Current approaches to the treatment of vaginal infections: the role of synergism of conventional antibiotics

Abstract

The current state of vaginal infections is characterized by the simultaneous involvement of a wide range of aerobic, anaerobic, and fungal pathogens, which are highly prone to forming polymicrobial communities protected by bacterial biofilms. Microbial synergism, most pronounced within biofilms, along with local changes in the vaginal microbiome typical of infectious processes, reduce the efficacy of antimicrobial therapy and may contribute to a high risk of recurrence. A combination medication containing nystatin, neomycin, and polymyxin B (NNP) represents a tool that can effectively act against both planktonic bacteria and biofilm-associated forms of Gram-negative, Gram-positive, and fungal pathogens, achieving high local concentrations while maintaining low systemic exposure. This literature review analyzes the existing in vitro and in vivo studies, as well as the results of clinical trials, which help to define the role of NNP combination in the treatment of patients with vaginal infections. Key words: vaginitis, polymyxin B, neomycin, nystatin, bacterial biofilms