Is Cleocin (clindamycin) effective for treating bacterial vaginosis (BV)?

Clindamycin Effectiveness for Bacterial Vaginosis

Yes, Cleocin (clindamycin) is an effective treatment option for bacterial vaginosis (BV), though it is generally considered an alternative to metronidazole regimens. According to CDC guidelines, clindamycin is a proven therapeutic option for BV with comparable efficacy to metronidazole treatments 1.

Treatment Options for BV

First-line Recommended Regimens

• Metronidazole 500 mg orally twice daily for 7 days
• Metronidazole gel 0.75%, one full applicator (5 g) intravaginally once daily for 5 days
• Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days

Alternative Regimens

• Metronidazole 2 g orally in a single dose
• Clindamycin 300 mg orally twice daily for 7 days
• Clindamycin ovules 100 g intravaginally once at bedtime for 3 days

Efficacy of Clindamycin

Clinical studies have demonstrated that clindamycin is effective for treating BV:

• Clindamycin vaginal cream (2%) has shown cure rates of 86.2% compared to 84.2% for oral metronidazole 2
• Oral clindamycin (300 mg twice daily for 7 days) has demonstrated similar efficacy to oral metronidazole with failure rates of only 6.1% versus 4% for metronidazole 3
• In a randomized trial, 97% of patients treated with clindamycin vaginal cream showed improvement or cure compared to 83% with oral metronidazole 4

Clinical Considerations

Advantages of Clindamycin

• Preferred option for patients with allergy or intolerance to metronidazole 1
• Lower systemic absorption with vaginal formulations (mean bioavailability of clindamycin cream is approximately 4%) 1
• May be better tolerated by some patients who experience gastrointestinal side effects with metronidazole

Important Caveats

1. Oil-based formulation concerns: Clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms 1
2. Pregnancy considerations:
   • Clindamycin vaginal cream is preferred during the first trimester of pregnancy when metronidazole is contraindicated 1
   • Some evidence suggests potential increase in adverse events after use of clindamycin cream during pregnancy 1
3. Recurrent BV: For recurrent cases, extended metronidazole treatment is typically recommended first, with clindamycin as an alternative 5

Follow-up Recommendations

• Follow-up visits are unnecessary if symptoms resolve 1
• No routine treatment of sex partners is recommended as clinical trials indicate it does not affect treatment response or recurrence rates 1
• Recurrence of BV is common, and patients should be advised to return for additional therapy if symptoms recur 1

Treatment Selection Algorithm

1. For non-pregnant women:

   • First choice: Metronidazole 500 mg orally twice daily for 7 days
   • If intolerant to oral metronidazole: Clindamycin cream 2% or metronidazole gel 0.75%
   • If allergic to metronidazole: Clindamycin (cream or oral)

2. For pregnant women:

   • First trimester: Clindamycin vaginal cream
   • Second/third trimester: Oral metronidazole or vaginal preparations

3. For recurrent BV:

   • Extended course of metronidazole treatment
   • If ineffective, consider maintenance therapy with metronidazole gel

Remember that while clindamycin is effective for BV, its use should be reserved for appropriate indications as outlined in the FDA label, which includes "infections of the female pelvis and genital tract such as endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection" 6.