days after treatment). After treatment, a statistically significant decrease in the pH of the vagina was observed (85% of women had less than 4.5) and the unpleasant odor of secretions disappeared in all patients (the sample with hydroxide potassium was negative). The authors conclude that the use of the probiotic L. in bacterial vaginosis acidophilus leads to the restoration of the normal microecosystem of the vagina.
In another randomized trial involving 60 patients with bacterial vaginosis, the appointment of vaginal suppositories containing only L. acidophilus was as effective as the simultaneous administration of suppositories with L. acidophilus in association with the use of a probiotic containing the subspecies Lactobacilllus paracasei paracasei F19 inside. In patients in the two study groups, 3 months after the end of treatment, a significant decrease in vaginal pH was observed, an improvement in the results of the potassium hydroxide test and a decrease or relief of the symptoms of sickness.
Ecofemin has a favorable safety profile and is approved for use in pregnant and lactating women.