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Antiseptics and disinfectants for the treatment of bacterial vaginosis: a systematic review

Hans Verstraelen UGent, Rita Verhelst, Kristien Roelens UGent and Marleen Temmerman UGent (2012) BMC INFECTIOUS DISEASES. 12.
abstract
Background: The study objective was to assess the available data on efficacy and tolerability of antiseptics and disinfectants in treating bacterial vaginosis (BV). Methods: A systematic search was conducted by consulting PubMed (1966-2010), CINAHL (1982-2010), IPA (1970-2010), and the Cochrane CENTRAL databases. Clinical trials were searched for by the generic names of all antiseptics and disinfectants listed in the Anatomical Therapeutic Chemical (ATC) Classification System under the code D08A. Clinical trials were considered eligible if the efficacy of antiseptics and disinfectants in the treatment of BV was assessed in comparison to placebo or standard antibiotic treatment with metronidazole or clindamycin and if diagnosis of BV relied on standard criteria such as Amsel's and Nugent's criteria. Results: A total of 262 articles were found, of which 15 reports on clinical trials were assessed. Of these, four randomised controlled trials (RCTs) were withheld from analysis. Reasons for exclusion were primarily the lack of standard criteria to diagnose BV or to assess cure, and control treatment not involving placebo or standard antibiotic treatment. Risk of bias for the included studies was assessed with the Cochrane Collaboration's tool for assessing risk of bias. Three studies showed non-inferiority of chlorhexidine and polyhexamethylene biguanide compared to metronidazole or clindamycin. One RCT found that a single vaginal douche with hydrogen peroxide was slightly, though significantly less effective than a single oral dose of metronidazole. Conclusion: The use of antiseptics and disinfectants for the treatment of BV has been poorly studied and most studies are somehow methodologically flawed. There is insufficient evidence at present to advocate the use of these agents, although some studies suggest that some antiseptics may have equal efficacy compared to clindamycin or metronidazole. Further study is warranted with special regard to the long-term efficacy and safety of antiseptics and disinfectants for vaginal use.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (review)
publication status
published
subject
keyword
Therapy, Systematic review, Disinfectants, Antiseptics, Bacterial vaginosis, Chlorhexidine, Polyhexamethylene biguanide, Hydrogen peroxide, NONSPECIFIC VAGINITIS, VAGINAL INFECTIONS, POVIDONE-IODINE, LOCAL TREATMENT, EFFICACY, METRONIDAZOLE, CLINDAMYCIN, ETIOLOGY
journal title
BMC INFECTIOUS DISEASES
BMC Infect. Dis.
volume
12
article number
148
pages
8 pages
Web of Science type
Review
Web of Science id
000309419100001
JCR category
INFECTIOUS DISEASES
JCR impact factor
3.025 (2012)
JCR rank
24/69 (2012)
JCR quartile
2 (2012)
ISSN
1471-2334
DOI
10.1186/1471-2334-12-148
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
3058321
handle
http://hdl.handle.net/1854/LU-3058321
date created
2012-11-22 14:51:12
date last changed
2016-12-21 15:42:10
@article{3058321,
  abstract     = {Background: The study objective was to assess the available data on efficacy and tolerability of antiseptics and disinfectants in treating bacterial vaginosis (BV). 
Methods: A systematic search was conducted by consulting PubMed (1966-2010), CINAHL (1982-2010), IPA (1970-2010), and the Cochrane CENTRAL databases. Clinical trials were searched for by the generic names of all antiseptics and disinfectants listed in the Anatomical Therapeutic Chemical (ATC) Classification System under the code D08A. Clinical trials were considered eligible if the efficacy of antiseptics and disinfectants in the treatment of BV was assessed in comparison to placebo or standard antibiotic treatment with metronidazole or clindamycin and if diagnosis of BV relied on standard criteria such as Amsel's and Nugent's criteria. 
Results: A total of 262 articles were found, of which 15 reports on clinical trials were assessed. Of these, four randomised controlled trials (RCTs) were withheld from analysis. Reasons for exclusion were primarily the lack of standard criteria to diagnose BV or to assess cure, and control treatment not involving placebo or standard antibiotic treatment. Risk of bias for the included studies was assessed with the Cochrane Collaboration's tool for assessing risk of bias. Three studies showed non-inferiority of chlorhexidine and polyhexamethylene biguanide compared to metronidazole or clindamycin. One RCT found that a single vaginal douche with hydrogen peroxide was slightly, though significantly less effective than a single oral dose of metronidazole. 
Conclusion: The use of antiseptics and disinfectants for the treatment of BV has been poorly studied and most studies are somehow methodologically flawed. There is insufficient evidence at present to advocate the use of these agents, although some studies suggest that some antiseptics may have equal efficacy compared to clindamycin or metronidazole. Further study is warranted with special regard to the long-term efficacy and safety of antiseptics and disinfectants for vaginal use.},
  articleno    = {148},
  author       = {Verstraelen, Hans and Verhelst, Rita and Roelens, Kristien and Temmerman, Marleen},
  issn         = {1471-2334},
  journal      = {BMC INFECTIOUS DISEASES},
  keyword      = {Therapy,Systematic review,Disinfectants,Antiseptics,Bacterial vaginosis,Chlorhexidine,Polyhexamethylene biguanide,Hydrogen peroxide,NONSPECIFIC VAGINITIS,VAGINAL INFECTIONS,POVIDONE-IODINE,LOCAL TREATMENT,EFFICACY,METRONIDAZOLE,CLINDAMYCIN,ETIOLOGY},
  language     = {eng},
  pages        = {8},
  title        = {Antiseptics and disinfectants for the treatment of bacterial vaginosis: a systematic review},
  url          = {http://dx.doi.org/10.1186/1471-2334-12-148},
  volume       = {12},
  year         = {2012},
}

Chicago
Verstraelen, Hans, Rita Verhelst, Kristien Roelens, and Marleen Temmerman. 2012. “Antiseptics and Disinfectants for the Treatment of Bacterial Vaginosis: a Systematic Review.” Bmc Infectious Diseases 12.
APA
Verstraelen, H., Verhelst, R., Roelens, K., & Temmerman, M. (2012). Antiseptics and disinfectants for the treatment of bacterial vaginosis: a systematic review. BMC INFECTIOUS DISEASES, 12.
Vancouver
1.
Verstraelen H, Verhelst R, Roelens K, Temmerman M. Antiseptics and disinfectants for the treatment of bacterial vaginosis: a systematic review. BMC INFECTIOUS DISEASES. 2012;12.
MLA
Verstraelen, Hans, Rita Verhelst, Kristien Roelens, et al. “Antiseptics and Disinfectants for the Treatment of Bacterial Vaginosis: a Systematic Review.” BMC INFECTIOUS DISEASES 12 (2012): n. pag. Print.