What is the recommended dose of amoxicillin (amoxicillin) to treat bacterial vaginosis with a culture showing a moderate amount of Escherichia coli (E. coli) and Enterococcus faecalis?

From the Guidelines

Amoxicillin is not the recommended treatment for bacterial vaginosis (BV), and its use should be avoided in favor of metronidazole or clindamycin, as these are the standard treatments for BV. The presence of E. coli and Enterococcus faecalis in a culture may indicate a different infection, such as aerobic vaginitis or a mixed infection, rather than BV. According to the guidelines from 1, the recommended treatments for BV are metronidazole (500 mg orally twice daily for 7 days or 0.75% gel intravaginally once daily for 5 days) or clindamycin (300 mg orally twice daily for 7 days or 2% cream intravaginally at bedtime for 7 days).

If treatment is specifically needed for E. coli and Enterococcus faecalis, amoxicillin-clavulanate would be more appropriate than amoxicillin alone, typically at a dose of 875/125 mg twice daily for 7 days, as suggested by general medical knowledge and not explicitly stated in the provided guidelines. This combination provides better coverage against these organisms because the clavulanic acid helps overcome bacterial resistance mechanisms. It's essential to note that the guidelines from 1 provide information on various sexually transmitted diseases but do not directly address the use of amoxicillin for BV or the specific bacteria mentioned.

Key points to consider:

• Bacterial vaginosis treatment should prioritize metronidazole or clindamycin.
• The presence of E. coli and Enterococcus faecalis may indicate a different infection.
• Amoxicillin-clavulanate could be considered for treating these specific bacteria, but it's not the first-line treatment for BV.
• A healthcare provider should evaluate the patient to determine the most appropriate diagnosis and treatment plan based on symptoms, examination findings, and culture results, as emphasized by 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment of Bacterial Vaginosis

The provided studies do not recommend the use of amoxicillin to treat bacterial vaginosis.

• The standard treatment for bacterial vaginosis includes antibiotics such as metronidazole and clindamycin 2, 3, 4.
• These antibiotics provide a short-term cure for bacterial vaginosis, but often fail to provide a consistent long-term cure for many women 2, 3, 4.
• Alternative non-antibiotic treatment options are being explored, including probiotics, vaginal microbiome transplantation, pH modulation, and biofilm disruption 2, 5, 6.
• The use of probiotics, lactic acid, and other non-antibiotic treatments has shown promise in preventing recurrences and improving efficacy, but more research is needed to provide sufficient evidence for these alternatives to be part of official treatment recommendations 4, 5, 6.

E. coli and Enterococcus faecalis

• There is no specific recommendation for the treatment of bacterial vaginosis with a culture showing a medium amount of E. coli and Enterococcus faecalis in the provided studies.
• The treatment of bacterial vaginosis is typically focused on restoring the balance of the vaginal microbiome, rather than targeting specific bacteria such as E. coli and Enterococcus faecalis 2, 3, 4, 5, 6.