From the Guidelines
For treating bacterial vaginosis in lactating women, metronidazole 500 mg orally twice a day for 7 days is the recommended first-line treatment. This regimen is considered safe during breastfeeding as the amount transferred to breast milk is minimal and unlikely to harm the infant 1. The treatment options for bacterial vaginosis include:
- Metronidazole 500 mg orally twice a day for 7 days
- Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days
- Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
It is essential to advise patients to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter, as well as to note that clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms 1. Alternative regimens, such as metronidazole 2 g orally in a single dose or clindamycin 300 mg orally twice a day for 7 days, have lower efficacy for BV and are not recommended as first-line treatment 1. Treatment is crucial even during lactation because untreated bacterial vaginosis can lead to complications such as increased risk of other genital infections. Mothers can continue breastfeeding throughout treatment without interruption, and partners typically don't require treatment as bacterial vaginosis is not considered a sexually transmitted infection, though recurrence is common.
From the FDA Drug Label
Metronidazole vaginal gel is indicated in the treatment of bacterial vaginosis For purposes of this indication, a clinical diagnosis of bacterial vaginosis is usually defined by the presence of a homogeneous vaginal discharge that (a) has a pH of greater than 4. 5, (b) emits a “fishy” amine odor when mixed with a 10% KOH solution, and (c) contains clue cells on microscopic examination.
The treatment of bacterial vaginosis in lactating women is not directly addressed in the provided drug labels.
- The labels do mention the treatment of bacterial vaginosis with metronidazole vaginal gel, but they do not specifically discuss lactating women.
- Therefore, no conclusion can be drawn about the treatment of bacterial vaginosis in lactating women based on the provided information 2, 2.
From the Research
Treatment Options for Bacterial Vaginosis in Lactating Women
There is limited information available on the treatment of bacterial vaginosis specifically in lactating women. However, based on the available studies, the following treatment options can be considered:
- Metronidazole (500 mg orally twice daily for 7 days) or clindamycin vaginal cream (2%, once daily for 7 days) are recommended for nonpregnant women 3
- Clindamycin vaginal cream has been shown to be as effective as oral metronidazole in treating bacterial vaginosis, with comparable cure rates and side effects 4, 5, 6
- Lactate-gel has also been found to be effective in treating bacterial vaginosis, with significant reduction in anaerobes and improvement in symptoms 7
Considerations for Lactating Women
While there is no specific information available on the treatment of bacterial vaginosis in lactating women, it is essential to consider the safety of the treatment options for both the mother and the infant. Metronidazole and clindamycin are generally considered safe for use during lactation, but it is crucial to consult with a healthcare provider before initiating treatment 3
Comparison of Treatment Options
The available studies suggest that clindamycin vaginal cream and oral metronidazole have comparable efficacy and safety profiles for treating bacterial vaginosis 4, 5, 6. Lactate-gel has also been found to be effective, but more research is needed to confirm its safety and efficacy in lactating women 7