Резюме

Лахно І.В. , Нейолова О.В. Методологічні акценти в лікуванні бактеріального вагінозу.

Проведено огляд існуючих уявлень і даних доказової медицини щoдо бактеріального вагінозу, його негативного впливу на репродуктивне здоров'я жінки, методів санації піхви у даної категорії пацієнток. Зазначено, що особливу увагу для профілактики рецидивів бактеріального вагінозу слід приділяти впливу на Atopobium vaginae. Зроблено висновок про доцільність застосування комбінованих вагінальних капсул з кліндаміцином і клотримазолом в лікуванні жінок з бактеріальним вагінозом.

Ключові слова: бактеріальний вагіноз , лікування , комбіновані капсули з кліндаміцином і клотримазолом .

Резюме

Лахно И.В., Неелова О.В. Методологические акценты в лечении бактериального вагиноза.

Проведен обзор существующих представлений и данных доказательной медицины о бактериальном вагинозе, его негативном влиянии на репродуктивное здоровье женщины методах санации влагалища у данной категории пациенток. Указано, что особое внимание для профилактики рецидивов бактериального вагиноза следует уделять воздействию на Atopobium vaginae. Сделан вывод о целесообразности применения комбинированных вагинальных капсул с клиндамицином и клотримазолом в лечении женщин с бактериальным вагинозом.

Ключевые слова: бактериальный вагиноз, лечение, комбинированные капсулы с клиндамицином и клотримазолом.

Summary

Lachno I.V., Neelova O.V. The emphasis in the treatment of bacterial vaginosis.

It was performed a review of existing conceptions and information about evidence-based medicine on bacterial vaginosis, its negative impact on women's reproductive health and theraputical methods in this category of patients. It was indicated that special attention to prevent a recurrence of bacterial vaginosis should be given to the eradication of Atopobium vaginae. It was made a conclusion about the expediency of combined clindamycin and clotrimazole containing vaginal capsules application in the eatment of women with bacterial vaginosis.

Key words: bacterial vaginosis, treatment, combined capsules with clindamycin and clotrimazole.

UDC 618.3+618.5+618.7]-06-036-084:616.018.2

Харьковская медицинская академия последипломного образования

61176, г. Харьков, ул.Корчагинцев, 58

Kharkov medical academy of Postgraduate Education

61176, Kharkov, 58 str.Korchahyntsev 

oksana.neelova78@gmail.com

Bacterial vaginosis (BV) is noninflammatory disease attended with intensive reproduction of anaerobic microorganisms with practically complete disappearance of lacto bacillar biotope.

Present strategies of treatment of patients with BV envisage local or system use of preparations of clindamycin and metronidazole and also possible prescription of probiotics. The last give an opportunity to restore quickly a vaginal lacto bacillar biotope, to modulate the immune response of organism and blotting capacity of nutricients, influencing on the resident stamms of intestinal biotope. Nowadays preference is given to preparations for an oral dosing containing the milliards of lactobacillus. The most popularity based on a vast evidential base possess preparations of metronidazole and clindamycin for the system and local use. The accumulated experience of application of peroral preparations of metronidazole carrying out a sanitate effect due to the disconnect of synergistic intercommunication between anaerobes and gardnerella vaginalis has not reveale advantages before the use of vaginal forms of preparations directly affecting gardnerella vaginalis [14]. Besides Mobiluncus is not susceptible to metronidazole. Metronidazole is also uneffective in regard to Atopobium vaginae. Therefore its using for treatment of bacterial vaginosis  is not succeeded in attaining elimination of Atopobium vaginae that conditions appearance of exacerbations of disease in 40-70% cases. Atopobium vaginae is a principal reason of failures in treatment of patients with BV. A necessary requirement to the active substance is absence of toxic influence on lactobacillus that  is not peculiar for metronidazole. In one wide-ranging research in the last few years it was set that treatment of pregnants with BV did not result in the decrease of frequency of premature delivery and in two researches, vice versa, the increase of risk of beforehand interruption of pregnancy was marked under influence of sanitation of vagina with metronidazole. Clindamycin does not have all indicated defects. Maybe, a certain role is played by the time of therapeutic influence. An optimal "window" for treatment of pregnants with BV is the Ist half of gestation. On the other hand, for the intravaginal or peroral use of clindamycin for pregnants with BV in most researches a prophylactic effect is proved in regard to miscarriage and preeclampsia. That is why it is necessary to screen BV and treatment with clindamycin both in case of presence of clinical symptoms and at a delitescent course. It is necessary, especially in the early terms of gestation, to give preference to the forms of clindamycin for the intravaginal use because of absence of adverse reaction. It is proved identical efficiency of vagina sanitation with peroral application of metronidazole and vaginal forms of clindamycin. Metronidazole refers to the category B, id est it is not determined the risk of teratogenesis for it. Nevertheless the special researches were not conducted. Intake of metronidazole for breast-feeding mothers can worsen the taste of breast milk. Clindamycin, as well as any high-efficiency antibiotic, can simulate the development of yeast fungi. Therefore its concomitant prescription with antimycotic medication is theoretically reasonable and practically justified.

Tendency to development of optimal medications for treatment of patients with BV resulted in creation of vaginal pharmaceutical form, containing clindamycin and clotrimazole. Vaginal gelcaps containing 100 mgs of clindamycin and 100 mgs of clotrimazole appeared at the pharmaceutical market of  post-soviet space countries. Clotrimazole is included in therapy of the "first row" of vaginal candidiasis that often coexist BV. It possesses the well-proven efficiency in regard to Candida albicans and nonalbicans, dermatophytes and mold fungi. Clotrimazole also affects  streptococci and staphylococci, some anaerobia (haemophilus vaginalis). In any case clotrimazole is needed for the prophylaxis of development of Candida fungi. The recommended course of treatment makes 7 days and implies daily intravaginal introduction of gelcap with clindamycin and clotrimazole. It is necessary to note appearance of peracute inflammatory phenomena on the 3-4 period of 24 hours of the use of the complex suppositories with clindamycin and clotrimazole. It demonstrates passing to the natural course of inflammatory process as far as elimination of anaerobic infection and is the pledge of complete completion of inflammatory process at the level of mucous membrane of vagina. Complete reduction of clinical symptomatology characterizes maximal efficiency of the therapy.

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