5. Conclusions
This systematic review and meta-analysis suggests that in patients with
active bacterial vaginosis, astodrimer gel is superior to placebo for
all efficacy outcomes, including clinical (Amsel criteria)
microbiological (Nugent score) measures as well as patient-reported
symptoms. Moreover, astodrimer gel is largely safe and associated with
marginal rate of vulvovaginal candidiasis when compared to standard of
care antibiotics. Unique features of astodrimer gel include satisfactory
effectiveness, well-endured safety profile, negligible rate of
vulvovaginal candidiasis, topical administration, reduced systemic
exposure, anti-biofilm activity, non-antibiotic mechanism of action and
absence of antibiotic resistance. Thus, astodrimer gel may represent a
promising alternative therapy to patients who fail to respond or
intolerant to various conventional antibiotics. Further placebo- and
active comparator-controlled trials with longer follow-up periods are
needed to solidify the therapeutic efficacy and safety of astodrimer gel
in treatment of patients with bacterial vaginosis.