From the Guidelines
Bacterial vaginosis (BV) should not be treated with Monistat (clotrimazole) as it is specifically designed to treat yeast infections (candidiasis), not bacterial vaginosis. The recommended first-line treatment for BV is 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 1. Alternative regimens include oral clindamycin 300 mg twice daily for 7 days or tinidazole 2 grams once daily for 2-3 days. Monistat and other azole antifungal medications are not effective against BV, which is caused by an overgrowth of anaerobic bacteria that disrupt the normal vaginal flora. Using the wrong treatment won't resolve symptoms and may delay proper care. During treatment, patients should avoid alcohol with metronidazole or tinidazole due to potential disulfiram-like reactions, abstain from sexual intercourse or use condoms, and complete the full course of antibiotics even if symptoms improve quickly. If symptoms persist after treatment, a follow-up with a healthcare provider is recommended as recurrence is common and may require extended therapy. It's also important to note that the treatment of BV with antibiotics has been shown to be effective in relieving symptoms and reducing the risk of adverse pregnancy outcomes, such as preterm birth and postpartum endometritis 1. In contrast, Monistat is used to treat vulvovaginal candidiasis, with recommended regimens including clotrimazole 1% cream applied intravaginally daily for 7-14 days, or clotrimazole 100 mg vaginal tablet applied intravaginally daily for 7 days 1. However, these regimens are not effective against BV and should not be used as a substitute for antibiotic treatment.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Bacterial Vaginosis (BV)
- The recommended treatment for BV includes oral metronidazole (500 mg twice daily for 7 days) or alternative regimens such as single-dose metronidazole (2 g orally), 2% clindamycin vaginal cream (once daily for 7 days), 0.75% metronidazole vaginal gel (twice daily for 5 days), and oral clindamycin (300 mg twice daily for 7 days) 2.
- Clindamycin vaginal cream has been shown to be effective in treating BV, with cure rates comparable to oral metronidazole 3, 4.
- A study comparing oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream found no statistically significant differences in cure rates between the three treatments 5.
Monistat (Clotrimazole) for BV
- There is no evidence to suggest that Monistat (clotrimazole) is effective in treating BV. The studies reviewed focus on the use of metronidazole and clindamycin for BV treatment 2, 3, 4, 5.
- Clotrimazole is an antifungal medication, and its use is not recommended for the treatment of BV, which is a bacterial infection.
Duration of Therapy
- The duration of therapy for BV varies depending on the treatment regimen. Common durations include 7 days for oral metronidazole, 7 days for 2% clindamycin vaginal cream, and 5 days for 0.75% metronidazole vaginal gel 2, 5.
- There is no evidence to support the use of Monistat (clotrimazole) for BV, and therefore, no recommended duration of therapy for this medication.