CHAPITRE I- REVUE BIBLIOGRAPHIQUE
B. Vaginoses bactériennes iatrogènes
I.2.9. Probiotique comme alternatif thérapeutique de la vaginose bactérienne
Le traitement antimicrobien des infections urogénitales, de la vaginose bactérienne et des IST n'est pas toujours efficace. En plus, les problèmes demeurent graves en raison de l’émergence des souches bactériennes qui résistent au traitement
conventionnel (Schimtt et al., 1992; Reid et al., 1997). Devant ce problème, la
recherche des remèdes alternatifs est un besoin essentiel pour la santé publique. Le concept d’inhalation de lactobacilles par voie orale pour reconstituer la flore vaginale a été rapporté pour la première fois en 2001 (Reid et al., 2001a), et repose sur la question: «si les agents pathogènes urogénitaux peuvent le faire, pourquoi pas les lactobacilles ?".
Dans une étude randomisée de 64 femmes atteintes de la vaginose bactérienne et d’autres en bonne santé (populations contrôle), contrôlée par un placebo, 37% des patientes auraient une reconstitution totale de leur flore vaginale en utilisant les souches probiotiques L. rhamnosus GR- 1 et L. reuteri RC 14 par voie orale. Ce type de traitement pourra créer une phase de transition d’un état de vaginose bactérienne
vers un rétablissement totale de la flore vaginale normale (Reid et al., 2001b).
Mastromarino et collaborateurs (2002) ont montré que parmi 10 souches évaluées
pour l’utilisation comme probiotique "vaginal", L. gasseri 335 et L. salivarius FV2 étaient capables de coaggréger avec G. vaginalis. En plus, l’utilisation de ces 2 souches en combinaison avec L. brevis CD2 et L. acidophilus pourrait inhiber totalement
l’adhésion de G. vaginalis. Shalev et collaborateurs (1996) ont réalisé une étude
randomisée sur 46 femmes possédant au moins 4 épisodes de vaginose bactérienne ou bien de CVV récurrentes. Un groupe des femmes (n=23) a été mis sous un régime
mois ; l’autre groupe (n=23) consomme du yaourt pasteurisé. L’étude a montré une réduction de 60% de la vaginose bactérienne et/ou bien de la CVV chez les consommateurs de yaourt contenant L. acidophilus. D’autre part, plusieurs études ont
montré l’efficacité de l’utilisation des probiotiques par voie vaginale (Figure 9).
Figure 9. Probiotique vaginale, forme d’ovule (http://www.ellentampon.ch/fr/action)
Neri et collaborateurs (1993) ont commencé à utiliser des souches vaginales
contenant une souche probiotique L. acidophilus (> 108CFU/ml). Chez les femmes qui
ont utilisé ce type de douche vaginale (une fois par jour), une réduction du taux de
vaginose bactérienne récurrente a été observée d’environ 38%, après un mois. Anukam
et collaborateurs (2006) ont réalisé une étude sur deux groupes de femmes (n=40)
possédant la vaginose bactérienne. Le premier groupe (n=20) correspond aux femmes utilisant des capsules vaginales contienant L. rhamnosus GR- 1 et L. reuteri RC 14
(109UFC) pendant 30 jours. Le deuxième groupe de femmes qui a été traité par
métronidazole gel pendant 5 jours. L’étude a montré que le taux de guérison était 65% et 33% pour les femmes appartenant au premier et deuxième groupe respectivement. Plusieurs études ont évalué l’efficacité de la combinaison entre l’antibiothérapie et l’utilisation des probiotiques. Cette combinaison semble être très efficace en termes de
guérison et diminution des effets secondaires (Eriksson et al., 2005; Petricevic et Witt
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