From the Guidelines
Gardnerella vaginalis infection, commonly known as bacterial vaginosis (BV), is typically treated with metronidazole, which can be taken orally as 500 mg twice daily for 7 days, or as a vaginal gel (0.75%) applied once daily for 5 days, as these regimens are equally efficacious 1. The treatment of Gardnerella vaginalis infection aims to reduce morbidity, mortality, and improve quality of life by alleviating symptoms and preventing complications.
Treatment Options
- 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, although it appears less efficacious than the metronidazole regimens 1
Important Considerations
- Patients should be advised to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter
- Clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms
- For women with recurrent infections, maintaining vaginal acidity through probiotics containing lactobacilli or boric acid suppositories may help prevent recurrence after antibiotic treatment
Follow-Up
Follow-up visits are unnecessary if symptoms resolve, but because recurrence of BV is not unusual, women should be aware of the signs and symptoms of recurrence and seek medical attention if they occur 1
From the FDA Drug Label
Tinidazole is indicated for the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, or anaerobic vaginosis) in adult women [see Use in Specific Populations ( 8.1) and Clinical Studies ( 14.5)]. A randomized, double-blind, placebo-controlled clinical trial in 235 non-pregnant women was conducted to evaluate the efficacy of tinidazole for the treatment of bacterial vaginosis. Therapeutic cure rates reported in this clinical study conducted with tinidazole were based on resolution of 4 out of 4 Amsel's criteria and a Nugent score of <4. In patients with all four Amsel's criteria and with a baseline Nugent score ≥4, tinidazole oral tablets given as either 2 g once daily for 2 days or 1 g once daily for 5 days demonstrated superior efficacy over placebo tablets as measured by therapeutic cure, clinical cure, and a microbiologic cure.
The treatment for Gardnerella (bacterial vaginosis) is tinidazole. The recommended dosage is either 2 g once daily for 2 days or 1 g once daily for 5 days 2.
- Therapeutic cure rates for tinidazole were 97.5% for the 2-day regimen and 93.8% for the 5-day regimen.
- Clinical cure rates for tinidazole were 93.4% for the 2-day regimen and 87.7% for the 5-day regimen.
- Microbiologic cure rates for tinidazole were 93.4% for the 2-day regimen and 87.7% for the 5-day regimen 2.
From the Research
Treatment Options for Gardnerella
- Metronidazole is a commonly used treatment for Gardnerella vaginalis infection, as it is effective against anaerobic bacteria, including Gardnerella vaginalis 3, 4.
- A single dose of 2 g metronidazole is recommended for the treatment of Gardnerella vaginalis infection, particularly when associated with trichomoniasis 5.
- Both oral and vaginal metronidazole can be used to treat bacterial vaginosis in pregnancy, with similar effects on the risk of preterm delivery 6.
- Oral metronidazole has been shown to be effective in decreasing concentrations of most BV-associated anaerobic bacteria, including Gardnerella vaginalis, in pregnant women 6.
Comparison of Treatment Options
- A comparison of oral metronidazole versus ampicillin for the treatment of urinary tract infection by Gardnerella vaginalis found that both treatments were effective, but ampicillin was better tolerated with fewer side effects 7.
- Metronidazole has been shown to be effective against Gardnerella vaginalis, but may have more adverse events compared to other treatments, such as ampicillin 7.
Efficacy of Metronidazole
- Metronidazole has been shown to be highly effective against Gardnerella vaginalis, with clinical and bacteriological cure rates of 92% and 96%, respectively 7.
- The efficacy of metronidazole against Gardnerella vaginalis has been demonstrated in several studies, making it a commonly used treatment option 3, 4, 5, 6, 7.