Megaspore BV is Not Recommended as First-Line Treatment for Bacterial Vaginosis
Megaspore BV (probiotic) is not recommended as a first-line treatment for bacterial vaginosis as there is insufficient evidence supporting its efficacy compared to established treatments like metronidazole and clindamycin. 1, 2
First-Line Treatment Recommendations for BV
The CDC recommends the following evidence-based first-line treatments:
- Oral metronidazole 500 mg twice daily for 7 days (95% cure rate) 1, 2
- Metronidazole gel 0.75%, one full applicator (5g) intravaginally once daily for 5 days 3, 1
- Clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days 3
Alternative Treatment Options
When first-line treatments cannot be used, the following alternatives are recommended:
- Metronidazole 2g orally in a single dose (lower efficacy at 84% cure rate) 3, 1
- Clindamycin 300 mg orally twice daily for 7 days 3, 2
- Clindamycin ovules 100g intravaginally once at bedtime for 3 days 3
Role of Probiotics in BV Treatment
While probiotics show promise, they are not currently recommended as first-line therapy:
- Meta-analyses suggest probiotics may play a positive role in BV treatment, but primarily as adjunctive therapy with antibiotics rather than as standalone treatment 4
- Probiotics combined with antibiotics show better cure rates than antibiotics alone [RR = 1.23,95% CI (1.05,1.43)] 4
- Probiotics may be more beneficial for preventing recurrence rather than as primary treatment 5, 6
- Current guidelines do not include probiotics among recommended first-line treatments 3, 1
Treatment Considerations
Side Effects and Precautions
- Patients using metronidazole should avoid alcohol during treatment and for 24 hours afterward due to potential disulfiram-like reaction 3, 1
- Clindamycin cream and ovules are oil-based and may weaken latex condoms and diaphragms 3, 2
- Metronidazole may cause gastrointestinal upset; intravaginal preparations have fewer systemic side effects 1
Follow-Up and Recurrence Management
- Follow-up visits are unnecessary if symptoms resolve 3, 1
- Because recurrence of BV is common, patients should return for additional therapy if symptoms recur 3
- Another recommended treatment regimen may be used for recurrent disease 3
Special Populations
Pregnancy
- During first trimester: Clindamycin vaginal cream is preferred due to contraindication of metronidazole 1
- During second and third trimesters: Metronidazole can be used 1
- Treatment of BV in high-risk pregnant women (history of preterm delivery) may reduce risk of prematurity 3, 1
Before Invasive Procedures
- Treatment of BV before surgical abortion or hysterectomy is recommended due to increased risk for postoperative infectious complications 3
- Treatment of BV with metronidazole has been shown to substantially reduce post-abortion PID 3
Emerging Treatments
Recent research shows dequalinium chloride (an antiseptic) is non-inferior to metronidazole for BV treatment with better tolerability and fewer adverse events, which may provide a non-antibiotic alternative 7