Editor—The editorial by Huovinen on bacteriotherapy is a reminder that the use of harmless bacteria to displace pathogenic ones is an alternative to the use of antibiotics for dealing with some infections, particularly those that are recurrent or persistent.1 He points out that this approach is not new: it dates back several decades, but it tended to lapse as potent antibacterial agents were developed.
Nevertheless, recently it has been used with some success to treat recurrent otitis media and prevent recurrences of streptococcal tonsillitis. Huovinen considers that bacteriotherapy is a promising approach to the future treatment and prevention of respiratory and gastrointestinal infections. He refers to studies in which the rate and severity of respiratory infections in children have been reduced by giving them milk containing Lactobacillus GG, and ulcerative colitis has been treated successfully with non-pathogenic Escherichia coli.
However, looking to the future and not mentioned at all is the possibility of using lactobacilli to treat the most common cause of vaginal discharge—namely, bacterial vaginosis. This occurs in about 10% of sexually mature women and is a condition in which the normal vaginal flora, dominated by lactobacilli, is displaced by a mixed flora of other bacteria.2 It is not trivial because it has been associated strongly with preterm labour and miscarriage and with other conditions including non-gonococcal urethritis in men.3
Treatment with metronidazole or clindamycin may be successful. Nevertheless, recurrence is common, and it is sensible to think of replacing the aberrant bacteria with lactobacilli. But strains isolated from dairy sources have been shown to be inappropriate, although they are sometimes used intravaginally by women.4 Preparations of Lactobacillus spp for oral ingestion are widely available over the counter. They are sold in some supermarkets as promoters of wellbeing. These are likely to be unhelpful to women with bacterial vaginosis because the lactobacilli are directed at the wrong anatomical site and are of the wrong kind. Vaginal lactobacilli should be used that have been shown to adhere strongly to vaginal epithelial cells and that have other desirable properties.5
Unfortunately, this approach to treatment, although logical and evaluable, has not caught the imagination of funding bodies, at least in the United Kingdom, so that basic research has been slow and clinical trials have not been initiated. We hope that a change of attitude will occur and lead to more rapid progress in the future.
References
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