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Complimentary probiotics with clotrimazole may increase yeast infection cure rates

New research suggests that adding probiotics to established VVC treatment options may be a path to increased cure rates.

Vulvovaginal candidiasis (VVC) is incredibly common and widespread among women of reproductive age. Its occurrence can be a result of several factors, including uncontrolled diabetes, long-term or repeat exposure to antibiotics, and unhealthy lifestyle habits.

While clotrimazole has established itself as a successful treatment method, providers still encounter women with antibiotic resistance, adverse effects and VVC recurrences, which can be challenging in practice.

Recent studies have begun exploring the complementary role of probiotics as a potential treatment option for VVC, as a normal vaginal microbial community plays an important role in yeast infection prevention.1

To further understand the relationship between vaginal microflora and Candida-induced VVC, researchers conducted a prospective, real-world study to explore treatment outcomes of uncomplicated VVC when combining probiotic Lacidophilin vaginal capsules with clotrimazole vaginal tablets (500mg).

The weekly journal Medicine published the results, which ultimately suggest this combination method may be a successful treatment option for women with uncomplicated VVC.2

The study was conducted from March 2018 to December 2018 at a tertiary hospital in China, for which researchers recruited a total of 42 women—27 of whom had normal vaginal flora and 15 of whom had uncomplicated VVC. Women were between the ages of 20 to 50 years old with an average of 28 years, all with a history of sexual intercourse.

They were either diagnosed with uncomplicated VVC or healthy vaginal microecology, had a regular period and had been menstruating for at least 72 hours. To be included in the study, no vaginal irrigation or intravaginal administration was to occur for 1 week, nor was sexual intercourse for at least the previous 72 hours.

The study excluded women who were currently menstruating—outside of the 72-hour time range—pregnant or lactating women, women with a history of uterine or adnexal surgery, and women with an incomplete medical record.

Women were treated with a single dose of clotrimazole tablets (500mg) supplemented with 2 Lacidophilin vaginal capsules for the following 7 days.

Over the course of the study, participants were examined 4 times—once during the first visit, then 8 to 10 days after the first visit, followed by 30 days after the second visit, and finally 30 days after the third visit.

Women in the control group of healthy, normal vaginal flora were examined a single time at the initial visit.

According to the results, 46.67% (7/15) of women were cured at the second visit, 61.54% (8/13) were cured at the third visit, and eventually 72.73% (8/11) were cured.

Researchers ultimately analyzed 81 samples and found that samples from women in the control group were exceedingly abundant in Lactobacillus, especially Lactobacillus crispatus, Lactobacillus iners, Lactobacillus jensenii and Gardneralla.

Samples from women with VVC, on the other hand, were relatively few in bacterial composition and dominated by Lactobacillus iners. However, bacterial abundance in women with VVC increased gradually as treatment progressed.

At the final visit, the abundance of vaginal flora was further increased with the dominant bacteria being Lactobacillus crispatus and Lactobacillus iners.

References

  1. Kronemyer B. Probiotics may increase cure rates for bacterial vaginosis. Contemporary OB/GYN. Published July 2022. Accessed January 20, 2023. https://www.contemporaryobgyn.net/view/probiotics-may-increase-cure-rates-for-bacterial-vaginosis
  2. Zeng X, An R, Li H, Zhang Y. Improved treatment of vulvovaginal candidiasis with Clotrimazole plus probiotic Lacidophilin Vaginal Capsules: A prospective, real-world study. Medicine. 2023;102(1):e32664. doi:10.1097/md.0000000000032664