From the Guidelines
The best treatment for bacterial vaginosis is metronidazole 500 mg orally twice a day for 7 days, as it has been shown to be equally efficacious as other metronidazole regimens and more efficacious than clindamycin cream. This recommendation is based on the Centers for Disease Control and Prevention's guidelines from 2002 1. The treatment options for bacterial vaginosis include:
- Metronidazole 500 mg orally twice a day for 7 days
- Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days
- Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
It is essential to note that patients should avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter, as it may cause disulfiram-like reactions. Additionally, clindamycin cream and ovules are oil-based and may weaken latex condoms and diaphragms.
Alternative regimens, such as metronidazole 2 g orally in a single dose, clindamycin 300 mg orally twice a day for 7 days, or clindamycin ovules 100 g intravaginally once at bedtime for 3 days, have lower efficacy for BV and are not recommended as first-line treatment.
Follow-up visits are unnecessary if symptoms resolve, but recurrence of BV is common, affecting many women within a few months after treatment, and may require repeated or extended antibiotic courses.
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.
The best treatment for bacterial vaginosis is tinidazole given as either 2 g once daily for 2 days or 1 g once daily for 5 days, as it has demonstrated superior efficacy over placebo in a randomized, double-blind, placebo-controlled clinical trial 2.
- Therapeutic cure rates were 97.5% for the 2-day regimen and 93.4% for the 5-day regimen.
- Clinical cure rates were 93.4% for the 2-day regimen and 87.7% for the 5-day regimen.
- Microbiologic cure rates were 93.4% for the 2-day regimen and 87.7% for the 5-day regimen.
From the Research
Treatment Options for Bacterial Vaginosis
The treatment for bacterial vaginosis can vary, with several options available. These include:
- Oral metronidazole (500 mg twice daily for 7 days) 3
- Single-dose metronidazole (2 g orally) 3
- 2% clindamycin vaginal cream (once daily for 7 days) 3, 4, 5
- 0.75% metronidazole vaginal gel (twice daily for 5 days) 3, 5
- Oral clindamycin (300 mg twice daily for 7 days) 3
- Tinidazole, which has been shown to be equivalent to oral metronidazole and has a more favorable side effect profile 6
- Vaginal clindamycin ovules, which have been shown to be as effective as and better tolerated than oral metronidazole 7
Comparison of Treatment Options
Studies have compared the efficacy of different treatment options for bacterial vaginosis. For example:
- A study found that 2% clindamycin vaginal cream and oral metronidazole had comparable cure rates 4
- Another study found that oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream had similar efficacy 5
- A study comparing tinidazole to oral metronidazole found that tinidazole had a more favorable side effect profile 6
- A randomized trial found that vaginal clindamycin ovules were as effective as and better tolerated than oral metronidazole 7
Special Considerations
There are special considerations for the treatment of bacterial vaginosis in certain populations, such as:
- Pregnant women, where treatment should focus on eliminating symptoms 3
- Women undergoing surgical abortion, where treatment of bacterial vaginosis should be considered to prevent pelvic inflammatory disease 3
- Women with recurrent bacterial vaginosis, where repeated courses of treatment may be necessary 6