From the Guidelines
Clindamycin gel is an effective treatment for bacterial vaginosis (BV), but its efficacy is lower compared to metronidazole regimens. The typical prescription is clindamycin 2% vaginal cream applied intravaginally at bedtime for 7 consecutive days 1. Patients should use the applicator provided with the medication and follow the package instructions carefully. It's essential to complete the full course of treatment even if symptoms improve before finishing. While using clindamycin gel, patients should avoid sexual intercourse or use condoms to prevent transferring the medication to partners. Some women may experience side effects such as vaginal irritation, itching, or yeast infections. Clindamycin works by stopping the growth of bacteria that cause BV by inhibiting bacterial protein synthesis. This medication specifically targets the overgrowth of anaerobic bacteria while allowing the normal vaginal flora to reestablish.
Key Considerations
- Clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms 1.
- The recommended metronidazole regimens are equally efficacious, and the vaginal clindamycin cream appears less efficacious than the metronidazole regimens 1.
- Patients should be advised to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter 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 1
Additional Information
The optimal treatment regimen for pregnant women with bacterial vaginosis is unclear, and research is needed to evaluate the benefit of screening and treating asymptomatic bacterial vaginosis in women at highest risk for preterm delivery 1. If symptoms persist after treatment or recur frequently, patients should consult their healthcare provider as alternative treatments or longer courses may be needed.
From the Research
Efficacy of Clindamycin Gel in Treating Bacterial Vaginosis
- Clindamycin vaginal cream has been shown to be effective in treating bacterial vaginosis, with cure rates comparable to those of oral metronidazole 2, 3, 4, 5.
- Studies have demonstrated that clindamycin vaginal cream offers similar efficacy and safety to standard oral metronidazole therapy for bacterial vaginosis 2, 3.
- The cure rates for clindamycin vaginal cream have been reported to be between 72% and 97% 2, 3, 4, 5.
- Clindamycin vaginal cream has been found to be a safe and well-tolerated alternative to oral metronidazole for the treatment of bacterial vaginosis 3, 5.
Comparison with Other Treatments
- Clindamycin vaginal cream has been compared to oral metronidazole and metronidazole vaginal gel in several studies, with no significant differences in cure rates found between the treatments 4, 5.
- One study found that clindamycin vaginal cream had a lower failure rate compared to oral metronidazole 5.
- Another study found that patients treated with clindamycin vaginal cream reported being more satisfied with the treatment compared to those treated with metronidazole vaginal gel 4.
Clinical Indications for Therapy
- Clindamycin vaginal cream is recommended as a preferred treatment for bacterial vaginosis in nonpregnant women, along with metronidazole and metronidazole vaginal gel 6.
- For pregnant women, the choice of treatment depends on the risk of preterm birth, with metronidazole recommended for high-risk women and either metronidazole or clindamycin vaginal cream recommended for low-risk women 6.