Современные аспекты лечения вагинальных инфекций в период гестации

Доброхотова Ю.Э., Озолиня Л.А., Бондаренко К.Р. и др. Современные аспекты лечения вагинальных инфекций в период гестации. Гинекология. 2016; 18 (3): 9–15.

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Dobrokhotova Yu.E., Ozolinia L.A., Bondarenko K.R. et al. Current issues in therapy of vaginal infections during gestation. Gynecology. 2016; 18 (3): 9–15.

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Аннотация

Инфекции органов репродуктивного тракта, вызванные различными представителями влагалищной микробиоты, способны существенно нарушить течение гестационного периода. В обзоре представлены современные литературные данные о роли бактериального вагиноза и вульвовагинального кандидоза в развитии акушерских осложнений. Стандартная терапия вагинальных инфекций имеет ограничения: в ряде случаев может быть сопряжена с возникновением нежелательных явлений и побочных эффектов, иногда – с клинической неэффективностью при необходимости комплексного воздействия на патогены при смешанных инфекциях. В качестве альтернативного лекарственного средства для лечения бактериального вагиноза и вульвовагинального кандидоза предлагается интравагинальное использование препарата с антисептическим действием – деквалиния хлорид 10 мг, который подтвердил свою безопасность и эффективность в клинических исследованиях, проведенных с участием более 3 тыс. женщин.

Ключевые слова: беременность, вагинальные инфекции, деквалиния хлорид.

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Infections of the reproductive tract caused by various representatives of the vaginal microbiota have been associated with increased risk of pregnancy complications. This review presents the current data from the literature on the role of bacterial vaginosis and vulvovaginal candidiasis in the development of obstetric complications. Standard therapy of vaginal infections has a number of restrictions: in some cases it can cause adverse events and side effects, sometimes it can be ineffective if it is necessary to achieve complex effects on pathogens in mixed infections. As an alternative drug for the treatment of bacterial vaginosis and vulvovaginal candidiasis intravaginal use of the drug with an antiseptic effect (dequalinium chloride 10 mg, which confirmed its safety and efficacy in clinical studies conducted with the participation of more than 3000 women) is proposed.

Key words: pregnancy, vaginal infections, dequalinium chloride.

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Список литературы

1. Romero R, Hassan SS, Gajer P et al. The vaginal microbiota of pregnant women who subsequently have spontaneous preterm labor and delivery and those with a normal delivery at term. Microbiome 2014; 27 (2): 18.
2. Aagaard K, Riehle K, Ma J et al. A metagenomic approach to characterization of the vaginal microbiome signature in pregnancy. PloS One 2012; 7 (6): e36466.
3. Lamont RF, Sobel JD, Akins RA et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. Br J Obstet Gynaecol 2011; 118 (5): 533–49.
4. Бондаренко К.Р., Озолиня Л.А., Бондаренко В.М. Патогенетические аспекты дисбиоза влагалища и современные возможности его коррекции. Акуш. и гинекол. 2014; 8: 127–32. / Bondarenko K.R., Ozolinia L.A., Bondarenko V.M. Patogeneticheskie aspekty disbioza vlagalishcha i sovremennye vozmozhnosti ego korrektsii. Akush. i ginekol. 2014; 8: 127–32. [in Russian]
5. Donati L, Di Vico A, Nucci M et al. Vaginal microbial flora and outcome of pregnancy. Arch Gynecol Obstet 2010; 281: 589–600.
6. Donders GG, van Calsteren K, Bellen G et al. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG 2009; 116 (10): 1315–24.
7. Kenyon C, Colebunders R, Crucitti T. The global epidemiology of bacterial vaginosis: a systematic review. Am J Obstet Gynecol 2013; 209 (6): 505–23.
8. Lamont RF. Advances in the Prevention of Infection-Related Preterm Birth. Front Immunol 2015; 16 (6): 566.
9. Swidsinski A, Mendling et al. An adherent Gardnerella vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazole. Am J Obstet Gynecol 2008; 198 (1): 97.e1-6.
10. Patterson JL, Girerd PH, Karjane NW, Jefferson KK. Effect of biofilm phenotype on resistance of Gardnerella vaginalis to hydrogen peroxide and lactic acid. Am J Obstet Gynecol 2007; 197: 170.
11. Bradshaw CS, Tabrizi SN, Fairley CK et al. The association of Atopobium vaginae and Gardnerella vaginalis with bacterial vaginosis and recurrence after oral metronidazole therapy. J Infect Dis 2006; 194 (6): 828–36.
12. Brocklehurst P, Gordon A, Heatley E, Milan SJ. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2013; 31 (1): CD000262.
13. Sheehy O, Santos F, Ferreira E, Berard A. The use of metronidazole during pregnancy: a review of evidence. Curr Drug Saf 2015; 10 (2): 170–9.
14. Dobias L, Cerna M, Rossner P, Sram R. Genotoxicity and carcinogenicity of metronidazole. Mutat Res 1994; 317: 177–94.
15. Rustia M, Shubik P. Experimental induction of hepatomas, mammary tumors, and other tumors with metronidazole in noninbred Sas: MRC(WI)BR rats. J Natl Cancer Inst 1979; 63: 863–8.
16. Koumans EH, Markowitz LE, Hogan V. Indications for therapy and treatment recommendations for bacterial vaginosis in nonpregnant and pregnant women: a synthesis of data. Clin Infect Dis 2002; 35: S152–S172.
17. Sobel JD. Bacterial vaginosis. Ann Rev Med 2000; 51: 349–56.
18. Mendling W, Weissenbacher ER, Gerber S et al. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Arch Gynecol Obstet 2016; 293 (3): 469–84.
19. Austin MN, Beigi RH, Meyn LA, Hillier SL. Microbiologic response to treatment of bacterial vaginosis with topical clindamycin or metronidazole. J Clin Microbiol 2005; 43: 4492–7.
20. Agnew KJ, Hillier SL. The effect of treatment regimens for vaginitis and cervicitis on vaginal colonization by lactobacilli. Sex Transm Dis 1995; 22: 269–73.
21. Weissenbacher ER, Donders G, Unzeitig V et al. A comparison of dequalinium chloride vaginal tablets (FluomizinR) and clindamycin vaginal cream in the treatment of bacterial vaginosis: a single-blind, randomized clinical trial of efficacy and safety. Gynecol Obstet Invest 2012; 73 (1): 8–15.
22. Petersen EE, Weissenbacher ER, Hengst P et al. Local treatment of vaginal infections of varying etiology with dequalinium chloride or povidone iodine. A randomised, double-blind, active-controlled, multicentric clinical study. Arzneimittelforschung 2002; 52 (9): 706–15.
23. Радзинский В.Е. и др. Двухэтапная терапия вагинальных инфекций. Акуш. и гинекол. 2011; 5: 78–81. / Radzinskii V.E. i dr. Dvukhetapnaia terapiia vaginal'nykh infektsii. Akush. i ginekol. 2011; 5: 78–81. [in Russian]
24. Aguin TJ, Sobel JD. Vulvovaginal candidiasis in pregnancy. Curr Infect Dis Rep 2015; 17 (6): 462.
25. Della Casa V, Noll H, Gonser S et al. Antimicrobial activity of dequalinium chloride against leading germs of vaginal infections. Arzneim-Forsch. Drug Res 2002; 52 (9): 699–705.
26. Sobel JD, Subramanian C, Foxman B et al. Mixed vaginitis-more than coinfection and with therapeutic implications. Curr Infect Dis Rep 2013; 15 (2): 104–8.
27. Strecker M, Kokemohr H, Teucher T, Schmitz H. Antiseptika gegen Vulvovaginitiden. TW Gynäkologie 1993; 6: 409–12.

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1. Romero R, Hassan SS, Gajer P et al. The vaginal microbiota of pregnant women who subsequently have spontaneous preterm labor and delivery and those with a normal delivery at term. Microbiome 2014; 27 (2): 18.
2. Aagaard K, Riehle K, Ma J et al. A metagenomic approach to characterization of the vaginal microbiome signature in pregnancy. PloS One 2012; 7 (6): e36466.
3. Lamont RF, Sobel JD, Akins RA et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. Br J Obstet Gynaecol 2011; 118 (5): 533–49.
4. Bondarenko K.R., Ozolinia L.A., Bondarenko V.M. Patogeneticheskie aspekty disbioza vlagalishcha i sovremennye vozmozhnosti ego korrektsii. Akush. i ginekol. 2014; 8: 127–32. [in Russian]
5. Donati L, Di Vico A, Nucci M et al. Vaginal microbial flora and outcome of pregnancy. Arch Gynecol Obstet 2010; 281: 589–600.
6. Donders GG, van Calsteren K, Bellen G et al. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG 2009; 116 (10): 1315–24.
7. Kenyon C, Colebunders R, Crucitti T. The global epidemiology of bacterial vaginosis: a systematic review. Am J Obstet Gynecol 2013; 209 (6): 505–23.
8. Lamont RF. Advances in the Prevention of Infection-Related Preterm Birth. Front Immunol 2015; 16 (6): 566.
9. Swidsinski A, Mendling et al. An adherent Gardnerella vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazole. Am J Obstet Gynecol 2008; 198 (1): 97.e1-6.
10. Patterson JL, Girerd PH, Karjane NW, Jefferson KK. Effect of biofilm phenotype on resistance of Gardnerella vaginalis to hydrogen peroxide and lactic acid. Am J Obstet Gynecol 2007; 197: 170.
11. Bradshaw CS, Tabrizi SN, Fairley CK et al. The association of Atopobium vaginae and Gardnerella vaginalis with bacterial vaginosis and recurrence after oral metronidazole therapy. J Infect Dis 2006; 194 (6): 828–36.
12. Brocklehurst P, Gordon A, Heatley E, Milan SJ. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2013; 31 (1): CD000262.
13. Sheehy O, Santos F, Ferreira E, Berard A. The use of metronidazole during pregnancy: a review of evidence. Curr Drug Saf 2015; 10 (2): 170–9.
14. Dobias L, Cerna M, Rossner P, Sram R. Genotoxicity and carcinogenicity of metronidazole. Mutat Res 1994; 317: 177–94.
15. Rustia M, Shubik P. Experimental induction of hepatomas, mammary tumors, and other tumors with metronidazole in noninbred Sas: MRC(WI)BR rats. J Natl Cancer Inst 1979; 63: 863–8.
16. Koumans EH, Markowitz LE, Hogan V. Indications for therapy and treatment recommendations for bacterial vaginosis in nonpregnant and pregnant women: a synthesis of data. Clin Infect Dis 2002; 35: S152–S172.
17. Sobel JD. Bacterial vaginosis. Ann Rev Med 2000; 51: 349–56.
18. Mendling W, Weissenbacher ER, Gerber S et al. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Arch Gynecol Obstet 2016; 293 (3): 469–84.
19. Austin MN, Beigi RH, Meyn LA, Hillier SL. Microbiologic response to treatment of bacterial vaginosis with topical clindamycin or metronidazole. J Clin Microbiol 2005; 43: 4492–7.
20. Agnew KJ, Hillier SL. The effect of treatment regimens for vaginitis and cervicitis on vaginal colonization by lactobacilli. Sex Transm Dis 1995; 22: 269–73.
21. Weissenbacher ER, Donders G, Unzeitig V et al. A comparison of dequalinium chloride vaginal tablets (FluomizinR) and clindamycin vaginal cream in the treatment of bacterial vaginosis: a single-blind, randomized clinical trial of efficacy and safety. Gynecol Obstet Invest 2012; 73 (1): 8–15.
22. Petersen EE, Weissenbacher ER, Hengst P et al. Local treatment of vaginal infections of varying etiology with dequalinium chloride or povidone iodine. A randomised, double-blind, active-controlled, multicentric clinical study. Arzneimittelforschung 2002; 52 (9): 706–15.
23. Radzinskii V.E. i dr. Dvukhetapnaia terapiia vaginal'nykh infektsii. Akush. i ginekol. 2011; 5: 78–81. [in Russian]
24. Aguin TJ, Sobel JD. Vulvovaginal candidiasis in pregnancy. Curr Infect Dis Rep 2015; 17 (6): 462.
25. Della Casa V, Noll H, Gonser S et al. Antimicrobial activity of dequalinium chloride against leading germs of vaginal infections. Arzneim-Forsch. Drug Res 2002; 52 (9): 699–705.
26. Sobel JD, Subramanian C, Foxman B et al. Mixed vaginitis-more than coinfection and with therapeutic implications. Curr Infect Dis Rep 2013; 15 (2): 104–8.
27. Strecker M, Kokemohr H, Teucher T, Schmitz H. Antiseptika gegen Vulvovaginitiden. TW Gynäkologie 1993; 6: 409–12.

Авторы

Ю.Э.Доброхотова*, Л.А.Озолиня, К.Р.Бондаренко, И.А.Лапина, А.С.Дворников

ГБОУ ВПО Российский национальный исследовательский медицинский университет им. Н.И.Пирогова Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*pr.dobrohotova@mail.ru

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Yu.E.Dobrokhotova*, L.A.Ozolinia, K.R.Bondarenko, I.A.Lapina, A.S.Dvornikov

N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*pr.dobrohotova@mail.ru

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