From the Guidelines
The treatment for bacterial vaginosis typically involves antibiotics, with the first-line treatment being oral metronidazole 500 mg twice daily for 7 days, or metronidazole gel 0.75% applied intravaginally once daily for 5 days, or clindamycin cream 2% applied intravaginally at bedtime for 7 days. The choice of treatment should be based on the patient's symptoms, medical history, and preferences. Some key points to consider when treating bacterial vaginosis include:
- Patients should avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter, as it can cause a disulfiram-like reaction 1.
- Clindamycin cream and ovules are oil-based and may weaken latex condoms and diaphragms, so patients should be advised to use alternative forms of contraception during treatment 1.
- The recommended metronidazole regimens are equally efficacious, while the vaginal clindamycin cream appears less efficacious than the metronidazole regimens 1.
- Alternative regimens include oral clindamycin 300 mg twice daily for 7 days, or metronidazole 2 g orally in a single dose, but these have lower efficacy for treating bacterial vaginosis 1.
- For pregnant women, the Centers for Disease Control and Prevention recommends 250 mg oral metronidazole 3 times daily for 7 days as the treatment of bacterial vaginosis in pregnancy 1.
- Patients should complete the full course of antibiotics even if symptoms resolve earlier, and follow-up visits are unnecessary if symptoms resolve 1. It's also important to note that bacterial vaginosis can recur, and extended or suppressive antibiotic regimens may be considered for women with recurrent infections 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)]. 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 bacterial vaginosis is tinidazole given as either:
- 2 g once daily for 2 days
- 1 g once daily for 5 days 2 2 2 Key points:
- Tinidazole is indicated for the treatment of bacterial vaginosis in adult women.
- The treatment regimen consists of either 2 g once daily for 2 days or 1 g once daily for 5 days.
- Tinidazole has demonstrated superior efficacy over placebo in achieving therapeutic, clinical, and microbiologic cure.
From the Research
Treatment Options for Bacterial Vaginosis
The current treatment options for bacterial vaginosis (BV) include:
- Antibiotics such as metronidazole and clindamycin, which are the only FDA-approved treatment regimens for BV 3
- Tinidazole, which has been used to treat BV for over 25 years and has a more favorable side effect profile than oral metronidazole 4
- Alternative strategies such as probiotics, vaginal microbiome transplantation, pH modulation, and biofilm disruption, which are being explored due to the high recurrence rates of BV 3, 5
Standard Treatments
Standard treatments for BV include:
- Metronidazole, which is administered orally or intravaginally 5, 6
- Clindamycin, which is administered orally or intravaginally 5, 6
- Tinidazole, which is administered orally 4
Recurrence Prevention
To prevent recurrence of BV, the following strategies may be considered:
- Male-partner treatment, which has been shown to reduce the rate of recurrence of BV 7
- Behavioral modifications such as smoking cessation, condom use, and hormonal contraception 3
- Dietary modification, non-medical vaginally applied products, and treatments from medical practices outside of allopathic medicine, which are considered by some people but require further research 3
Comparison of Treatments
Comparative studies have shown that: