Clindamycin Vaginal Cream for Bacterial Vaginosis
The CDC recommends clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days as a first-line treatment option for bacterial vaginosis in non-pregnant women. 1, 2
Dosing Regimen
- Clindamycin cream 2%: Apply one full applicator (5g) intravaginally at bedtime for 7 consecutive days 3, 1, 2
- This regimen is considered equally acceptable to oral metronidazole 500mg twice daily for 7 days as first-line therapy 2
Alternative Clindamycin Formulations
- Clindamycin ovules 100mg intravaginally once at bedtime for 3 days is an alternative regimen with similar efficacy to the 7-day cream 3, 1
- A randomized trial demonstrated equivalent cure rates between the 3-day ovule regimen (53.7%) and 7-day cream regimen (47.8%) 4
- The 3-day ovule regimen offers better compliance with comparable efficacy 4
Efficacy Considerations
- Clindamycin vaginal cream achieves cure rates of approximately 86% using traditional clinical criteria 5
- The CDC notes that vaginal clindamycin cream appears less efficacious than metronidazole regimens, though clinical trials show comparable results 3
- When compared head-to-head with oral metronidazole, clindamycin ovules demonstrated similar cure rates (68.1% vs 66.7%) 6
Critical Patient Counseling
- Clindamycin cream and ovules are oil-based and will weaken latex condoms and diaphragms 3, 1, 7, 2
- Patients must be advised to use alternative contraception or barrier methods during treatment 1, 2
- Unlike metronidazole, clindamycin does not require alcohol avoidance 2
Special Populations
Pregnancy - First Trimester
- Clindamycin vaginal cream is the preferred treatment during the first trimester because metronidazole is contraindicated 1
- However, some studies have associated clindamycin vaginal cream with increased risk of preterm delivery 1
Pregnancy - After First Trimester
- For high-risk pregnant women (prior preterm birth), systemic therapy is preferred over vaginal clindamycin to address possible subclinical upper tract infection 7, 8
- Metronidazole 250mg orally three times daily for 7 days is recommended instead 7, 8
Metronidazole Allergy or Resistance
- Clindamycin cream 2% intravaginally at bedtime for 7 days OR clindamycin 300mg orally twice daily for 7 days are the preferred alternatives 1, 7
- This is particularly important for documented metronidazole resistance 7
Follow-Up and Recurrence
- Follow-up visits are unnecessary if symptoms resolve 1, 2
- For recurrent BV after clindamycin failure, switch to an alternative regimen rather than repeating the same therapy 7
- No long-term maintenance regimen is recommended 1
- Treatment of male sex partners is not recommended as it does not affect cure rates or recurrence 1, 7, 2
Common Pitfalls
- The most commonly reported adverse event is vulvovaginal pruritus, occurring at similar rates with clindamycin cream and other BV treatments 4
- Posttreatment vulvovaginal candidiasis occurs in approximately 14.8% of patients treated with clindamycin vaginal cream 5
- Patients may prefer intravaginal products over oral therapy despite similar efficacy 5