Adjunctive probiotic therapy enhances metronidazole efficacy in bacterial vaginitis: a clinical trial on Iranian women

Background: Because probiotics have a positive effect on vaginal dysbiosis, it should be investigated whether the treatment of bacterial vaginosis (BV) with metronidazole can be improved by combining with a probiotic. Methods: The clinical trial enrolled married women aged 18–48 with BV and employed a rigorous double-blind, placebo-controlled design. The study compared the efficacy of a 7-day regimen of oral metronidazole (2×500 mg/d) and a vaginal probiotic (Lactobacillus plantarum 299v 1×109 cfu/day over 21 days) to the same regimen with a placebo instead the probiotic. Results: The study enrolled 121 participants. Adding vaginal probiotics to metronidazole significantly reduced BV recurrence compared to metronidazole alone. With the combination therapy being well-tolerated and no serious adverse events reported Conclusions: The study suggest, that vaginal probiotics may be a promising adjunctive therapy for BV, although further studies are needed to confirm these findings and determine the optimal probiotic strains and dosage, as well as to investigate the potential benefits of probiotics for other aspects of BV management Other factors such as dietary habits, hygiene practices, and lifestyle were not controlled in this study and should be considered in future research.