The Pharmaceutical Journal
Vol 273 No 7315 p307
4 September 2004

This article
Reprint   Photocopy

  Acrobat Reader

News summary

Probiotics not effective in vaginal thrush

Lactobacillus is not effective in preventing vulvovaginal candidiasis after antibiotic treatment, a new Australian study has shown.

A randomised controlled trial assessed the efficacy of this commonly used probiotic treatment. General practices and community pharmacies recruited non-pregnant women, aged 18 to 50 years, with non-gynaecological infections who were starting a short course of antibiotics.

The treatments tested were lactobacillus oral powder or lactobacillus vaginal pessary, with matched placebos. The main constituent was Lactobacillus rhamnosus. Women were randomised to four groups: oral and vaginal lactobacillus, oral lactobacillus and vaginal placebo, oral placebo and vaginal lactobacillus, and oral and vaginal placebo. Treatment was taken during the antibiotic course and for four days after. The women recorded any symptoms of candidiasis and provided vaginal swabs for analysis (at baseline and after 14 days).

Overall, 55 of 235 women (23 per cent) developed post-antibiotic candidiasis. There was no evidence of any beneficial effect from the “active” treatment.

The authors comment that use of lactobacillus in post-antibiotic vulvovaginitis is widespread, despite lack of a biologically plausible basis or evidence of effectiveness. They have previously found that 40 per cent of women with a history of vulvovaginitis had used yoghurt or lactobacillus to prevent antibiotic-associated candidiasis. “Our results should prompt health professionals to inform women that lactobacillus is unlikely to prevent post-antibiotic vulvovaginitis and that they should consider using proved antifungal treatment if symptoms develop,” they say.

The study is published on BMJ online (August 27).