The goal of this study is to evaluate how treatment with FB301 affects the balance of vaginal bacteria in women (aged 18-45) with bacterial vaginosis after pre-treatment with either a vaginal antiseptic wash (chlorhexidine), an oral antibiotic (metronidazole), or both. The main question it aims to answer is: Does treatment with FB301, with or without pre-treatment using a vaginal antiseptic (chlorhexidine) or an oral antibiotic (metronidazole), change the balance of vaginal bacteria, measured by the proportion of two key bacteria (Lactobacillus crispatus and Lactobacillus jensenii), between the start of treatment and follow-up visits over the next 10 weeks? Researchers will compare participants randomly assigned to 4 different groups: * Group 1 will receive FB301for 15 days with the antibiotic (metronidazole) for the first seven days. In the next menstrual cycle, they will receive just FB301 for an additional 15-days. * Group 2 will receive FB301for 15 days. On the first day only, they will first undergo a vaginal cleanse with chlorhexidine (antiseptic solution). In the next menstrual cycle, they will receive just FB301 for an additional 15-days. * Group 3 will receive FB301for 15 days with the antibiotic (metronidazole) for the first seven days. On the first day only, they will first undergo a vaginal cleanse with chlorhexidine (antiseptic solution). In the next menstrual cycle, they will receive FB301 for an additional 15-days following a vaginal cleanse with chlorhexidine (antiseptic solution) on the first day only. * Group 4 will receive just FB301for 15 days. In the next menstrual cycle, they will receive just FB301 for an additional 15-days. Participants will: * Attend the study centre for up to 6 visits * Provide vaginal swab samples at up to 6 visits * Provide vaginal secretion samples using a menstrual disc at up to 4 visits * Have blood samples taken at up to 6 visits * Receive the study treatments for the randomly assigned group over two consecutive menstrual cycles.
Bacterial vaginosis is a dysbiosis of vaginal microbiota characterized by a shift from Lactobacillus dominance to that of communities of various mostly anaerobic bacteria. It is the most common vaginal disorder worldwide in women of childbearing age presenting with a range of clinical features from asymptomatic to an increase in vaginal discharge with or without the characteristic fishy odour. In addition, it is a risk factor for and/or associated with worse outcomes in sexually transmitted infections, reproduction and immune-driven diseases of the female reproductive tract. During the trial, the participants will either receive, (1) FB301, a Live Biotherapeutic Product (LBP) comprising consortia of Lactobacillus strains, together with oral antibiotic treatment metronidazole, (2) FB301 following vaginal antisepsis with 0.5% chlorhexidine solution, (3) FB301 together with oral antibiotic treatment metronidazole following vaginal antisepsis with 0.5% chlorhexidine solution or (4) FB301. In addition, all participants will receive FB301in a second treatment cycle, either alone (Groups 1,2 and 4) or following a second vaginal antisepsis with 0.5% chlorhexidine solution in Group 3. Treatment Group 1: Oral metronidazole 500 mg twice daily for 7 days starting 1 day after menses, plus intravaginal FB301 once daily for 15 days, followed by a second course of intravaginal FB301 once daily for additional 15 days starting 1 day after menses. Treatment Group 2: Intravaginal antisepsis with a single dose of 0.5% chlorhexidine solution 1 day after menses, then intravaginal FB301 once daily for 15 days, followed by second course of intravaginal FB301 once daily for additional 15 days starting immediately after the next menstrual cycle. Treatment Group 3: Intravaginal antisepsis with a single dose of 0.5% chlorhexidine solution 1 day after menses, then oral metronidazole 500 mg twice daily for 7 days and intravaginal FB301 once daily for 15 days, followed by second intravaginal antisepsis with a single dose of 0.5% chlorhexidine solution then a second course of intravaginal FB301 once daily for additional 15 days 1 day after menses. Treatment Group 4: Intravaginal FB301 once daily for 15 days starting 1 day after menses, followed by second course of intravaginal FB301 once daily for additional 15 days 1 day after menses The primary objective is to assess the impact on change in vaginal microbiome in terms of relative abundance of combined Lactobacillus species with chlorhexidine vaginal antisepsis (0.5%) and/or oral metronidazole pre-treatment followed by administration of FB301 in women with bacterial vaginosis. Secondary objectives are to assess the safety and tolerability of FB301 with chlorhexidine vaginal antisepsis (0.5%) and/or oral metronidazole pre-treatment followed by administration of FB301 in women with bacterial vaginosis and to assess the impact on rate of cure of bacterial vaginosis with chlorhexidine vaginal antisepsis (0.5%) and/or oral metronidazole pre-treatment followed by administration of FB301 in women with bacterial vaginosis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
120
FB 301 capsule
Vaginal cleanse with 0.5% Chlorhexidine solution
Metronidazole 500 mg tablets
CRS Clinical Research Services Berlin GmbH
Berlin, State of Berlin, Germany
The change in vaginal microbiome in terms of relative abundance of combined Lactobacillus crispatus and jensenii species
Metagenomic sequencing is performed on cervical vaginal swab samples. Relative abundance is expressed as a percentage of bacterial sequencing reads that are assigned to a specific bacterial species. The change in vaginal microbiome in terms of relative abundance of combined Lactobacillus crispatus and jensenii species measured by metagenomic sequencing of vaginal samples obtained from Visit 2 (Baseline) to Visit 3 (Week 3).
Time frame: Baseline to visit 3 (week 3)
The change in vaginal microbiome in terms of relative abundance of combined Lactobacillus crispatus and jensenii species.
The change in vaginal microbiome in terms of relative abundance of combined Lactobacillus crispatus and jensenii species, measured by metagenomic sequencing in vaginal samples from Visit 2 (Baseline) to Visit4 (Week 5), Visit 5 (Week 7), and Visit 6 (Week10).
Time frame: Visit 2 (Baseline) to visit 6 (week 10)
The change in vaginal microbiome in terms of relative abundance of combined vaginal Lactobacillus crispatus, jensenii, mulieris, gasseri and paragasseri
The change in vaginal microbiome in terms of relative abundance of combined vaginal Lactobacillus crispatus, jensenii, mulieris, gasseri and paragasseri measured by metagenomic sequencing in vaginal samples from Visit 2 (Baseline) to Visit 3 (Week 3), Visit 4 (Week 5), Visit 5 (Week 7), and Visit 6 (Week 10).
Time frame: Visit 2 Baseline to Visit 6 (week 10)
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