WHAT’S NEW: A new use for probiotics is established
This trial supports the use of probiotic vaginal capsules in the prevention of recurrent BV. We found the specific formulation (Probaclac Vaginal) that was tested in this RCT on an online natural health site (http://www.lady tobaby.com/show.php?item=219). This Web site sells Probaclac Vaginal at a cost of $28 for 10 capsules. A full course of a week’s treatment, repeated once, would cost approximately $56.
CAVEATS: Will other formulations work?
This study was funded by the makers of Probaclac Vaginal, so we will be watching for independent replication of these findings in other populations. The vaginal probiotic tested had 80 times the current recommended concentration of lactobacilli required to restore and maintain normal vaginal flora, so we are unsure as to whether less concentrated formulations would be equally effective.
Probiotic formulations differ widely, although some are similar to the species/ concentration used in Probaclac Vaginal, including LactoViden ID by Metagenics (http://www.metagenics.com/products/az-products-list/LactoViden-ID), with 15 billion CFUs, and Therbiotic by Klaire Labs (http://www.klaire.com/prod/proddetail. asp?id=V775-06-CN), with 25 billion CFUs.
Also, this intervention has not been tested in populations outside of China, in heavy smokers, or in women with more than one sexual partner, so there is a small risk that these findings may not be confirmed in subsequent RCTs or may not be generalizable to other populations. Nonetheless, we think the potential benefit outweighs any possible harm, and we will be watching for studies that confirm or challenge these findings.
CHALLENGES TO IMPLEMENTATION: Finding the right probiotic
The brand used in the study is available only on the Web, which may be difficult for some patients to access, and some patients will find the probiotic to be fairly expensive. In addition, other brands of probiotics may not be available as a vaginal capsule with applicator. It should be noted, though, that it is possible to use an applicator to insert an oral probiotic capsule into the vagina.
Acknowledgement
The PURLs Surveillance System is supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.