From the Guidelines
Bacterial vaginosis should be treated with metronidazole 500 mg orally twice a day for 7 days as the first-line treatment. This recommendation is based on the Centers for Disease Control and Prevention's guidelines for the treatment of sexually transmitted diseases, including bacterial vaginosis 1. The standard regimen of oral metronidazole has been shown to be effective in relieving symptoms and signs of infection. Alternative options include metronidazole gel 0.75% (one applicator intravaginally once daily for 5 days) or clindamycin cream 2% (one applicator intravaginally at bedtime for 7 days) 1.
Some key points to consider when treating bacterial vaginosis include:
- Patients should be advised to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter 1.
- Clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms 1.
- Recurrence is common, affecting about 30% of women within 3 months after treatment, and may require repeated or extended antibiotic courses.
- Bacterial vaginosis occurs when the normal vaginal flora, dominated by Lactobacillus species, is disrupted and replaced by an overgrowth of anaerobic bacteria.
- The antibiotics work by targeting these anaerobic bacteria, allowing the normal Lactobacillus-dominant flora to be restored.
In pregnant women, treatment of bacterial vaginosis is also recommended to relieve vaginal symptoms and signs of infection, as well as to reduce the risk of infectious complications associated with BV during pregnancy 1. High-risk pregnant women who have asymptomatic BV may be evaluated for treatment to reduce the risk of prematurity 1.
From the FDA Drug Label
A randomized, double-blind, placebo-controlled clinical trial in 235 non-pregnant women was conducted to evaluate the efficacy of tinidazole for the treatment of bacterial vaginosis. In patients with all four Amsel's criteria and with a baseline Nugent score ≥4, tinidazole oral tablets given as either 2 g once daily for 2 days or 1 g once daily for 5 days demonstrated superior efficacy over placebo tablets as measured by therapeutic cure, clinical cure, and a microbiologic cure. Table 2 Efficacy of Tinidazole in the Treatment of Bacterial Vaginosis in a Randomized, Double-Blind, Double-Dummy, Placebo-Controlled Trial:
- Therapeutic Cure: 97.5% CI ‡ 36.8 31.7 (16.8,46.6) for 1g × 5 days, 27.4 22.3 (8.0,36.6) for 2g × 2 days
- Clinical Cure: 51.3 39.8 (23.3,56.3) for 1g × 5 days, 35.6 24.1 (7.8,40.3) for 2g × 2 days
- Nugent Score Cure: 38.2 33.1 (18.1,48.0) for 1g × 5 days, 27.4 22.3 (8.0,36.6) for 2g × 2 days
Tinidazole Treatment for Bacterial Vaginosis
- Dosage: 2 g once daily for 2 days or 1 g once daily for 5 days
- Efficacy: Demonstrated superior efficacy over placebo in therapeutic cure, clinical cure, and microbiologic cure
- Key Findings:
- Therapeutic cure rates: 97.5% for 1g × 5 days, 92.5% for 2g × 2 days
- Clinical cure rates: 92.1% for 1g × 5 days, 86.3% for 2g × 2 days
- Nugent score cure rates: 92.1% for 1g × 5 days, 86.3% for 2g × 2 days 2
From the Research
Treatment Options for Bacterial Vaginosis
- Oral metronidazole (500 mg twice daily for 7 days) is the preferred treatment for bacterial vaginosis, as suggested by studies 3, 4.
- Other effective treatment regimens include:
- Tinidazole is also an effective treatment option, with a more favorable side effect profile compared to metronidazole 6.
- Ornidazole, secnidazole, and metronidazole have also been evaluated as treatment options, with varying degrees of efficacy 7.
Special Considerations
- Treatment of bacterial vaginosis during pregnancy should focus on eliminating symptoms, with metronidazole (250 mg orally three times a day for 7 days) being a recommended option 4.
- Routine treatment of male sex partners is not supported by the data 3, 4.
- Treatment of bacterial vaginosis before surgical abortion should be considered to prevent pelvic inflammatory disease 3.