4.4. Study strengths and limitations
Our study has several strengths. Most significantly, this is the first
systematic review and meta-analysis report that pooled the efficacy and
safety outcomes of astodrimer gel for the treatment of patients with
bacterial vaginosis. In addition, we pooled as many efficacy and safety
outcomes as possible using meta-analysis as a high-quality study design.
Moreover, we conducted subgroup analyses at 9-12 and 21-30 days for all
the reported efficacy outcomes. Whenever heterogeneous findings existed,
we performed a sensitivity analysis. Nonetheless, our study is not
without limitations. Such limitations include the small number of
included studies and their respective small sample size. Moreover, two
independent clinical trials originated from a single
study.22 Lastly, one of the included studies was
published in a preprint server and did not yet undergo
peer-review.24