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Longitudinal evaluation of self-reported antibioitc use and its association with vaginal and rectal colonization by lactobacillus and vulvovaginal candidiasis in non-pregnant women

Meyn, Leslie (2014) Longitudinal evaluation of self-reported antibioitc use and its association with vaginal and rectal colonization by lactobacillus and vulvovaginal candidiasis in non-pregnant women. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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This dissertation includes three manuscripts describing the use of systemic and intra-vaginal antibiotics in non-pregnant women. The first manuscript described the scope of antibiotic use and showed that the antibiotic use rate was high. Nearly half of the antibiotics were used to treat genitourinary infections. However, one in five antibiotics were used to treat upper respiratory tract illnesses for which antibiotics are not indicated according to CDC recommendations and these antibiotics were primarily β-lactam agents.
The second manuscript evaluated whether antibiotic use impacted vaginal and rectal colonization by hydrogen peroxide (H2O2)-producing lactobacilli, which are the predominant members of the healthy vaginal microbiome. These analyses showed there was a significant reduction in vaginal colonization by H2O2-producing lactobacilli following the use of β-lactam antibiotics, while other classes of antibiotics had no measurable effect on Lactobacillus colonization. A novel finding was that β-lactam use also reduced rectal colonization by lactobacilli to a similar degree as that observed for the vagina and that the effects persisted for a longer period of time.
The third manuscript evaluated whether antibiotic use was associated with acquisition of vaginal yeast infections. Antibiotic use was associated with increased acquisition of yeast vaginitis, and while the highest risk was associated with the use of β-lactam antibiotics, the use of some other classes of antibiotics, including metronidazole, fluoroquinolones, and nitrofurantoin, were also associated with increased yeast vaginitis.
Each manuscript provided new insights into the public health significance of antibiotic use in reproductive-aged women. The first confirmed that antibiotic use was common in women and extended our knowledge by showing that the treatment of genitourinary tract infections was the primary indication for antibiotic use and that treatment of upper respiratory tract infections was the major contributor to exposure of women to β-lactam antibiotics. The results of the second and third manuscripts suggest that decreasing the inappropriate use of β-lactam antibiotics deserve special attention since β-lactams were associated with decreased colonization by beneficial lactobacilli and increased yeast vaginitis. This research has provided insights on how efforts to reduce antibiotic use should be tailored in young women for the greatest public health benefit.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairCauley A, Jane AJCauley@edc.pitt.eduJCAULEY
Committee MemberHillier, Sharon Lslh6@pitt.eduSLH6
Committee MemberBrooks, Maria Mbrooks@edc.pitt.eduMBROOKS
Committee MemberHarrison, Lee Hlharriso@edc.pitt.eduLHARRISO
Committee MemberHaggerty, Catherine LHaggertyC@edc.pitt.eduHAGGERTY
Date: 27 June 2014
Date Type: Publication
Defense Date: 7 April 2014
Approval Date: 27 June 2014
Submission Date: 3 April 2014
Access Restriction: 3 year -- Restrict access to University of Pittsburgh for a period of 3 years.
Number of Pages: 117
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: antibiotic use, Lactobacillus colonization, vulvovaginal candidiasis, nonpregnant women
Date Deposited: 27 Jun 2014 20:18
Last Modified: 01 May 2017 05:15


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