From the Guidelines
The recommended treatment for Bacterial Vaginosis (BV) is metronidazole 500 mg orally twice a day for 7 days, as it has been shown to be equally efficacious as other metronidazole regimens and more efficacious than clindamycin cream 1. When treating BV, it is essential to consider the potential side effects and interactions of the recommended regimens.
- Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days, is an alternative option for patients who prefer a topical treatment or have difficulty taking oral medications.
- Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days, is another alternative, although it appears to be less efficacious than the metronidazole regimens. It is crucial to advise patients to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter due to potential disulfiram-like reactions 1. Additionally, patients should be informed that clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms, and refer to condom product labeling for additional information 1. Follow-up visits are unnecessary if symptoms resolve, but because recurrence of BV is not unusual, women should be aware of the potential for recurrence and the need for repeated treatment 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. Therapeutic cure was a composite endpoint, consisting of both a clinical cure and microbiologic cure 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 (BV) 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 (BV)
The recommended treatment for BV varies depending on the patient's pregnancy status and the severity of symptoms.
- For nonpregnant women, treatment options include:
- For pregnant women, the treatment options are:
- Metronidazole (250 mg orally three times a day for 7 days) for both high-risk and low-risk women 3
- For recurrent BV, an extended course of metronidazole treatment (500 mg twice daily for 10-14 days) is recommended 4
- Alternative treatments for recurrent BV include metronidazole vaginal gel 0.75% for 10 days, followed by two times per week for 3-6 months 4
- Other treatment options that have shown promise include tinidazole, secnidazole, and the use of probiotics and prebiotics 4, 5
Effectiveness of Current Therapies
Studies have shown that current therapies for BV are not always effective, with recurrence rates as high as 50% within one year of treatment 4, 6
- A study found that treatment of BV with standard methods was not always effective, with no significant difference between women under 21 years and older women found in regards to response to treatment 6
- Another study found that metronidazole was more effective than cefdinir in treating BV, with a significant decrease in abnormal vaginal discharge and other symptoms 7
Alternative Treatments
Some studies have suggested that alternative treatments, such as probiotics and prebiotics, may be effective in treating BV 4, 6
- A study found that Lactobacillus acidophilus, a type of probiotic, may be an effective alternative treatment for BV, but more research is needed to confirm this 6