title: Bacterial vaginosis, Atopobium vaginae and nifuratel.
abstract: As bacterial vaginosis (BV) is a potential cause of obstetric complications and gynecological disorders, there is substantial interest in establishing the most effective treatment. Standard treatment - metronidazole or clindamycin, by either vaginal or oral route � is followed by relapses in about 30% of cases, within a month from treatment completion. This inability to prevent recurrences reflects our lack of knowledge on the origins of BV. Atopobium vaginae has been recently reported to be associated with BV in around 80% of the cases and might be involved in the therapeutic failures. This review looks at the potential benefits of nifuratel against A. vaginae compared to the standard treatments with metronidazole and clindamycin. In vitro, nifuratel is able to inhibit the growth of A. vaginae, with a MIC range of 0.125-1 μg/mL; it is active against G. vaginalis and does not affect lactobacilli. Metronidazole is active against A. vaginae only at very high concentrations (8-256 μg/mL); it is partially active against G. vaginalis and also has no effect on lactobacilli. Clindamycin acts against A. vaginae with an MIC lower than 0.125 μg/mL and is active on G. vaginalis but it also affects lactobacilli, altering the vaginal environment. These observations suggest that nifuratel is probably the most valid therapeutic agent for BV treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Policlinico San Matteo, University of Pavia, Pavia, Italy. polattif@libero.it
authors.forename: Franco
authors.initials: F
authors.lastname: Polatti
mesh_terms: D039903:Actinobacteria / Q000187:drug effects* / Q000302:isolation & purification; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D002981:Clindamycin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006194:Gardnerella vaginalis / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D009545:Nifuratel / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D055502:Secondary Prevention; D016585:Vaginosis, Bacterial / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002981:Clindamycin; D009545:Nifuratel
references.citation: APMIS. 2005 May;113(5):305-16
references.pmid: 16011656
references.citation: Cochrane Database Syst Rev. 2007 Jan 24;(1):CD000262
references.pmid: 17253447
references.citation: Eur J Obstet Gynecol Reprod Biol. 2008 Sep;140(1):3-11
references.pmid: 18456385
references.citation: Ther Clin Risk Manag. 2009 Jun;5(3):485-9
references.pmid: 19707258
references.citation: Am J Obstet Gynecol. 1996 Aug;175(2):435-41
references.pmid: 8765265
references.citation: J Infect Dis. 1998 Dec;178(6):1698-706
references.pmid: 9815222
references.citation: J Gen Microbiol. 1989 Mar;135(3):475-80
references.pmid: 2576032
references.citation: BJOG. 2001 May;108(5):439-50
references.pmid: 11368127
references.citation: BMC Microbiol. 2004 Apr 21;4:16
references.pmid: 15102329
references.citation: Am J Obstet Gynecol. 2004 Oct;191(4):1124-9
references.pmid: 15507930
references.citation: J Microbiol. 2007 Dec;45(6):515-20
references.pmid: 18176534
references.citation: FEMS Microbiol Lett. 1992 Aug 15;74(2-3):235-40
references.pmid: 1382033
references.citation: Obstet Gynecol. 2005 Nov;106(5 Pt 1):1013-23
references.pmid: 16260520
references.citation: Antimicrob Agents Chemother. 2011 May;55(5):2490-2
references.pmid: 21321147
references.citation: Curr Opin Infect Dis. 2009 Feb;22(1):82-6
references.pmid: 19532085
references.citation: Antimicrob Agents Chemother. 2002 Dec;46(12):3995-6
references.pmid: 12435709
references.citation: Aust Fam Physician. 2009 Jun;38(6):394-7
references.pmid: 19521581
references.citation: Gynecol Obstet Invest. 1988;25(1):47-57
references.pmid: 3257743
references.citation: Indian J Med Microbiol. 2008 Apr-Jun;26(2):155-7
references.pmid: 18445953
references.citation: Rev Obstet Gynecol. 2009 Winter;2(1):28-37
references.pmid: 19399292
references.citation: Clin Infect Dis. 1995 Jun;20 Suppl 2:S271-5
references.pmid: 7548573
references.citation: Int J Antimicrob Agents. 2010 Apr;35(4):322-32
references.pmid: 20149602
references.citation: Aust N Z J Obstet Gynaecol. 2005 Oct;45(5):450-2
references.pmid: 16171487
references.citation: J Clin Microbiol. 2004 Dec;42(12):5892-4
references.pmid: 15583334
references.citation: J Clin Microbiol. 2009 Mar;47(3):721-6
references.pmid: 19144794
references.citation: BMC Infect Dis. 2006 Mar 16;6:51
references.pmid: 16542416
references.citation: J Clin Invest. 2003 Nov;112(10):1466-77
references.pmid: 14617746
references.citation: J Clin Microbiol. 2003 Jun;41(6):2788-90
references.pmid: 12791933
references.citation: Annu Rev Med. 2000;51:349-56
references.pmid: 10774469
references.citation: Curr Infect Dis Rep. 2000 Dec;2(6):506-512
references.pmid: 11095900
references.citation: Am J Obstet Gynecol. 2004 Oct;191(4):1130-2
references.pmid: 15507931
references.citation: N Engl J Med. 2005 Nov 3;353(18):1899-911
references.pmid: 16267321
references.citation: Int J Syst Bacteriol. 1999 Oct;49 Pt 4:1573-6
references.pmid: 10555338
references.citation: J Clin Microbiol. 2004 Apr;42(4):1829-31
references.pmid: 15071062
references.citation: Arch Gynecol Obstet. 2010 Apr;281(4):589-600
references.pmid: 19967381
references.citation: J Midwifery Womens Health. 2008 May-Jun;53(3):227-235
references.pmid: 18455097
references.citation: J Fam Pract. 1995 Nov;41(5):443-9
references.pmid: 7595261
references.citation: Am J Obstet Gynecol. 2008 Jan;198(1):97.e1-6
references.pmid: 18005928