Lactobacillus Vaginal Tablets in Preventing Recurrence of Bacterial Vaginosis: A Systematic Review and Meta-Analysis

Bacterial vaginosis (BV) is a common polymicrobial infectious condition that occurs exclusively in females. Several studies have suggested that probiotics, specifically Lactobacillus vaginal tablets, may be both feasible and beneficial in managing BV. This meta-analysis aims to systematically evaluate the role of Lactobacillus vaginal tablets in preventing the recurrence of BV. A systematic literature search was conducted in PubMed/MEDLINE, EMBASE, and the Cochrane Library. The search was limited to studies published in English up to August 2024. Studies were included if they involved women diagnosed with BV and evaluated the effectiveness of Lactobacillus vaginal tablets in preventing the recurrence of BV. Two independent reviewers were involved in the selection process. Recurrence of BV and adverse events associated with the interventions were the primary and secondary outcomes analyzed. Meta-analysis was performed in Review Manager 5.4.1 software using random-effects model using the DerSimonian and Laird method to systematically evaluate the role of Lactobacillus vaginal tablets in preventing the recurrence of BV. The quality of the included studies was assessed using the Cochrane Risk of Bias tool and the evidence was GRADED. Eight randomized controlled trials involving a total of 562 women with BV were included in this review. The evidence suggests that Lactobacillus vaginal tablets have no effect on recurrence of BV (RR 0.86, 95% CI 0.54 to 1.35; uncertainty evidence). Overall, the evidence for the effectiveness of Lactobacillus vaginal tablets to prevent the BV recurrence is uncertain. Further research is needed to clarify the which Lactobacillus is effective.PROSPERO: CRD42024531832.