5. Conclusions
This systematic review and meta-analysis suggests that in patients with active bacterial vaginosis, astodrimer gel is superior to placebo for all efficacy outcomes, including clinical (Amsel criteria) microbiological (Nugent score) measures as well as patient-reported symptoms. Moreover, astodrimer gel is largely safe and associated with marginal rate of vulvovaginal candidiasis when compared to standard of care antibiotics. Unique features of astodrimer gel include satisfactory effectiveness, well-endured safety profile, negligible rate of vulvovaginal candidiasis, topical administration, reduced systemic exposure, anti-biofilm activity, non-antibiotic mechanism of action and absence of antibiotic resistance. Thus, astodrimer gel may represent a promising alternative therapy to patients who fail to respond or intolerant to various conventional antibiotics. Further placebo- and active comparator-controlled trials with longer follow-up periods are needed to solidify the therapeutic efficacy and safety of astodrimer gel in treatment of patients with bacterial vaginosis.