4.2. Clinical implications
The etiopathogenesis of BV is not completely delineated. Nonetheless, formation of a pathogenic biofilm—principally by Gardnerella vaginalis —is a prime event in bacterial vaginosis.8, 39 This biofilm has an augmented propensity to attach to vaginal epithelial cells, consequently mediating the adherence and propagation of additional bacterial vaginosis-associated anaerobes, for instance,Atopobium vaginae and others. The end result in bacterial vaginosis is a substitution in vaginal microbiota composition from normal Gram-positive lactobacilli to pathogenic anaerobic bacteria, most prominently Gardnerella vaginalis .8, 39 This biofilm barrier persists after therapy. Additionally, it contributes to treatment resistance and relapse by reducing the penetration capability of drugs targeting bacterial vaginosis 8, 40.
Astodrimer gel emerges as a novel therapy for treatment of bacterial vaginosis. When compared to conventional antibiotics, astodrimer gel holds several substantial advantages. Most importantly, astodrimer gel exhibits a unique non-antibiotic based activity against biofilms, in terms of dismantling and suppressing the formation of biofilms implicated in the pathogenesis of bacterial vaginosis. This anti-biofilm activity is principally related to the structural features of astodrimer. To elaborate, astodrimer is a large-sized molecule with negative charge, which favorably impedes the capacity of bacteria to attach to epithelial surfaces, thus eventually inhibiting and disrupting biofilms. This non-antibiotic mechanism of action is highly beneficial, particularly for patients who are intolerant of current antibiotic medications or those who desire a substitute management option. Also, astodrimer gel may be appealing to patients who fail to respond to various conventional antibiotics. Eventually, astodrimer gel evades the hurdle of antibiotic resistance. The satisfactory pharmacokinetic properties of astodrimer gel—particularly local drug application and lack of systemic absorption—further encourage its use in patients with bacterial vaginosis. With regard to safety, astodrimer gel is largely well endured and the rate of posttreatment candidiasis overgrowth is marginal. Overall, astodrimer gel carries the prospect to satisfy the gap of unmet clinical necessity for a more suitable treatment option for patients with bacterial vaginosis.