What is the recommended treatment for bacterial vaginosis?

From the Guidelines

The recommended treatment for bacterial vaginosis is typically a course of antibiotics, with metronidazole being the first-line treatment, either as a 500 mg oral dose taken twice daily for 7 days, or as a 0.75% vaginal gel applied once daily for 5 days, as supported by the Centers for Disease Control and Prevention guidelines 1.

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

Important Considerations

• Patients should be advised to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter due to potential disulfiram-like reactions 1.
• Clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms, so patients should be aware of this potential interaction 1.
• Pregnant women should be treated with antibiotics as bacterial vaginosis can increase the risk of pregnancy complications, with the Centers for Disease Control and Prevention recommending 250 mg oral metronidazole 3 times daily for 7 days as the treatment of bacterial vaginosis in pregnancy 1.

Recurrence and Suppressive Therapy

• Recurrent bacterial vaginosis may require longer treatment courses or suppressive therapy.
• The U.S. Preventive Services Task Force recommends against screening for bacterial vaginosis in asymptomatic pregnant women at low risk for preterm delivery, but the evidence is insufficient to assess the balance of benefits and harms of screening for bacterial vaginosis in asymptomatic pregnant women at high risk for preterm delivery 1.

From the FDA Drug Label

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. 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 recommended treatment for bacterial vaginosis is tinidazole oral tablets, given as either:

• 2 g once daily for 2 days
• 1 g once daily for 5 days 2

From the Research

Treatment Options for Bacterial Vaginosis

The recommended treatment for bacterial vaginosis varies depending on the patient's pregnancy status and other factors.

• For nonpregnant women, treatment options include:
  • Metronidazole (500 mg orally twice daily for 7 days) 3
  • Clindamycin vaginal cream (2%, once daily for 7 days) 3, 4, 5
  • Metronidazole vaginal gel (0.75%, twice daily for 5 days) 3
• For pregnant women, the treatment objective is to prevent adverse outcomes of pregnancy and relieve symptoms.
  • For high-risk pregnant women (those with a prior preterm birth), metronidazole (250 mg orally three times a day for 7 days) is recommended 3
  • For low-risk pregnant women (those without a prior preterm birth) with symptomatic disease, metronidazole (250 mg orally three times a day for 7 days) is also recommended 3

Alternative Treatment Options

• Secnidazole, a single-dose regimen, has been shown to be at least as effective as the multiple-dose metronidazole regimen in treating bacterial vaginosis 6
• Clindamycin vaginal cream has been found to be a safe and effective alternative to oral metronidazole for the treatment of bacterial vaginosis 4, 5

Comparison of Treatment Options

• A study comparing oral and vaginal metronidazole therapy found that both regimens were equally effective in treating bacterial vaginosis 7
• Another study found that clindamycin vaginal cream and oral metronidazole had comparable cure rates and side effects 5