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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
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Figure 1

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
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Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Comparison 1 Probiotic + Metronidazole versus placebo + Metronidazole, Outcome 1 Microbiological cure.
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Analysis 1.1

Comparison 1 Probiotic + Metronidazole versus placebo + Metronidazole, Outcome 1 Microbiological cure.

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Comparison 2 Vaginal probiotic capsules versus metronidazole vaginal gel, Outcome 1 Microbiological cure.
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Analysis 2.1

Comparison 2 Vaginal probiotic capsules versus metronidazole vaginal gel, Outcome 1 Microbiological cure.

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Comparison 2 Vaginal probiotic capsules versus metronidazole vaginal gel, Outcome 2 Resolution of symptoms as reported by patient.
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Analysis 2.2

Comparison 2 Vaginal probiotic capsules versus metronidazole vaginal gel, Outcome 2 Resolution of symptoms as reported by patient.

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Comparison 2 Vaginal probiotic capsules versus metronidazole vaginal gel, Outcome 3 Adverse effects.
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Analysis 2.3

Comparison 2 Vaginal probiotic capsules versus metronidazole vaginal gel, Outcome 3 Adverse effects.

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Comparison 3 Probiotic versus placebo (after open treatment with clindamycin ovules), Outcome 1 Microbiological cure.
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Analysis 3.1

Comparison 3 Probiotic versus placebo (after open treatment with clindamycin ovules), Outcome 1 Microbiological cure.

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Comparison 3 Probiotic versus placebo (after open treatment with clindamycin ovules), Outcome 2 Resolution of symptoms as reported by patient.
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Analysis 3.2

Comparison 3 Probiotic versus placebo (after open treatment with clindamycin ovules), Outcome 2 Resolution of symptoms as reported by patient.

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Comparison 3 Probiotic versus placebo (after open treatment with clindamycin ovules), Outcome 3 Clinical cure as reported by physician.
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Analysis 3.3

Comparison 3 Probiotic versus placebo (after open treatment with clindamycin ovules), Outcome 3 Clinical cure as reported by physician.

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Comparison 4 Probiotics with estriol versus placebo, Outcome 1 Microbiological cure.
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Analysis 4.1

Comparison 4 Probiotics with estriol versus placebo, Outcome 1 Microbiological cure.

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Comparison 4 Probiotics with estriol versus placebo, Outcome 2 Clinical cure as reported by physician.
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Analysis 4.2

Comparison 4 Probiotics with estriol versus placebo, Outcome 2 Clinical cure as reported by physician.

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Comparison 1. Probiotic + Metronidazole versus placebo + Metronidazole

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Microbiological cure Show forest plot

1

106

Odds Ratio (M‐H, Fixed, 95% CI)

0.09 [0.03, 0.26]
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Comparison 1. Probiotic + Metronidazole versus placebo + Metronidazole
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Comparison 2. Vaginal probiotic capsules versus metronidazole vaginal gel

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Microbiological cure Show forest plot

1

35

Odds Ratio (M‐H, Fixed, 95% CI)

0.27 [0.07, 1.10]

2 Resolution of symptoms as reported by patient Show forest plot

1

35

Odds Ratio (M‐H, Fixed, 95% CI)

0.27 [0.05, 1.57]

3 Adverse effects Show forest plot

1

35

Odds Ratio (M‐H, Fixed, 95% CI)

0.08 [0.01, 0.49]
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Comparison 2. Vaginal probiotic capsules versus metronidazole vaginal gel
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Comparison 3. Probiotic versus placebo (after open treatment with clindamycin ovules)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Microbiological cure Show forest plot

1

217

Odds Ratio (M‐H, Fixed, 95% CI)

1.21 [0.67, 2.19]

2 Resolution of symptoms as reported by patient Show forest plot

1

216

Odds Ratio (M‐H, Fixed, 95% CI)

0.75 [0.43, 1.32]

3 Clinical cure as reported by physician Show forest plot

1

224

Odds Ratio (M‐H, Fixed, 95% CI)

1.11 [0.65, 1.89]
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Comparison 3. Probiotic versus placebo (after open treatment with clindamycin ovules)
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Comparison 4. Probiotics with estriol versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Microbiological cure Show forest plot

1

15

Odds Ratio (M‐H, Fixed, 95% CI)

0.02 [0.00, 0.47]

2 Clinical cure as reported by physician Show forest plot

1

17

Odds Ratio (M‐H, Fixed, 95% CI)

0.04 [0.00, 0.56]
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Comparison 4. Probiotics with estriol versus placebo
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