Efficacy of Rifaximin Vaginal Tablets in Treatment of Bacterial Vaginosis: a Molecular Characterization of the Vaginal Microbiota

Overview

Journal Antimicrob Agents Chemother

Publisher American Society for Microbiology

Specialty Pharmacology

Date 2012 May 16

PMID 22585228

Citations 10

Authors

Federica Cruciani

Patrizia Brigidi

Fiorella Calanni

Vittoria Lauro

Raffaella Tacchi

Gilbert Donders

Klaus Peters

Secondo Guaschino

Beatrice Vitali

Affiliations

Soon will be listed here.

Abstract

Bacterial vaginosis (BV) is a common vaginal disorder characterized by an alteration of the vaginal bacterial morphotypes, associated with sexually transmitted infections and adverse pregnancy outcomes. The purpose of the present study was to evaluate the impact of different doses of rifaximin vaginal tablets (100 mg/day for 5 days, 25 mg/day for 5 days, and 100 mg/day for 2 days) on the vaginal microbiota of 102 European patients with BV enrolled in a multicenter, double-blind, randomized, placebo-controlled study. An integrated molecular approach based on quantitative PCR (qPCR) and PCR-denaturing gradient gel electrophoresis (PCR-DGGE) was used to investigate the effects of vaginal tablets containing the antibiotic. An increase in members of the genus Lactobacillus and a decrease in the BV-related bacterial groups after the antibiotic treatment were demonstrated by qPCR. PCR-DGGE profiles confirmed the capability of rifaximin to modulate the composition of the vaginal microbial communities and to reduce their complexity. This molecular analysis supported the clinical observation that rifaximin at 25 mg/day for 5 days represents an effective treatment to be used in future pivotal studies for the treatment of BV.

Citing Articles

Univariate Statistical Analysis as a Guide to ¹H-NMR Spectra Signal Assignment by Visual Inspection.

Zhu C, Vitali B, Donders G, Parolin C, Li Y, Laghi L Metabolites. 2019; 9(1).

PMID: 30650532 PMC: 6359365. DOI: 10.3390/metabo9010015.

Design and validation of a DNA-microarray for phylogenetic analysis of bacterial communities in different oral samples and dental implants.

Parolin C, Giordani B, Nahui Palomino R, Biagi E, Severgnini M, Consolandi C Sci Rep. 2017; 7(1):6280.

PMID: 28740183 PMC: 5524749. DOI: 10.1038/s41598-017-06743-6.

Novel approaches for the taxonomic and metabolic characterization of lactobacilli: Integration of 16S rRNA gene sequencing with MALDI-TOF MS and 1H-NMR.

Foschi C, Laghi L, Parolin C, Giordani B, Compri M, Cevenini R PLoS One. 2017; 12(2):e0172483.

PMID: 28207855 PMC: 5312945. DOI: 10.1371/journal.pone.0172483.

Improvement of abnormal vaginal flora in Ugandan women by self-testing and short use of intravaginal antimicrobials.

Donders G, Bellen G, Donders F, Pinget J, Vandevelde I, Michiels T Eur J Clin Microbiol Infect Dis. 2016; 36(4):731-738.

PMID: 27933401 DOI: 10.1007/s10096-016-2856-9.

Microbicides for the Treatment of Sexually Transmitted HIV Infections.

Singh O, Garg T, Rath G, Goyal A J Pharm (Cairo). 2015; 2014:352425.

PMID: 26556193 PMC: 4590794. DOI: 10.1155/2014/352425.

References

Lamont R, Sobel J, Akins R, Hassan S, Chaiworapongsa T, Kusanovic J . The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG. 2011; 118(5):533-49. PMC: 3055920. DOI: 10.1111/j.1471-0528.2010.02840.x. View

Kim T, Thomas S, Ho M, Sharma S, Reich C, Frank J . Heterogeneity of vaginal microbial communities within individuals. J Clin Microbiol. 2009; 47(4):1181-9. PMC: 2668325. DOI: 10.1128/JCM.00854-08. View

Kaewsrichan J, Peeyananjarassri K, Kongprasertkit J . Selection and identification of anaerobic lactobacilli producing inhibitory compounds against vaginal pathogens. FEMS Immunol Med Microbiol. 2006; 48(1):75-83. DOI: 10.1111/j.1574-695X.2006.00124.x. View

Bradshaw C, Morton A, Hocking J, Garland S, Morris M, Moss L . High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis. 2006; 193(11):1478-86. DOI: 10.1086/503780. View

Biagi E, Vitali B, Pugliese C, Candela M, Donders G, Brigidi P . Quantitative variations in the vaginal bacterial population associated with asymptomatic infections: a real-time polymerase chain reaction study. Eur J Clin Microbiol Infect Dis. 2008; 28(3):281-5. DOI: 10.1007/s10096-008-0617-0. View

Nugent R, Krohn M, Hillier S . Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991; 29(2):297-301. PMC: 269757. DOI: 10.1128/jcm.29.2.297-301.1991. View

Scarpignato C, Pelosini I . Rifaximin, a poorly absorbed antibiotic: pharmacology and clinical potential. Chemotherapy. 2005; 51 Suppl 1:36-66. DOI: 10.1159/000081990. View

Heilig H, Zoetendal E, Vaughan E, Marteau P, Akkermans A, de Vos W . Molecular diversity of Lactobacillus spp. and other lactic acid bacteria in the human intestine as determined by specific amplification of 16S ribosomal DNA. Appl Environ Microbiol. 2002; 68(1):114-23. PMC: 126540. DOI: 10.1128/AEM.68.1.114-123.2002. View

Wiesenfeld H, Hillier S, Krohn M, Landers D, Sweet R . Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis. 2003; 36(5):663-8. DOI: 10.1086/367658. View

10.

Zariffard M, Saifuddin M, Sha B, Spear G . Detection of bacterial vaginosis-related organisms by real-time PCR for Lactobacilli, Gardnerella vaginalis and Mycoplasma hominis. FEMS Immunol Med Microbiol. 2002; 34(4):277-81. DOI: 10.1111/j.1574-695X.2002.tb00634.x. View

11.

Hoover W, Gerlach E, Hoban D, Eliopoulos G, Pfaller M, Jones R . Antimicrobial activity and spectrum of rifaximin, a new topical rifamycin derivative. Diagn Microbiol Infect Dis. 1993; 16(2):111-8. DOI: 10.1016/0732-8893(93)90004-q. View

12.

Donders G, Bellen G, Rezeberga D . Aerobic vaginitis in pregnancy. BJOG. 2011; 118(10):1163-70. DOI: 10.1111/j.1471-0528.2011.03020.x. View

13.

Fredricks D, Fiedler T, Marrazzo J . Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med. 2005; 353(18):1899-911. DOI: 10.1056/NEJMoa043802. View

14.

Ling Z, Kong J, Liu F, Zhu H, Chen X, Wang Y . Molecular analysis of the diversity of vaginal microbiota associated with bacterial vaginosis. BMC Genomics. 2010; 11:488. PMC: 2996984. DOI: 10.1186/1471-2164-11-488. View

15.

Chen K, Forsyth P, Buchanan T, Holmes K . Amine content of vaginal fluid from untreated and treated patients with nonspecific vaginitis. J Clin Invest. 1979; 63(5):828-35. PMC: 372023. DOI: 10.1172/JCI109382. View

16.

Marconi C, Cruciani F, Vitali B, Donders G . Correlation of Atopobium vaginae Amount With Bacterial Vaginosis Markers. J Low Genit Tract Dis. 2012; 16(2):127-32. DOI: 10.1097/LGT.0b013e31823c79c4. View

17.

Ronnqvist P, Forsgren-Brusk U, Grahn-Hakansson E . Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH. Acta Obstet Gynecol Scand. 2006; 85(6):726-35. DOI: 10.1080/00016340600578357. View

18.

Oakley B, Fiedler T, Marrazzo J, Fredricks D . Diversity of human vaginal bacterial communities and associations with clinically defined bacterial vaginosis. Appl Environ Microbiol. 2008; 74(15):4898-909. PMC: 2519371. DOI: 10.1128/AEM.02884-07. View

19.

Mardh P . The vaginal ecosystem. Am J Obstet Gynecol. 1991; 165(4 Pt 2):1163-8. DOI: 10.1016/s0002-9378(12)90721-8. View

20.

Ling Z, Liu X, Chen X, Zhu H, Nelson K, Xia Y . Diversity of cervicovaginal microbiota associated with female lower genital tract infections. Microb Ecol. 2011; 61(3):704-14. DOI: 10.1007/s00248-011-9813-z. View