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(1) Background: The goal of this retrospective cohort study, based on real-world data and conducted in Germany, was to investigate the prevalence of antibiotic (AB) prescription in patients with acute rhinosinusitis (ARS). (2) Methods: Data from the Disease Analyzer database were used for this cross-sectional study. Patients aged ≥18 years diagnosed with acute sinusitis by general practitioners (GPs) and ear, nose, throat (ENT) specialists between January 2012 and December 2020 were included. The main outcome of the study was the proportion of patients with ARS who received an AB prescription on the day of diagnosis or within three days afterwards. The proportion was estimated separately for patients treated by GPs and ENTs, and also for five age groups, as well as women and men. (3) Results: In total, 308,095 patients were diagnosed with ARS (187,838 by GPs and 120,257 by ENTs). 50.9% of patients treated by GPs and 50.0% treated by ENTs received an AB prescription. AB prevalence increased with age from 46.9% in the age group 18–30 years to 55.5% in the age group > 60 years. (4) Conclusions: We have shown a high prevalence of potentially inappropriate AB prescription for adult patients with ARS in both GP and ENT practices and also among both women and men and in several age groups. There is an urgent need for interventions to reduce inappropriate AB use.

Abstract Background Bacterial vaginosis (BV) is the most common vaginal syndrome among women in their reproductive years. It is associated with an increased risk of acquiring sexually transmitted infections and complications like preterm labor. BV is characterized by a high recurrence rate for which biofilms frequently found on vaginal epithelial cells may be a reason. Results Here, we report a controlled randomized clinical trial that tested the safety and effectiveness of a newly developed pessary containing an amphoteric tenside (WO3191) to disrupt biofilms after metronidazole treatment of BV. Pessaries containing lactic acid were provided to the control group, and microbial community composition was determined via Illumina sequencing of the V1-V2 region of the 16S rRNA gene. The most common community state type (CST) in healthy women was characterized by Lactobacillus crispatus. In BV, diversity was high with communities dominated by either Lactobacillus iners, Prevotella bivia, Sneathia amnii, or Prevotella amnii. Women with BV and proven biofilms had an increased abundance of Sneathia sanguinegens and a decreased abundance of Gardnerella vaginalis. Following metronidazole treatment, clinical symptoms cleared, Nugent score shifted to Lactobacillus dominance, biofilms disappeared, and diversity (Shannon index) was reduced in most women. Most of the patients responding to therapy exhibited a L. iners CST. Treatment with WO 3191 reduced biofilms but did not prevent recurrence. Women with high diversity after antibiotic treatment were more likely to develop recurrence. Conclusions Stabilizing the low diversity healthy flora by promoting growth of health-associated Lactobacillus sp. such as L. crispatus may be beneficial for long-term female health. Trial registration ClinicalTrials.gov NCT02687789

Abstract Background The urinary microbiota is similarly complex as the vaginal and penile microbiota, yet its role as a reservoir for pathogens and for recurrent polymicrobial biofilm diseases like bacterial vaginosis (BV) is not clear. Results Here, we analysed the urinary microbiota of healthy men and women and compared it with that of women during BV and after antibiotic treatment using next-generation sequencing of the 16S rRNA gene V1-V2 regions. Eight different community types, so called urotypes (UT), were identified in healthy humans, all of which were shared between men and women, except UT 7, dominated in relative abundance by Lactobacillus crispatus, which was found in healthy women only. Orally applied metronidazole significantly reduced Shannon diversity and the mean relative abundance of Gardnerella vaginalis, Atopobium vaginae, and Sneathia amnii, while L. iners increased to levels twofold higher than those found in healthy women. Although individual urine microbial profiles strongly responded to the antibiotic, the healthy community could not be restored. The correlation between urinary and vaginal fluid microbiota was generally weak and depending on UT and BV status. It was highest in UT 1 in acute BV (59% of samples), but after metronidazole treatment, only 3 out of 35 women showed a significant correlation between their urinary and vaginal microbiota composition. Conclusions Urethra and bladder thus harbor microbial communities distinct from the vagina. The high abundance of BV related species in the urine of both men and women suggests that urine may act as a reservoir of pathogens and contribute to recurrence. Trial registration ClinicalTrials.gov, NCT02687789

This open, prospective, multicenter, observational study was performed to investigate the efficacy and safety of a non-hormonal cream in women undergoing breast cancer treatment and experiencing vulvovaginal dryness symptoms. Overall, 128 patients from 22 study centers participated. The cream was applied to the vagina and vulva for 28 days. For the efficacy analysis, changes in subjective symptoms (feeling of dryness, itching, burning, pain independent of sexual intercourse, dyspareunia, urinary incontinence) were evaluated. Additionally, the following objective diagnostic findings were assessed by a physician: thinning of vaginal epithelium, redness, petechiae, and discharge. Safety and tolerability were assessed by evaluating type and frequency of adverse events, including adverse medical device-related effects. The frequency and intensity of all subjective symptoms significantly improved from baseline at 28 days (p

ABSTRACT Bacterial vaginosis (BV) is a prevalent multifactorial disease of women in their reproductive years characterized by a shift from the Lactobacillus species-dominated microbial community toward a taxonomically diverse anaerobic community. For unknown reasons, some women do not respond to therapy. In our recent clinical study, among 37 women diagnosed with BV, 31 were successfully treated with metronidazole, while 6 still had BV after treatment. To discover possible reasons for the lack of response in those patients, we performed a metatranscriptome analysis of their vaginal microbiota, comparing them to the patients who responded. Seven of 8 clustered regularly interspaced short palindromic repeat (CRISPR)-associated (Cas) genes of Gardnerella vaginalis were highly upregulated in nonresponding patients. Cas genes, in addition to protecting against phages, might be involved in DNA repair, thus mitigating the bactericidal effect of DNA-damaging agents such as metronidazole. In the second part of our study, we analyzed the vaginal metatranscriptomes of four patients over 3 months and showed high in vivo expression of genes for pore-forming toxins in L. iners and of genes encoding enzymes for the production of hydrogen peroxide and d-lactate in L. crispatus. IMPORTANCE Bacterial vaginosis is a serious issue for women in their reproductive years. Although it can usually be cured by antibiotics, the recurrence rate is very high, and some women do not respond to antibiotic therapy. The reasons for that are not known. Therefore, we undertook a study to detect the activity of the complete microbiota in the vaginal fluid of women who responded to antibiotic therapy and compared it to the activity of the microbiota in women who did not respond. We found that one of the most important pathogens in bacterial vaginosis, Gardnerella vaginalis, has activated genes that can repair the DNA damage caused by the antibiotic in those women that do not respond to therapy. Suppressing these genes might be a possibility to improve the antibiotic therapy of bacterial vaginosis.

The impact of increasing age on body odor has become an important issue as our understanding of underlying skin changes in older people has increased. Therefore, cosmetic skin products especially for the needs of the elderly are of growing importance. This randomized single-blind crossover study assessed the deodorizing efficacy of two cosmetic products with different pH values on the age-specific odor of an elderly female subject panel (≥60 years). The two test products, adjusted to pH 4.0 and pH 5.8 were applied to the axillae once daily for three consecutive days after standardized washing of the axillae. The untreated axilla was used as a control. Six odor judges evaluated the efficacy of both products. Additionally, bactericidal and fungicidal activity was investigated with in vitro microbiologic tests. The pH 4.0 water in oil (W/O) emulsion significantly reduced axillary malodor in 44 elderly subjects at 8 and 24 h after treatment, compared with controls (untreated axillae) (p < 0.001 after 8 and 24 h), whereas pH 5.8 emulsion had no effect (p = 0.441 after 8 h; p = 0.425 after 24 h). Moreover, the pH 4.0 emulsion reduced axillary malodor at 8 and 24 h after treatment, compared with the pH 5.8 emulsion just narrowly missing statistical significance (p = 0.078 after 8 h; p = 0.053 after 24 h). Microbiologic in vitro tests showed that the pH 4.0 emulsion reduced the levels of odor-producing bacteria S. epidermidis and C. minutissimum after 1 h (2.98 log and 4.25 log). After 24 h, levels of S. aureus (>5.50 log), P. acnes (>5.30 log) and E. coli (>5.46 log) were further reduced whereas no effect was observed for pH 5.8. A pH 4.0 emulsion significantly reduced axillary malodor for up to 24 h after application in females aged at least 60 years. This reduction in malodor is very likely due to a reduction of odor-producing bacteria.

The acidic skin surface pH (pHSS) plays a crucial role in the maintenance of a vital stratum corneum (SC) and an intact epidermal barrier. However, ageing affects the pH of the skin, both pHSS and the pH of the stratum corneum (pHSC). The purpose of this article is to review the physiological function of skin pH and the effects of an age-related increase of skin pH. Moreover, the consequences for the development of skin care products, specifically for the elderly, will be discussed. Reported pHSS values of the skin range between 4 and 6 in non-intertriginous areas. The acidity of the outer surface of the skin is essential regarding the following functions: epidermal barrier homeostasis, integrity/cohesion of the SC, support of proteolytic processes leading to desquamation, metabolism of extracellular lipids, and microbiological colonisation of the SC. Exogenous, as well as endogenous factors, affect skin pH (especially pHSS), thereby influencing its functions. Age is one important endogenous factor. Interestingly, pHSS of adults slightly increases with age. This increase of pHSS influences several functions in ageing skin. Increased pHSS may impair epidermal barrier permeability, integrity/cohesion of the SC, and even antimicrobial capacity. Hence, ageing skin shows an increased vulnerability, not only towards mechanical stress. Moreover, aged skin often appears rough and dry, which is sometimes associated with itching. However, so far only a few studies have investigated the effect of skin care products on ageing skin. In addition, normalising the increased skin pH in the elderly by appropriate skin care products formulated with a lower pH, e.g. 4, may improve impaired skin functions, which are impaired.

Bacterial vaginosis (BV) is a common infection in reproductive age woman and is characterized by dysbiosis of the healthy vaginal flora which is dominated by Lactobacilli, followed by growth of bacteria like Gardnerella vaginalis. The ability of G. vaginalis to form biofilms contributes to the high rates of recurrence that are typical for BV and which unfortunately make repeated antibiotic therapy inevitable. Here we developed a biofilm model for G. vaginalis and screened a large spectrum of compounds for their ability to prevent biofilm formation and to resolve an existing G. vaginalis biofilm. The antibiotics metronidazole and tobramycin were highly effective in preventing biofilm formation, but had no effect on an established biofilm. The application of the amphoteric tenside sodium cocoamphoacetate (SCAA) led to disintegration of existing biofilms, reducing biomass by 51% and viability by 61% and it was able to increase the effect of metronidazole by 40% (biomass) and 61% (viability). Our data show that attacking the biofilm and the bacterial cells by the combination of an amphoteric tenside with the antibiotic metronidazole might be a useful strategy against BV.