Objective — to investigate the efficiency of different therapeutic approaches to managing patients with recurrent bacterial vaginosis. Design. An open-label prospective randomized study. Subject and methods. In January 2014 to October 2017, an open-label randomized prospective study was conducted to investigate the efficacy and safety of vaginal lactic acid suppositories as part of combination therapy in patients with recurrent bacterial vaginosis. The study enrolled 88 patients diagnosed with recurrent bacterial vaginosis, who had four or more recurrences per year. The patients were divided into two groups: Group 1 (a study group) of 52 women received 0.75% vaginal metronidazole gel at a single dose of 5.0 g for 5 days and then one femilex suppository overnight for 10 days; Group 2 (a comparison group) of 36 patients used only metronidazole at the indicated dose. A control group (Group 3) consisted of 30 apparently healthy women of reproductive age. All the patients underwent clinical and laboratory examinations involving the collection of data on a patient’s complaints and those from medical history, as well as objective examination, microscopic examination of vaginal content, vaginal pH-metry, amine test, and evaluation of the vaginal microbiocenosis by real-time polymerase chain reaction. The clinical and laboratory efficiency of therapy for recurrent bacterial vaginosis was evaluated after completion of a treatment cycle at 6, 12, and 24 months. Results. The evaluation of microbiocenosis revealed a sharp inhibition of Lactobacillus ssp. and an increase in the total bacterial contamination. The clinical and laboratory efficiency of combination therapy with 0.75% metronidazole gel and femilex was 98.9% just immediately after the end of treatment; that of monotherapy with 0.75% metronidazole gel was 94.4%; however, a recurrence of bacterial vaginosis occurred in 3 patients from this group at 1 month after the end of therapy. In the group receiving femilex as part of the combination therapy, only two patients had one recurrence of bacterial vaginosis and one patient had 2 recurrences at a control visit following 24 months. In the comparison group, the situation was as follows: 1 recurrence was observed in 8 patients; 2 recurrences in 2; 3 recurrences in 4; and 4 recurrences in two patients. The logarithm (lg) of the mean number of Lactobacillus titers was 5.92 and 3.63 in Groups 1 and 2, respectively. Conclusion. The use of lactic acid-containing femilex as part of combination therapy in patients with recurrent bacterial vaginosis makes it possible to restore a Lactobacillus population and to reduce the rate of its recurrences during a 2-year follow-up.