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Can p Rio Biotics Prevent Vaginitis

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  Evidence-based answers from the Family Physicians Inquiries Network 357 JFPONLINE.COMVOL 61, NO 6 | JUNE 2012 | THE JOURNAL OF FAMILY PRACTICE CLINICAL INQUIRIES Lucinda Jurden, MD; Megan Buchanan, PharmD, MS; Gary Kelsberg, MD Valley Family Medicine Residency, Renton, Wash Sarah Safranek, MLIS University of Washington Health Sciences Library, Seattle ASSISTANT EDITOR Jon O. Neher, MD Valley Family Medicine Residency, Renton, Wash The views expressed here are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the US government. Evidence summary  A double-blind RCT found that probiotic  vaginal suppositories reduce the incidence of recurrent BV. Investigators randomized 120 Chinese women, 18 to 55 years of age with a history of 2 or more episodes of BV in the previous year, to use suppositories containing either probiotics ( Lactobacillus   rhamnosus ,  L acidophilus , and S treptococcus thermophilus, total of 8×10 9  colony-forming units [cfu]) or placebo . 1    All the women used suppositories daily for a week, stopped for a week, and then used them for another week. Fewer women who used probiotic sup-positories had recurrences of BV on exami-nation during the following 2 months than  women who used placebo (16% vs 45%; P  <.001; number needed to treat [NNT]=3.4), and fewer reported recurrences in telephone interviews 2 to 11 months after treatment (11% vs 28%; P  <.05; NNT=5.8). Interview-ers recorded two-thirds fewer complaints of discharge and malodor among women who used probiotics than among women who used placebo ( P  <.05 for both comparisons). But another RCT finds no effect on recurrent BV or VVC  Another RCT treated 95 women 18 to 45 years of age with clindamycin ovules (for BV) or clotrimazole suppositories (for VVC) and, af-ter 5 days, randomized them to use probiotic suppositories ( Lactobacillus  species, 10 8 -10 10  cfu) or placebo for 5 more days. 2  Probiotic suppositories after treatment didn’t reduce clinician-diagnosed recurrences of either BV or VVC compared with placebo (7% vs 17% after 2-3 days; 22% vs 29% after the first menstrual cycle; P  =not significant for both). Probiotics did reduce self-reported malodorous discharge, however ( P  =.03). Pro-biotics didn’t produce adverse effects. Probiotic yogurt decreases recurrent BV but not VVC in an RCT  An RCT that randomized 46 women, 20 to 39 years of age with a history of 4 or more episodes of BV or VVC in the previous year, to eat L acidophilus -enriched yogurt (10 8  cfu) or pasteurized yogurt daily for 2 months found that consuming probiotic-containing yogurt reduced the incidence of recurrent BV but not VVC. 3  Women who ate L acidophilus  yogurt had fewer episodes of clinician-diagnosed BV at 1 month than women who ate pasteurized yo-gurt (24% vs 53%; P  <.05) and also at 2 months (4% vs 36%; P  <.05). However, they didn’t have significantly fewer episodes of VVC (43%  vs 37% at 1 month, 21% vs 29% at 2 months; Can probiotics safely prevent recurrent vaginitis? EVIDENCE-BASED ANSWER  A 󰁹󰁥󰁳, using vaginal suppositories or eating yogurt with Lactobacillus  may reduce recurrences of bacterial vaginosis (BV) (strength of recommendation [SOR]: B , randomized controlled trials [RCTs] with conflicting results). Neither suppositories nor yogurt con-taining Lactobacillus  are likely to prevent recurrences of vulvovaginal candidia-sis (VVC) (SOR: B , RCTs with conflicting results). Probiotic suppositories and yogurt don’t appear to have significant adverse ef-fects (SOR:  A  , RCTs). CONTINUED ON PAGE 368  368 THE JOURNAL OF FAMILY PRACTICE | JUNE 2012 | VOL 61, NO 6 CLINICAL INQUIRIES References P  =not significant for both). Investigators re-ported no adverse effects. Small, flawed trial finds fewer episodes of VVC with yogurt  An unblinded crossover trial found that daily consumption of probiotic yogurt reduced  VVC recurrences in women with a history of the infection. Investigators randomized 33 women 24 to 50 years of age to eat either 8 ounces a day of yogurt (with L acidophilus , 10 8  cfu) or a yogurt-free diet. 4  After 6 months, the groups switched. Investigators saw all pa-tients monthly. Women who ate yogurt had fewer epi-sodes of VVC than women who didn’t (0.4 vs 2.5 over 6 months; P  <.001) and reported no adverse effects. e study was flawed by small size and high attrition rates (only 13 women completed the trial).   Recommendations e World Health Organization says some clinical evidence suggests that oral and vagi-nal administration of lactobacilli can eradi-cate asymptomatic and symptomatic BV. Supporting evidence for prevention of recur-rent BV or VVC by probiotics is limited. 5   A literature review by the Natural Stan-dard Research Collaboration states that in-sufficient evidence exists to recommend probiotics for treating or preventing bacte-rial vaginosis and that preventing or treating  vaginal yeast infections with probiotics hasn’t been adequately studied. 6 JFP  1. Ya W, Reifer C, Miller LE. Efficacy of vaginal probiotic cap-sules for recurrent bacterial vaginosis: a double-blind, ran-domized, placebo-controlled study.  Am J Obstet Gynecol  . 2010;203:120.e1-120.e6. 2. Ehrstrom S, Daroczy K, Rylander E, et al. Lactic acid bacteria colonization and clinical outcome after probiotic supple-mentation in conventionally treated bacterial vaginosis and  vulvovaginal candidiasis. Microbes Infect  . 2010;12:691-699. 3. Shalev E, Battino S, Weiner E, et al. Ingestion of yogurt con-taining Lactobacillus   acidophilus  compared with pasteurized  yogurt as prophylaxis for recurrent candidal vaginitis and bacterial vaginosis.  Arch Fam Med  . 1996;5:593-596. 4. Hilton E, Isenberg HD, Alperstein P, et al. Ingestion of  yogurt containing Lactobacillus acidophilus  as prophy-laxis for candidal vaginitis.  Ann Intern Med  . 1992;116:353-357. 5. Food and Agriculture Organization of the United Nations and  World Health Organization. Health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. October 1-4, 2001. Cordoba, Argentina. 6. National Standard Research Collaboration. Unclear if probi-otics effective for bacterial vaginosis. October 2009. Available at: http://www.naturalstandard.com/news/news20091028.asp. Accessed September 1, 2011. Probiotic vaginal suppositories or yogurt may decrease recurrences of bacterial vaginosis. CONTINUED FROM PAGE 357  EMERGENCY MEDICINE OPPORTUNITY IN GULF COAST PANHANDLE Titan Emergency Group is seeking FT or IC Emergency Medicine Physicians for Twin Cities Hospital in Niceville, FL. Physician must be boarded in Emergency Medicine or other Primary Care Specialty (FP or IM) to work in this 14K annual volume ED. Single physician coverage, 12 hour shifts. Niceville is centrally located in Florida’s panhandle between Pensacola and Panama City nestled close to two State Parks where  you can experience some of the world’s most beautiful beaches. Rated the best place to raise your kids in Florida, come find out  why Niceville is such a nice place to live! For more information, contact Alisha Lane at (904) 332-4322 or a.lane@titandoctors.com. Employment Opportunites

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