Table 3.
Antimicrobial activity of chitosan-formulations targeting vaginal infections.
| Formulation/Role of Chitosan | Targeted Vaginal Infection | Active Ingredient | Main Finding(s) | Ref. |
|---|---|---|---|---|
| Particles and carriers | Candidiasis | Clotrimazole | Decreased antifungal activity in vitro but improved safety profile for CNP-associated clotrimazole | [285] |
| Callophycin A | Synergetic and improved antifungal effect both in vitro and in vivo by Callophycin A in CNPs | [286] | ||
| Thiosemicarbazide | CNP-associated thiosemicarbazide obtained a prominent reduction of fungal burden in vivo | [287] | ||
| Miconazole | CNPs containing a seven-fold lower miconazole concentration than conventional miconazole cream obtained equal therapeutic effect | [288] | ||
| Miconazole and farnesol |
The combination of miconazole and farnesol in CNPs expressed a greater antifungal effect in vivo | [289] | ||
| Argentinean medicinal plants | Chitosan microcapsules containing active substances exhibited strong antifungal capacity in vitro | [290] | ||
| Bacterial vaginosis | Doxycycline | CNP-associated doxycycline expressed a significant reduction in E. coli viability in vitro | [291] | |
| Metronidazole | Superior in vitro inhibition of B. fragilis growth by chitosan-alginate microspheres containing metronidazole | [265] | ||
| Aerobic vaginitis | Cefixime | Cefixime microspheres reduced E. coli viability in vitro | [292] | |
| Trichomoniasis | - | CNPs expressed concentrations and time-dependent antimicrobial activity against T. vaginalis in vitro | [293] | |
| Gonorrhoea | - | CNPs expressed antigonoccocal activity against all tested strains, including high-level resistant N. gonorrhoeae | [294] | |
| Coating material and excipient | Candidiasis | Tioconazole and econazole | Chitosan-coated nanocapsules maintained the antifungal activity for both drugs in vitro | [295] |
| Clotrimazole | Chitosan-coated PLGA NPs increased the antifungal activity of clotrimazole in vitro | [296] | ||
| Metronidazole | Fungal inhibition was equal for the chitosan-based formulation containing metronidazole and the drug-free formulation | [27] | ||
| Herbal medicine | All constituents of the microemulsion expressed antifungal activity in vitro, including chitosan | [297] | ||
| Metronidazole | In vitro antifungal activity was increased in the presence of chitosan and independent of metronidazole | [298] | ||
| Amphotericin B | The hydrogel containing amphotericin B-loaded chitosan microplatelets obtained a complete cure of infection in vivo | [299] | ||
| Fluconazole | Chitosan-based vaginal inserts containing fluconazole showed improved antifungal activity both in vitro and in vivo compared to free drug | [300] | ||
| Curcumin | Curcumin liquid crystal system containing chitosan increased the antifungal potency of curcumin in vitro | [301] | ||
| Curcumin liquid crystal system containing chitosan significantly decreased fungal burden in vivo and efficiently reduced the growth of biofilm in vitro | [302] | |||
| Fluconazole | Chitosan-based vaginal tablets increased the antifungal activity of fluconazole | [303] | ||
| Chelidonii herba extract | Chitosan-based vaginal tablets detained the in vitro antimicrobial activity of the extract | [304] | ||
| Ketoconazole | Ketoconazole-containing chitosan and gellan gum gel flakes in thermosensitive gel expressed antifungal effect in vivo | [305] | ||
| Itraconazole | Thermosensitive gel with a chitosan gel-flake system significantly improved the antifungal effect of itraconazole in vivo | [306] | ||
| Chlorhexidine | Chitosan-based vaginal inserts increased the antifungal activity of chlorhexidine in vitro | [307] | ||
| Chitosan-based vaginal inserts increased the antifungal activity of chlorhexidine in vitro | [308] | |||
| Bacterial vaginosis | - | Chitosan-coated liposomes expressed in vitro antibacterial effect against S. epidermidis and S. aureus | [8] | |
| Metronidazole | Vaginal tablets containing chitosan and metronidazole inhibited B. fragilis growth in vitro | [309] | ||
| Aerobic vaginitis | Chlorhexidine | Chitosan-based vaginal inserts increased the antimicrobial activity against E. coli of chlorhexidine in vitro | [307] | |
| Chitosan-based vaginal inserts increased the antimicrobial activity against E. coli of chlorhexidine in vitro | [308] | |||
| Metronidazole | Metronidazole vaginal tablets containing chitosan exhibited in vitro antimicrobial effect against E. coli | [310] | ||
| Trichomoniasis | - | In vitro antimicrobial effect was related to the PIBCA NPs and dependent on chitosan coating of NPs | [271] | |
| Metronidazole | Increased in vitro antimicrobial activity of chitosan-coated NPs compared to noncoated | [270] | ||
| Antimicrobial effect of metronidazole was maintained when in chitosan delivery system | [311] | |||
| - | The hydrogel containing chitosan proved to reduce T. vaginalis motility in biological fluids | [312] | ||
| Vaginal gel | Candidiasis | - | Chitosan hydrogel was confirmed to have intrinsic antifungal properties in vitro | [313] |
| Thymbra capitata essential oil | Chitosan hydrogel with essential oil showed increased in vitro antifungal activity and the ability to disrupt biofilm in a dose-dependent manner | [314] | ||
| Mitracarpus frigidus extract | Chitosan hydrogel with the extract obtained antifungal effect in vivo comparable to the marketed product | [315] | ||
| Miconazole or econazole | Superior in vitro antifungal activity by LMW chitosan hydrogel containing miconazole | [316] | ||
| Pelargonium graveolens essential oil | Chitosan hydrogel-thickened nanoemulsion containing essential oil expressed antifungal activity in vitro | [317] | ||
| - | Chitosan hydrogel significantly reduced biofilm formations both in vitro and in an in vivo model | [318] | ||
| Iminoboronate | Fungicidal activity in biomimetic conditions and inhibition of biofilm formation in vitro was obtained | [319] | ||
| Bacterial vaginosis | - | Low concentration chitosan hydrogel efficiently eradicated Pseudomonas aeruginosa biofilms in vitro | [24] | |
| Superior in vitro activity against S. aureus and S. epidermidis by chitosan formulated as hydrogel | [8] | |||
| Metronidazole | 3D printed vaginal ring containing chitosan and metronidazole obtained a bactericidal effect against E. coli and confirmed synergistic antibacterial effect by chitosan and metronidazole | [320] | ||
| Trichomoniasis | Auranofin | The chitosan-based hydrogel containing auranofin NPs managed to completely inhibit parasite growth in vitro in a dose-dependent manner | [321] | |
| Chlamydia | Resveratrol | Superior antichlamydial activity in vitro was by resveratrol liposomes-in-hydrogel in the lower concentrations | [276] | |
| Vaginal film | Candidiasis | Fluconazole | The chitosan-based vaginal film obtained in vitro fungal growth inhibition comparable to the marketed product | [322] |
| Tioconazole | Drug-free chitosan vaginal film expressed in vitro fungicidal activity; however, superior activity when loaded with tioconazole | [323] | ||
| Econazole | Chitosan-based matrices containing econazole microparticles expressed antifungal activity in vitro | [324] | ||
| Bacterial vaginosis | Metronidazole | Chitosan-based membrane did not restrain the effect of metronidazole against S. aureus and G. vaginalis in vitro | [325] | |
| Aerobic vaginitis | Ciprofloxacin | Vaginal films enhanced the activity of ciprofloxacin against E. coli and S. aureus in vitro | [326] |
CNPs: chitosan nanoparticles, NPs: nanoparticles, PIBCA: poly(isobutylcyanoacrylate), LMW: low molecular weight, MPs: microparticles.