Bacterial vaginosis medical therapy: Difference between revisions
| Line 15: | Line 15: | ||
In a [[randomized controlled trial]],<ref name="pmid11127100">{{cite journal |author=Hanson JM, McGregor JA, Hillier SL, ''et al'' |title=Metronidazole for bacterial vaginosis. A comparison of vaginal gel vs. oral therapy |journal=J Reprod Med |volume=45 |issue=11 |pages=889–96 |year=2000 |pmid=11127100 |doi=}}</ref> researchers found the efficacy of 0.75% metronidazole vaginal gel in treating bacterial vaginosis (cure rate 70.7%) was equivalent to that of standard oral metronidazole treatment (cure rate 71%). Treatment with vaginal metronidazole gel was associated with fewer gastrointestinal complaints. | In a [[randomized controlled trial]],<ref name="pmid11127100">{{cite journal |author=Hanson JM, McGregor JA, Hillier SL, ''et al'' |title=Metronidazole for bacterial vaginosis. A comparison of vaginal gel vs. oral therapy |journal=J Reprod Med |volume=45 |issue=11 |pages=889–96 |year=2000 |pmid=11127100 |doi=}}</ref> researchers found the efficacy of 0.75% metronidazole vaginal gel in treating bacterial vaginosis (cure rate 70.7%) was equivalent to that of standard oral metronidazole treatment (cure rate 71%). Treatment with vaginal metronidazole gel was associated with fewer gastrointestinal complaints. | ||
===Antimicrobial Regimen===:* 1.'''Bacterial Vaginosis'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref> | |||
::* Gardnerella vaginalis is one of the anaerobic bacteria causing Bacterial Vaginosis,which is a polymicrobial clinical syndrome | |||
:::* Preferred regimen (1): [[Metronidazole]] 500 mg PO bid for 7 days | |||
:::* Preferred regimen (2): [[Metronidazole]] gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days | |||
:::* Preferred regimen (3): [[Clindamycin]] cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days | |||
:::* Alternative regimen (1): [[Tinidazole]] 2 g PO qd for 2 days | |||
:::* Alternative regimen (2): [[Tinidazole]] 1 g PO qd for 5 days | |||
:::* Alternative regimen (3): [[Clindamycin]] 300 mg PO bid for 7 days | |||
:::* Alternative regimen (4): [[Clindamycin]] ovules 100 mg intravaginally once at bedtime for 3 days | |||
:::* Note: [[Clindamycin]] ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and vaginal contraceptive diaphragms). Use of such products within 72 hours following treatment with clindamycin ovules is not recommended. | |||
::* 2. '''Management of Sex Partners''' | |||
:::* Routine treatment of sex partners is not recommended. | |||
::* 3. '''Special Considerations''' | |||
:::* 3.1 '''Allergy, Intolerance, or Adverse Reactions''' | |||
:::* Intravaginal [[Clindamycin]] cream is preferred in case of allergy or intolerance to [[Metronidazole]] or [[Tinidazole]]. Intravaginal [[Metronidazole]] gel can be considered for women who are not allergic to [[Metronidazole]] but do not tolerate oral metronidazole. It is advised to avoid consuming alcohol during treatment with nitroimidazoles. To reduce the possibility of a disulfiram-like reaction, abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole. | |||
::* 3.2 '''Pregnancy''' | |||
:::* Preferred regimen (1): [[Metronidazole]] 500 mg PO bid for 7 days | |||
:::* Preferred regimen (2): [[Metronidazole]] gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days | |||
:::* Note: [[Tinidazole]] should be avoided during pregnancy | |||
::*3.3 '''HIV Infection''' | |||
:::* Women with HIV who have BV should receive the same treatment regimen as those who do not have HIV infection. | |||
{| class="wikitable" border="1" style="background:FloralWhite" | {| class="wikitable" border="1" style="background:FloralWhite" | ||
Revision as of 16:00, 22 July 2015
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
|
Bacterial vaginosis Microchapters |
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Bacterial vaginosis medical therapy On the Web |
|
American Roentgen Ray Society Images of Bacterial vaginosis medical therapy |
|
Risk calculators and risk factors for Bacterial vaginosis medical therapy |
Overview
Treatment with appropriate antibiotics is recommended in all symptomatic women and high risk asymptomatic pregnant women.
Medical Therapy
Pharmacotherapy
Bacterial vaginosis can be treated with antibiotics such as metronidazole and clindamycin. However, there is a high rate of recurrence.
Currently, there are very few over the counter products that address bacterial vaginosis. A vaginal gel product called RepHresh claims to regulate the pH level. Boric acid capsules inserted vaginally is considered a home treatment. Lactobacillus supplements may also be used; Fem-dophilus (Jarrow Formulas) is a lactobacillus product which specifically claims to help maintain healthy vaginal flora.[1]
It should be noted that seeking medical attention is often necessary, because none of the over the counter products can claim to treat an active infection. More importantly, patients often inaccurately diagnose BV as a yeast infection, and delay proper treatment which may lead to complications.
In a randomized controlled trial,[2] researchers found the efficacy of 0.75% metronidazole vaginal gel in treating bacterial vaginosis (cure rate 70.7%) was equivalent to that of standard oral metronidazole treatment (cure rate 71%). Treatment with vaginal metronidazole gel was associated with fewer gastrointestinal complaints.
===Antimicrobial Regimen===:* 1.Bacterial Vaginosis[3]
- Gardnerella vaginalis is one of the anaerobic bacteria causing Bacterial Vaginosis,which is a polymicrobial clinical syndrome
- Preferred regimen (1): Metronidazole 500 mg PO bid for 7 days
- Preferred regimen (2): Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
- Preferred regimen (3): Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
- Alternative regimen (1): Tinidazole 2 g PO qd for 2 days
- Alternative regimen (2): Tinidazole 1 g PO qd for 5 days
- Alternative regimen (3): Clindamycin 300 mg PO bid for 7 days
- Alternative regimen (4): Clindamycin ovules 100 mg intravaginally once at bedtime for 3 days
- Note: Clindamycin ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and vaginal contraceptive diaphragms). Use of such products within 72 hours following treatment with clindamycin ovules is not recommended.
- 2. Management of Sex Partners
- Routine treatment of sex partners is not recommended.
- 3. Special Considerations
- 3.1 Allergy, Intolerance, or Adverse Reactions
- Intravaginal Clindamycin cream is preferred in case of allergy or intolerance to Metronidazole or Tinidazole. Intravaginal Metronidazole gel can be considered for women who are not allergic to Metronidazole but do not tolerate oral metronidazole. It is advised to avoid consuming alcohol during treatment with nitroimidazoles. To reduce the possibility of a disulfiram-like reaction, abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole.
- 3.2 Pregnancy
- Preferred regimen (1): Metronidazole 500 mg PO bid for 7 days
- Preferred regimen (2): Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
- Note: Tinidazole should be avoided during pregnancy
- 3.3 HIV Infection
- Women with HIV who have BV should receive the same treatment regimen as those who do not have HIV infection.
| Characteristics of the Patient | Possible Pathogens | Preferred Treatment | Duration of Treatment | Alternative Treatment |
| All symptomatic women and
High risk asymptomatic pregnant women |
Prevotella spp,
Mobiluncus spp, G. vaginalis, Ureaplasma, Mycoplasma |
Metronidazole gel
0.75%, one full applicator (5 g) intravaginally, once daily |
5 days | Metronidazole 500 mg PO BID for 7 days
OR Clindamycin 300 mg PO BID for 7 days |
References
- ↑ "Specific probiotic strains are effective for genitourinary infections Townsend Letter for Doctors and Patients - Find Articles". Retrieved 2007-12-04.
- ↑ Hanson JM, McGregor JA, Hillier SL; et al. (2000). "Metronidazole for bacterial vaginosis. A comparison of vaginal gel vs. oral therapy". J Reprod Med. 45 (11): 889–96. PMID 11127100.
- ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.