JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v7i2.2621 jpsim.v7i2.2621 Original Research Comparison of Effectiveness of Probiotic versus Antibiotic Monotherapy in the Treatment of Bacterial Vaginosis: A Quasiexperimental Study Kanwal Sumera sumera_kanwal11@yahoo.com * Shahzad Quratulain Jawad Zobia Ashraf Nomia Fatima Musarrat Malik Aisha King Edward Medical University/ Lady Willingdon Hospital, Lahore Akhtar Saeed Medical College, Lahore Fatima Jinnah Medical University, Lahore Government Judicial Complex, Hafizabad *Correspondence: Sumera Kanwal (sumera_kanwal11@yahoo.com) 03 06 2026 2026 7 2 104 108 18 08 2025 15 04 2026 04 05 2026 Copyright © 2026 The Author(s) 2026 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective

To compare the treatment success rate among women with bacterial vaginosis receiving either probiotic or antibiotic monotherapy.

 Methodology

A quasi-experimental study was conducted in the Department of Obstetrics & Gynaecology at Lady Willingdon Hospital, Lahore, from August 2022 to March 2023. Total 168 women were allocated into two non-randomized groups of equal size. Group A (n = 84) received probiotics twice daily for six weeks, while Group B (n = 84) received antibiotics twice daily for seven days. At six weeks post-intervention, women meeting at least three of the four Amsel’s criteria were diagnosed as bacterial vaginosis positive; those who did not were considered treated successfully. Chi-square test used to compare the treatment success rate between groups.

 Results

The distribution of baseline characteristics was comparable between study groups (all p-values >0.05). Six weeks after intervention, women in Probiotic group had slight higher frequency of vaginal discharge (60.7% vs. 57.1%; p-value 0.638), and significantly lower frequencies of fishy odor vaginal fluid (33.3% vs. 51.2%; p-value 0.019), vaginal pH >4.5 (22.6% vs. 53.6%; p-value

 Conclusion

Probiotics were more effective than antibiotics in treating bacterial vaginosis, with higher success rates and better symptom resolution. These findings support probiotics as a viable standalone treatment option.

 Keywords Probiotics Antibiotics Effectiveness Bacterial Vaginosis Ethics Statement

Ethics committee: Institutional Review Board, King Edward Medical University, Lahore, Pakistan. Approval number: 15567/REG/KEMU/2021, dated November 8, 2021.

 References Kaambo E, Africa C, Chambuso R, Passmore JS. Vaginal microbiomes associated with aerobic vaginitis and bacterial vaginosis. Front Public Health. 2018;6:78. 10.3389/fpubh.2018.00078. Mogha KV, Prajapati JB. Selection of promising strain of Lactobacillus for treating vaginal infections. Rev Res Med Microbiol. 2017;28(2):49-55. Valenti P, Rosa L, Capobianco D, Lepanto MS, Schiavi E, Cutone A, et al. Role of lactobacilli and lactoferrin in the mucosal cervicovaginal defense. Front Immunol. 2018;9:376. 10.3389/fimmu.2018.00376. Onderdonk AB, Delaney ML, Fichorova RN. The human microbiome during bacterial vaginosis. Clin Microbiol Rev. 2016;29(2):223-38. Muzny CA, Taylor CM, Swords WE, Tamhane A, Chattopadhyay D, Cerca N, et al. An updated conceptual model on the pathogenesis of bacterial vaginosis. J Infect Dis. 2019;220(9):1399-405. Nasioudis D, Linhares IM, Ledger WJ, Witkin SS. Bacterial vaginosis: a critical analysis of current knowledge. BJOG. 2017;124(1):61-9. Zozaya M, Ferris MJ, Siren JD, Lillis R, Myers L, Nsuami MJ, et al. Bacterial communities in penile skin, male urethra, and vaginas of heterosexual couples with and without bacterial vaginosis. Microbiome. 2016;4(1):16. Muthusamy S, Varghese J, Raveendran V, Ezilarasan K, Easow JM. Evaluation of interobserver reliability of Nugent score for diagnosis of bacterial vaginosis. Indian J Sex Transm Dis AIDS. 2018;39(2):120-3. Verstraelen H, Swidsinski A. The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment: 2018 update. Curr Opin Infect Dis. 2019;32(1):38-42. Menard JP. Antibacterial treatment of bacterial vaginosis: current and emerging therapies. Int J Womens Health. 2011;3:295-305. 10.2147/IJWH.S23814. Nayana AR, Keerthi TR. Harnessing probiotics and prebiotics for the prophylaxis and treatment of bacterial vaginosis. Biosci Biotech Res Asia. 2024;21(4):1289-1301. Abbe C, Mitchell CM. Bacterial vaginosis: a review of approaches to treatment and prevention. Front Reprod Health. 2023;5:1100029. Arooj A, Bano N, Nazir R, Chaudhri R. Comparison of combined probiotic and antibiotic therapy versus antibiotic therapy alone in treatment of bacterial vaginosis. J Soc Obstet Gynaecol Pak. 2017;7(2):57-60. Hanson L, VandeVusse L, Jermé M, Abad CL, Safdar N. Probiotics for treatment and prevention of urogenital infections in women: a systematic review. J Midwifery Womens Health. 2016;61(3):339-55. Huang H, Song L, Zhao W. Effects of probiotics for the treatment of bacterial vaginosis in adult women: a meta-analysis of randomized clinical trials. Arch Gynecol Obstet. 2014;289(6):1225-34. Wang Z, He Y, Zheng Y. Probiotics for the treatment of bacterial vaginosis: a meta-analysis. Int J Environ Res Public Health. 2019;16(20):3859. Heczko PB, Tomusiak A, Adamski P, Jakimiuk AJ, Stefański G, Mikołajczyk-Cichońska A, et al. Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial. BMC Womens Health. 2015;15:115. 10.1186/s12905-015-0246-6. Liu HF, Yi N. A systematic review and meta-analysis on the efficacy of probiotics for bacterial vaginosis. Eur Rev Med Pharmacol Sci. 2022;26(1):90-8. Nurainiwati SA, Ma'roef M, Pravitasari DN, Putra PYP. Effectivity and efficacy probiotics for bacterial vaginosis treatments: meta-analysis. Infect Dis Model. 2022;7(4):597-604. Shan Y, Cui Z, Ding Z, Yao Y, Chen A. Efficacy of probiotics in the treatment of adult female bacterial vaginosis: a meta-analysis. Clin Exp Obstet Gynecol. 2023;50(3):50. Armstrong E, Hemmerling A, Miller S, Burke K, Newmann S, Morris S, et al. Impact of LACTIN-V (Lactobacillus crispatus CTV-05) on genital immunology following standard bacterial vaginosis treatment: Results from a randomized placebo-controlled trial. J Int AIDS Soc. 2021;24(S1):46-7. Zhang Y, Lyu J, Ge L, Huang L, Peng Z, Liang Y, et al. Probiotic Lacticaseibacillus rhamnosus GR-1 and Limosilactobacillus reuteri RC-14 as an adjunctive treatment for bacterial vaginosis do not increase the cure rate in a Chinese cohort: a prospective, parallel-group, randomized, controlled study. Front Cell Infect Microbiol. 2021;11:669901. 10.3389/fcimb.2021.669901. Li C, Wang T, Li Y, Zhang T, Wang Q, He J, et al. Probiotics for the treatment of women with bacterial vaginosis: A systematic review and meta-analysis of randomized clinical trials. Eur J Pharmacol. 2019;864:172660. 10.1016/j.ejphar.2019.172660. Vicariotto F, Mogna L, Del Piano M. Effectiveness of the two microorganisms Lactobacillus fermentum LF15 and Lactobacillus plantarum LP01, formulated in slow-release vaginal tablets, in women affected by bacterial vaginosis: a pilot study. J Clin Gastroenterol. 2014;48 (Suppl 1):S106-12. Ling Z, Liu X, Chen W, Luo Y, Yuan L, Xia Y, et al. The restoration of the vaginal microbiota after treatment for bacterial vaginosis with metronidazole or probiotics. Microb Ecol. 2013;65(3):773-80.