Bacterial Vaginosis Empiric Therapy
Updated: Sep 25, 2017
Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD
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]
Metronidazole 500 mg PO BID for 7d ormetronidazole 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
Secnidazole 1 packet (2 gram) of granules PO qDay, without regard to timing of meals
Tinidazole 2 g PO once daily for 2d or tinidazole 1 g PO once daily for 5d orclindamycin 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]
Metronidazole 500 mg PO BID for 7d or metronidazole 250 mg PO TID for 7d or clindamycin 300 mg PO BID for 7d
Intravaginal clindamycin cream is preferred in the presence of patient allergies or intolerance
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
Probiotic (Lactobacillus rhamnosus, L acidophilus, and Streptococcus thermophilus) vaginal capsule daily for 7d, repeat 7d later (not FDA approved)[5]
Specific etiology is not typically established for the diagnosis of bacterial vaginosis