Restoring of vaginal microbiota in the bacterial vaginosis therapy: the efficacy of butyric acid and inulin. A prospective randomized study

Background. Bacterial vaginosis remains one of the most common vaginal microbiome disorders, affecting from 20% to 30% women of reproductive age worldwide. Despite standard antibiotic guidelines, recurrence rates can reach up to 50% within 12 months posttherapy. This necessitates the search for new therapeutic approaches aimed not only at eliminating pathogens, but also at the restoration of vaginal microbiota physiological balance. Studying the role of short-chain fatty acids including butyric acid (butyrate) and prebiotics such as inulin in maintaining vaginal microenvironment homeostasis is of particular interest. Butyric acid, being a key metabolite of the healthy microbiota, possesses anti-inflammatory properties and promotes the restoration of epithelial barrier function. Inulin, on the other hand, serves as a selective substrate for the growth of beneficial bacteria, including Lactobacillus spp. Recent studies demonstrate the potential benefit of a strategy of bacterial vaginosis comprehensive treatment including butyric acid and inulin combination as an additional component of standard therapy. This synergistic effect leads to speedier recovery of microbiota. Inulin serves as a substrate for the endogenous butyric acid production, colonization resistance is enhanced; the pH-dependent metabolism of lactobacilli is optimised. The combination of inulin and butyric acid has a beneficial effect on the vaginal microbiota.

Objective. This study aimed to evaluate the effectiveness of the combination therapy including butyric acid and inulin for the restoration of the normal vaginal microbiome in female patients with bacterial vaginosis.

Results. The data obtained demonstrate that the inclusion of a combination of butyric acid and inulin in standard treatment for bacterial vaginosis promotes more sustainable recovery of vaginal microbiota. Statistically significant differences in pH levels and lactobacillus count at 6 months support the long-term efficacy of a combined approach. The limitations of the study include the small sample size and open-label design, which could have influenced the subjective assessment of symptoms. To confirm the efficacy of the combination, it is advisable to conduct a double-blind, placebo-controlled study with an extended follow-up period.

Conclusion. The combination of butyric acid and inulin has demonstrated significant potential as adjuvant therapy for bacterial vaginosis. Its application is associated with sustained lactobacilli restoration, vaginal pH normalization and reduction in recurrence rates. Further research is needed to elucidate the complex interactions among butyric acid, gut microbiota, and female reproductive system. These findings may pave the way for new microbiota-based therapeutic approaches to improve the reproductive health and the overall quality of life in women with bacterial vaginosis. A promising approach suggests the optimisation of the treatment duration to prolong the beneficial effects on microbiota.

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