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Oral and intravaginal administration of metronidazole for the treatment of bacterial vaginosis during pregnancy

Recent studies have shown that oral and intravaginal administration of metronidazole is also effective for the treatment of bacterial vaginosis during pregnancy.

The study included 102 pregnant women with bacterial vaginosis. The diagnosis of bacterial vaginosis was made on the basis of the Gram stain score or the Nugent test (a scoring system based on counting bacteria in a Gram stain. For a total of 7 to 10 points, a diagnosis of bacterial vaginosis is posed, from 4 to 6 is an intermediate flora condition, less than 3 points - the norm) in conjunction with clinical symptoms.

All patients were randomized into 2 groups: the first was prescribed oral metronidazole (n = 52) for 7 days, the second intravaginal metronidazole (n = 50) for 5 days.

The level of cytokines was determined in the cervical secretion and the vaginal secretion when they were included in the study and 4 weeks after the end of treatment.

There was no statistically significant difference in the efficacy of the treatment (restoration of normal vaginal microflora - 0-3 points at evaluation) and the absence of the 4 clinical symptoms of bacterial vaginosis) in the two groups were not detected (71% and 70%, respectively, p = 1, p = 1.0, respectively).

The level of cytokines, namely the interleukins (IL-1β, IL-6 and IL-8), was significantly lower at the end of treatment in women for whom the prescribed treatment was effective compared to those who had not no observed response to treatment (p is less than 0.001, p = 0.001 and p = 0.02, respectively). It should be noted that a significant decrease in the levels of IL-1β and IL-6 was observed both in the first group (oral metronidazole) and in the second (intravaginal metronidazole).

The study showed that a favorable result of bacterial vaginosis is the result of the restoration of normal vaginal microflora and a change in the level of cytokines.

In conclusion, the researchers note that, when evaluating the effectiveness of a treatment, it is necessary to take into account not only the microbiological eradication of the pathogen, but also the level of the main markers of inflammation.