Probiotic Efficacy in Postmenopausal Women with Bacterial Vaginosis

NCT ID: NCT06659380

Last Updated: 2024-10-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

12 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-06-26

Study Completion Date

2024-12-31

Brief Summary

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This study is a double-blind, randomized, controlled trial (RCT) aimed at evaluating the effects of Lactobacillus sp. probiotic administration on the vaginal microbiota changes in postmenopausal women with bacterial vaginosis and how its affect to immunology profile. Postmenopausal women diagnosed with bacterial vaginosis will be recruited as subjects as long as collected period in this study. All patients will receive Metronidazole antibiotic treatment then blind-randomly be divided into two groups: the treatment group, receiving Floragyn® probiotic tablets (Lapi, Indonesia), and the placebo group, receiving Cal 95® (Lapi, Indonesia). As a control, postmenopausal women without bacterial vaginosis will also be included and receive Floragyn® probiotic tablets only.

Detailed Description

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Postmenopausal women experience hormonal changes, particularly in estrogen and progesterone levels. The reduction or even cessation of estrogen secretion in postmenopausal women leads to an increased dominance of pathogenic bacteria in the vagina, which during the premenopausal period was inhibited by Lactobacillus sp. The presence of Lactobacillus in the vaginal epithelium acts as a barrier against external pathogens and produces metabolic byproducts that are unfavorable for the growth of other bacteria. The availability of glycogen, which is influenced by estrogen levels, supports the presence of Lactobacillus as an energy source. This association explains why women entering menopause are at increased risk of developing bacterial vaginosis. In addition, it is known that female reproductive hormones regulate both innate and adaptive immune responses and modulate endocrine functions that influence Th1 and Th2 cytokines, suppress excessive inflammation, and restore homeostasis.

This study conduct to investigate the effects of probiotic therapy on the vaginal microbiota changes in menopausal women and its impact on immunological profiles. Administering Lactobacillus sp. probiotics is expected to modulate bacterial growth disrupted during perimenopause and help restore homeostasis.

All postmenopausal women, during sample collected period, who meet the inclusion criteria will be enrolled as research subjects. Initially, vaginal swabs and venous blood samples will be collected to assess the bacterial vaginosis condition and hematological profiles. Once bacterial vaginosis is diagnosed, subjects will receive standard antibiotic therapy, metronidazole oral 400-500 mg twice daily or 0,75% metronidazole gel 5 grams intravaginally once daily for 5 days. 48 hours after antibiotic administration, participants will be randomly divided into two groups: the treatment group, receiving Floragyn® probiotics, and the placebo group, receiving Cal95®. Probiotic or placebo treatment will be administered orally once daily for two weeks. A healthy control group will also be included for comparison and will receive Floragyn® for two weeks.

Four weeks after the last probiotic dose, vaginal swabs and venous blood samples will be collected. The analysis will include pH, glucose, protein levels, and microbiome composition from the vaginal swabs, while venous blood samples will be analyzed for interleukin 6 and 10 levels, as well as inflammatory markers such as platelets, leukocytes, and differential leukocyte counts. The collected data will be analyzed to evaluate microbiome alterations and inflammatory markers in the treatment and placebo groups.

Conditions

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Bacterial Vaginosis (BV) Menopause

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

All patients will receive Metronidazole antibiotic treatment then blind-randomly be divided into two groups: the treatment group, receiving Floragyn® probiotic tablets (Lapi, Indonesia), and the placebo group, receiving Cal 95® (Lapi, Indonesia). As a control, postmenopausal women without bacterial vaginosis will also be included and receive Floragyn® probiotic tablets only. Patients are assessed at T0, T1 and T7 week.
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
Participant, care provider, investigator, and outcomes assessor are blind to treatment status as well as patients and families.

Study Groups

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Intervention

This group consist of postmenopausal women diagnosed with bacterial vaginosis. All subjects will receive metronidazole oral 400-500 mg twice daily or 0,75% metronidazole gel 5 grams intravaginally once daily for 5 days, then blind-randomly including to the treatment group and will receive Floragyn® probiotic tablets (Lapi, Indonesia) orally once daily for two weeks.

Group Type EXPERIMENTAL

Metronidazole + Floragyn® probiotic tablets (Lapi, Indonesia)

Intervention Type DIETARY_SUPPLEMENT

Metronidazole, sold under the brand name Flagyl among others, is an antibiotic and antiprotozoal medication. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vaginosis. It is effective for dracunculiasis, giardiasis, trichomoniasis, and amebiasis.

One tablet Floragyn contains Lactobacillus rhamnosus and lactobacillus reuteri, bacteria that are normal flora (good bacteria) of the vagina.

Placebo

This group consist of postmenopausal women diagnosed with bacterial vaginosis. All subjects will receive metronidazole oral 400-500 mg twice daily or 0,75% metronidazole gel 5 grams intravaginally once daily for 5 days, then blind-randomly including to the placebo group and will receive Cal95® probiotic tablets (Lapi, Indonesia) orally once daily for two weeks.

Group Type PLACEBO_COMPARATOR

Metronidazole + Cal95

Intervention Type DIETARY_SUPPLEMENT

Metronidazole, sold under the brand name Flagyl among others, is an antibiotic and antiprotozoal medication. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vaginosis. It is effective for dracunculiasis, giardiasis, trichomoniasis, and amebiasis.

Cal 95 is a supplement containing multivitamins and minerals including: Calcium, Zinc, Boron and Magnesium. This tablet is used to help meet calcium needs and maintain bone health in menopausal women.

Control

This group consist of postmenopausal women with no bacterial vaginosis. All subjects will receive Floragyn® probiotic tablets (Lapi, Indonesia) orally once daily for two weeks.

Group Type ACTIVE_COMPARATOR

Floragyn® probiotic tablets (Lapi, Indonesia)

Intervention Type DIETARY_SUPPLEMENT

Given to the control group to ensure the ability of probiotics to maintain a healthy vaginal ecosystem and not the opposite.

Interventions

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Metronidazole + Floragyn® probiotic tablets (Lapi, Indonesia)

Metronidazole, sold under the brand name Flagyl among others, is an antibiotic and antiprotozoal medication. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vaginosis. It is effective for dracunculiasis, giardiasis, trichomoniasis, and amebiasis.

One tablet Floragyn contains Lactobacillus rhamnosus and lactobacillus reuteri, bacteria that are normal flora (good bacteria) of the vagina.

Intervention Type DIETARY_SUPPLEMENT

Metronidazole + Cal95

Metronidazole, sold under the brand name Flagyl among others, is an antibiotic and antiprotozoal medication. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vaginosis. It is effective for dracunculiasis, giardiasis, trichomoniasis, and amebiasis.

Cal 95 is a supplement containing multivitamins and minerals including: Calcium, Zinc, Boron and Magnesium. This tablet is used to help meet calcium needs and maintain bone health in menopausal women.

Intervention Type DIETARY_SUPPLEMENT

Floragyn® probiotic tablets (Lapi, Indonesia)

Given to the control group to ensure the ability of probiotics to maintain a healthy vaginal ecosystem and not the opposite.

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

1. Postmenopausal with estradiol levels \< 25 mg/ml
2. Diagnosed have bacterial vaginosis by an obstetrician and gynecologist

Exclusion Criteria

1. Medically unable to perform a pap smear examination
2. Experiencing vaginal bleeding of unknown cause
3. Diagnosed or suspected of having a malignant disease
4. Hypersensitivity to the research treatment to be carried out
5. In the last 3 months have received hormone therapy
6. Suffering from acute infectious diseases of the genital organs
7. Using vaginal therapy in any form
8. Suffering from systemic diseases
Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Hasanuddin University

OTHER

Sponsor Role lead

Responsible Party

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Yenti Purnamasari

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Alfa Farma Health Clinic, Obstetrics and Gynecology Doctor's Practice.

Kendari, South East Sulawesi, Indonesia

Site Status RECRUITING

Countries

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Indonesia

Central Contacts

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Yenti Purnamasari

Role: CONTACT

+628114058258

Facility Contacts

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Juminten Sp.OG(K), Professor

Role: primary

+6282197276207

References

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Munoz-Barreno A, Cabezas-Mera F, Tejera E, Machado A. Comparative Effectiveness of Treatments for Bacterial Vaginosis: A Network Meta-Analysis. Antibiotics (Basel). 2021 Aug 13;10(8):978. doi: 10.3390/antibiotics10080978.

Reference Type BACKGROUND
PMID: 34439028 (View on PubMed)

Cohen CR, Wierzbicki MR, French AL, Morris S, Newmann S, Reno H, Green L, Miller S, Powell J, Parks T, Hemmerling A. Randomized Trial of Lactin-V to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med. 2020 May 14;382(20):1906-1915. doi: 10.1056/NEJMoa1915254.

Reference Type BACKGROUND
PMID: 32402161 (View on PubMed)

France M, Alizadeh M, Brown S, Ma B, Ravel J. Towards a deeper understanding of the vaginal microbiota. Nat Microbiol. 2022 Mar;7(3):367-378. doi: 10.1038/s41564-022-01083-2. Epub 2022 Mar 4.

Reference Type BACKGROUND
PMID: 35246662 (View on PubMed)

Laniewski P, Herbst-Kralovetz MM. Connecting microbiome and menopause for healthy ageing. Nat Microbiol. 2022 Mar;7(3):354-358. doi: 10.1038/s41564-022-01071-6.

Reference Type BACKGROUND
PMID: 35246661 (View on PubMed)

Peacock K, Carlson K, Ketvertis KM. Menopause. 2023 Dec 21. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK507826/

Reference Type BACKGROUND
PMID: 29939603 (View on PubMed)

Peebles K, Velloza J, Balkus JE, McClelland RS, Barnabas RV. High Global Burden and Costs of Bacterial Vaginosis: A Systematic Review and Meta-Analysis. Sex Transm Dis. 2019 May;46(5):304-311. doi: 10.1097/OLQ.0000000000000972.

Reference Type BACKGROUND
PMID: 30624309 (View on PubMed)

Related Links

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https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2018.02279/full

Moulton Vaishall R (2018). Sex Hormones in Acquired Immunity and Autoimmune Disease. Frontiers in Immunology. Doi: 10.3389/fimmu.2018.02279

https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2019.00193/full

Gliniewicz Karol et al (2019). Comparison of the Vaginal Microbiomes of Premenopausal and Postmenopausal Women. Frontiers in Microbiology. Front Microbiol. 2019;10:193. Doi: 10.3389/fmicb.2019.00193

Other Identifiers

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B3/UN4.6.4.5.31-1/ PP36 / 2024

Identifier Type: -

Identifier Source: org_study_id

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