Clindamycin for Treatment of Bacterial Vaginosis and Mycoplasma

Clindamycin is an effective alternative treatment for bacterial vaginosis (BV), but it is not specifically indicated for Mycoplasma infections. 1

Treatment Options for Bacterial Vaginosis

Oral metronidazole 500 mg twice daily for 7 days is the preferred treatment with the highest efficacy (95% cure rate) 2, 1
Metronidazole gel 0.75%, one full applicator (5g) intravaginally once daily for 5 days is equally effective as oral therapy but with fewer systemic side effects 2, 1
Clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days is an effective first-line option with comparable efficacy to metronidazole 2, 3
Oral clindamycin 300 mg twice daily for 7 days is an alternative regimen 2

Studies have shown that clindamycin vaginal cream (2%) has similar efficacy to oral metronidazole, with cure rates of 97% compared to 83% for metronidazole in one study 3
Another study found comparable cure rates between clindamycin cream (72%) and oral metronidazole (87%) 4
Clindamycin vaginal cream appears to have good microbiologic efficacy against BV-associated flora, including Gardnerella vaginalis, Bacteroides species, and Peptostreptococcus species 5

While Mycoplasma hominis is often associated with BV and was found in 58% of women with BV in one study 5, the CDC guidelines do not specifically recommend clindamycin for isolated Mycoplasma infections 2, 1
Clindamycin treatment for BV resulted in decreased frequency and concentration of Mycoplasma hominis as part of the overall treatment effect 5

During first trimester: Clindamycin vaginal cream is preferred due to contraindication of metronidazole 2, 1
During second and third trimesters: Metronidazole is preferred, though clindamycin cream remains an option 2, 1

Clindamycin cream or oral clindamycin is the preferred treatment for patients with allergy or intolerance to metronidazole 2, 1

Clindamycin cream and ovules are oil-based and may weaken latex condoms and diaphragms 2
Clindamycin vaginal ovules (100g once at bedtime for 3 days) offer similar efficacy to the 7-day cream regimen, potentially improving compliance 6

Follow-up visits are unnecessary if symptoms resolve 2
For recurrent BV, alternative treatment regimens may be used 2, 7
Extended course of metronidazole (500 mg twice daily for 10-14 days) is recommended for recurrent BV 7

Routine treatment of sex partners is not recommended as it has not been shown to influence a woman's response to therapy or reduce recurrence rates 2

For first-line treatment of BV: Choose metronidazole (oral or vaginal) or clindamycin (vaginal cream) 1
If patient has metronidazole allergy or intolerance: Use clindamycin (cream or oral) 2, 1
If patient is in first trimester of pregnancy: Use clindamycin vaginal cream 2, 1
For recurrent BV: Use extended course of metronidazole or alternative regimens 7
For Mycoplasma infections without BV: Clindamycin is not specifically indicated; consult specific guidelines for Mycoplasma treatment 1