Bacterial vaginosis: modern anti-relapse treatment tactics
Bacterial vaginosis (BV) is a disorder of the vaginal microflora resulting from the replacement of normal microbiota with high concentrations of anaerobic bacteria. Taking into account the frequency of bacterial vaginosis relapses, treatment and prevention are considered an important problem of pharmacotherapy. The inefficacy of antimicrobial drugs arises from the lack of a complete understanding of the bacterial vaginosis pathogenesis, as well as the causes of its relapses, which affects the treatment efficacy. This review examines the latest data on the bacterial vaginosis pathogenesis, treatment methods, as well as possible treatment tactics to reduce disease relapses. At the moment, new tactics to improve the treatment efficacy include changing the drug dose, the duration of treatment, long-term preventive regimens and the use of agents destructing the biofilm. A number of studies have established the positive effect of using high doses of suppositories containing metronidazole in combination with an antifungal agent, commonly miconazole, which is also useful for mixed, bacterial and fungal vaginal infections. It is likely that in the future, for the purpose of treatment efficacy, therapy will include the simultaneous use of several components, including combinations of antibiotics, antibiotic agents and probiotics.