Bacterial vaginosis, metronidazole

Clindamycin vaginal cream is the preferred therapy for bacterial vaginosis during lactation because metronidazole is listed as a drug of concern by the American Academy of Pediatrics (AAP)14 (Tables 44—4 and 44—5). Counsel patients that clindamycin cream weakens latex condoms and diaphragms, potentially rendering them ineffective. 

Symonds J, Biswas AK Amoxicillin, Augmen-tin, and metronidazole in bacterial vaginosis associated with Gardnerella vaginalis (letter). Genitourin Med 1986,62 136. 

Cefuroxime is indicated to treat infections of bacterial origin such as urinary tract infections, otitis media and upper respiratory tract infections. Bacterial vaginosis is likely to be treated with metronidazole and clindamycin. 

Metronidazole also is indicated for amebiasis and trichomoniasis, intravaginally for bacterial vaginosis, and topically for acne rosacea. 

Unlabeled uses The CDC has recommended the use of oral metronidazole for bacterial vaginosis (500 mg twice daily for 7 days). Single-dose therapy for bacterial vaginosis (2 g) also appears to be as effective as multiple-dose therapy. 

Metronidazole is indicated for treatment of anaerobic or mixed intra-abdominal infections, vaginitis (trichomonas infection, bacterial vaginosis), C difficile colitis, and brain abscess. The typical dosage is 500 mg three times daily orally or intravenously (30 mg/kg/d). Vaginitis may respond to a single 2-g dose. A vaginal gel is available for topical use. 

Polycarbophil-based bioadhesive tablets of metronidazole were tested for adhesion on bovine submaxillary mucin [74]. In a more recent study, metronidazole tablets based on a mixture of modified starch-polyacrylic acid showed an increased potential for the treatment of bacterial vaginosis [75]. 

Bouckaert, S., et al. 1995. Preliminary efficacy study of bioadhesive vaginal metronidazole tablet in the treatment of bacterial vaginosis. J Pharm Pharmacol 47 970. 

Clindamycin also is indicated for the treatment of bacterial vaginosis Its efficacy as a 2% cream is similar to oral metronidazole treatment. Measurable... 

Fischbach, F. Petersen, E. Weissenbacher, E. Martins, J. Hosmann, J. Mayer, H. Efficacy of clindamycin vaginal cream versus oral metronidazole in the treatment of bacterial vaginosis. Obstet. Gynecol. 1993, 82, 405-410. 

In 233 women with bacterial vaginosis, a 3-day regimen of clindamycin (intravaginal ovules, 100 mg/day) was as effective as a 7-day regimen of oral metronidazole (500 mg bd) and better tolerated (4). Treatment-related adverse events were reported more often with metronidazole, and systemic symptoms, such as nausea and taste disturbance, accounted for most of the difference between the groups. 

Vaginal clindamycin and oral metronidazole for bacterial vaginosis a randomized trial. Obstet Gynecol... 

Metronidazole has been formulated as a vaginal gel (0.75%) for the treatment of bacterial vaginosis. A single daily 5-day regimen has been approved by the FDA and has been shown to be as effective as oral metronidazole (1). 

Pregnant women with a history of preterm delivery should undergo screening for bacterial vaginosis at the first prenatal visit. If the infection is present, the recommended regimen is metronidazole 250 mg three times a day for 7 days or clindamycin 300 mg twice a day for 7 days. ... 

Anukam KC, Osazuwa E, Osemene Gl, Ehigiagbe F, Bruce AW, Reid G. Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes and Infection. 2006 8(12) 2772—2776. 

Simbar. M.. Azarbad. Z.. Mojab, E., Alavi Majd, H. 2008. A comparative study of the therapeutic effects of the Zataria multi ora vaginal cream and metronidazole vaginal gel on bacterial vaginosis. Phvtomedicine 15(12) 1025-1031. 

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