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