From the Guidelines
Treatment for Bacterial Vaginosis in Breastfeeding Patients
The treatment for bacterial vaginosis in a breastfeeding patient is metronidazole 500 mg orally twice a day for 7 days [ 1 ].
- This regimen is recommended due to its efficacy and safety profile, with minimal risk of adverse effects on the infant [ 1 ].
- Alternatively, metronidazole gel 0.75% can be used, one full applicator (5 g) intravaginally, once a day for 5 days, or clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days [ 1 ].
- It is crucial to advise patients to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter [ 1 ].
- Breastfeeding can continue as usual during treatment, as the risk of adverse effects on the infant is considered low [ 1 ].
- Clindamycin can also be used at a dose of 300 mg orally, twice daily for 7 days, although it is less preferred due to its higher milk concentration and potential for adverse effects [ 1 ].
From the Research
Treatment Options for Bacterial Vaginosis in Breastfeeding Patients
- The use of most antibiotics is considered compatible with breast feeding, including penicillins, aminopenicillins, clavulanic acid, cephalosporins, macrolides, and metronidazole at dosages at the low end of the recommended dosage range 2
- Metronidazole is considered safe for use during lactation, with a relative infant dose of 11% 3
- A study developed a method for quantifying metronidazole in breast milk, which can be used to support clinical studies on the safety of metronidazole during breastfeeding 4
Alternative Treatment Options
- Probiotics have been shown to have good efficacy in the treatment of bacterial vaginosis in pregnancy, leading to decreased burden of subsequent preterm birth 5
- However, there is limited evidence on the use of probiotics in breastfeeding patients with bacterial vaginosis