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Bacterial Vaginosis Empiric Therapy 

  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Mar 09, 2016
 
 

Empiric Therapy

The treatment regimens for bacterial vaginosis are provided below, including primary, alternative, and adjunctive treatments, as well as specific treatments for pregnant patients, patients allergic to metronidazole, and patients with recurrent infection.[1, 2, 3, 4, 5, 6]

Primary treatment

Metronidazole 500 mg PO BID for 7d or metronidazole gel 0.75% (use one full applicator [5g] intravaginally daily for 5d) or clindamycin cream 2% (use one full applicator [5g] intravaginally at bedtime for 7d

Alternative treatment

Tinidazole 2 g PO once daily for 2d or  tinidazole 1 g PO once daily for 5d or clindamycin 300 mg PO BID for 7d or  clindamycin ovules 100 mg intravaginally once at bedtime for 3d or  metronidazole extended-release 750 mg PO once daily for 7d. Intravaginal dequalinium chloride 10 mg once daily for 6d also appears to be effective but is not FDA approved for use in the United States.[6]

Pregnant patients

Metronidazole 500 mg PO BID for 7d or  metronidazole 250 mg PO TID for 7d or clindamycin 300 mg PO BID for 7d

Patients allergic to metronidazole

Intravaginal clindamycin cream is preferred in the presence of patient allergies or intolerance

Recurrent infection

Metronidazole gel 0.75% (after completion of recommended regimen, use one full applicator [5g] intravaginally twice weekly for 4-6mo or using a different treatment regimen is an option in patients with recurrent infections; re-treatment with the same topical regimen is also an acceptable approach in early stages of infection

Treatment of partners has not been shown to decrease recurrence rates

Adjunctive therapy

Probiotic (Lactobacillus rhamnosus, L acidophilus, and Streptococcus thermophilus) vaginal capsule daily for 7d, repeat 7d later (not FDA approved)[5]

Organism-specific therapy

Specific etiology is not typically established for the diagnosis of bacterial vaginosis

 
Contributor Information and Disclosures
Author

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of Ohio, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References
  1. Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983 Jan. 74(1):14-22. [Medline].

  2. Workowski KA, Bolan GA, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5. 64:69-72. [Medline].

  3. Gor HB. Vaginitis. Medscape Reference from WebMD. Updated Nov 3, 2015. Available at http://emedicine.medscape.com/article/257141-overview. Accessed: January 17, 2016.

  4. Verstraelen H, Verhelst R. Bacterial vaginosis: an update on diagnosis and treatment. Expert Rev Anti Infect Ther. 2009 Nov. 7(9):1109-24. [Medline].

  5. Ya W, Reifer C, Miller LE. Efficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a double-blind, randomized, placebo-controlled study. Am J Obstet Gynecol. 2010 Aug. 203(2):120.e1-6. [Medline].

  6. Mendling W, Weissenbacher ER, Gerber S, Prasauskas V, Grob P. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Arch Gynecol Obstet. 2015 Oct 27. e1-16. [Medline].

 
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