Lactic acid gel cost effective compared to metronidazole for recurrent bacterial vaginosis

In general, women hated taking metronidazole in many courses and preferred lactic acid gel, even though they were informed that it was less likely to give symptom relief. According to a new study conducted by Lindsay Armstrong-Buisseret and team, lactic acid was cost effective compared to metronidazole in recurrent bacterial vaginosis.

The findings of this study were published in National Institute of Health research.

Bacterial vaginosis is a common and painful illness that can lead to significant complications. In the near term, antibiotic therapy is typically clinically beneficial, although recurrence is common, and adverse effects might develop. The goal of this study was to see if intravaginal lactic acid gel is more successful and less expensive than oral metronidazole in treating recurrent bacterial vaginosis (Flagyl, Sanofi).

This was an open-label, multicenter, parallel-arm, randomized (1 : 1) controlled experiment that took place in one general practice and 19 sexual health clinics in the United Kingdom. This research included 16-year-old women with bacterial vaginosis symptoms and one or more episodes within the previous two years. The treatments were either 5 mL of intravaginal lactic acid gel taken once daily for 7 days (intervention) or 400 mg oral metronidazole pills taken twice daily for 7 days (control) (control). The major goal was to see if the bacterial vaginosis symptoms went away 14 days following randomization. Time to first recurrence of symptoms; number of recurrences and treatment courses over 6 months; microbiological resolution on microscopy of vaginal smears at week 2; time to resolution of symptoms; tolerability, adherence, and acceptability of treatment; prevalence of concurrent sexually transmitted infections; quality of life; and cost-effectiveness were the secondary outcomes.

The key findings were as follow:

1. On the suggestion of the Data Monitoring Committee and Trial Steering Committee, recruitment was halted before achieving the objective of 1900 participants, after a scheduled analysis of the findings revealed that the study question had been answered.

2. In all, 518 individuals were randomly assigned, and primary outcome data were available for 409 of them.

3. At week 2, metronidazole had a better rate of symptom relief than lactic acid gel. Recurrence in 6 months was comparable across arms in a sample of patients who had initial remission and were available for follow-up.

4. Some adverse effects were observed to be more common with metronidazole than with lactic acid gel.

5. The average cost per participant with cured symptoms at week 2 was £86.94 (metronidazole), compared to £147.00 at week 1. (lactic acid gel).

6. Even though they thought lactic acid gel was less efficient than metronidazole, several individuals liked it.

In conclusion, in the absence of effective curative medication, further research into non-antibiotic therapies to address the symptoms of recurrent bacterial vaginosis is needed to enhance these patients' quality of life. Further microbiological examination of vaginal samples might be beneficial in identifying other parameters influencing treatment response.

Reference:

Armstrong-Buisseret L, Brittain C, Kai J, David M, Watkins JA, Ozolins M, et al. Lactic acid gel versus metronidazole for recurrent bacterial vaginosis in women aged 16 years and over: the VITA RCT. Health Technol Assess 2022;26(2). https://doi.org/10.3310/ZZKH4176