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Landon Stewart
Landon Stewart

Using Clindamycin To Treat Bacterial Vaginosis ((HOT))

Bacterial vaginosis can cause symptoms such as discharge with an unpleasant smell. The antibiotics clindamycin and metronidazole are both effective treatments for bacterial vaginosis. There has not yet been enough research on the possible benefits of lactic acid bacteria treatments.

Using Clindamycin to Treat Bacterial Vaginosis

It's not uncommon for bacterial vaginosis to return after a few weeks. That happens quite often. About half of all women have symptoms again about one year after the first infection. If bacterial vaginal infections return more frequently, it may be a good idea to discuss options for preventive treatment with your doctor.

Antibiotic treatment kills not only gardnerella bacteria, but also useful bacteria in the vaginal flora that work to keep other germs in check. This means that antibiotic treatment can sometimes end up causing a vaginal yeast infection (candida fungus). This happens to about 10% of women who use clindamycin or metronidazole. Itching and a thick, white discharge are typical signs of a yeast infection, and it can also be treated with medication.

Most study participants experienced no symptoms and their infection was detected during other routine pregnancy tests. If bacterial vaginosis starts causing symptoms during pregnancy, it is usually treated anyway.

* Clindamycin ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and diaphragms). Use of such products within 72 hours after treatment with clindamycin ovules is not recommended.

Oral therapy has not been reported to be superior to topical therapy for treating symptomatic BV in effecting cure or preventing adverse outcomes of pregnancy. Pregnant women can be treated with any of the recommended regimens for nonpregnant women, in addition to the alternative regimens of oral clindamycin and clindamycin ovules.

One hundred forty-three women with complaints of vaginitis were assigned to receive either 500 mg of metronidazole twice daily for 7 days or clindamycin 300 mg twice daily for 7 days. There was no significant difference in the failure rate between patients treated with clindamycin (6.1%) and those treated with metronidazole (4%). Adverse reactions were infrequent and mild in both treatment groups. Three patients who received clindamycin developed non-bloody diarrhea, which was mild and did not necessitate discontinuing therapy. We conclude that clindamycin may be a safe and effective alternative to metronidazole for treating women with bacterial vaginosis.

Bacterial vaginosis is the most common cause of vaginal discharge. Recent studies have confirmed its association with pelvic inflammatory disease and adverse pregnancy outcomes. Bacterial vaginosis is treated with oral metronidazole (given either as a single dose or a seven-day course) or clindamycin. Treatment with topical clindamycin or metronidazole is also effective in returning the vaginal flora to normal but may be less effective in preventing the increased incidence of adverse pregnancy outcomes.

Bacterial vaginosis, previously known as nonspecific vaginitis or Gardnerella vaginitis, is the most common cause of vaginal discharge. It may be the cause of up to one half of cases of vaginitis1 in all women and the cause of from 10 to 30 percent of cases in pregnant women.2 This clinical syndrome is now recognized as a polymicrobial superficial vaginal infection involving a loss of the normal lactobacilli and an overgrowth of anaerobes. While commonly found in increased numbers in women with bacterial vaginosis, Gardnerella vaginalis is not invariably present. G. vaginalis has been reported in from 16 to 42 percent of women with no signs or symptoms of vaginitis.3

Bacterial vaginosis is associated with an increased risk of several pathologic conditions, including postoperative infection following hysterectomy4 and postabortion pelvic inflammatory disease5 (Table 1). The risk of plasma cell endometritis in women with bacterial vaginosis has been reported to be 15 times higher than the risk in women without bacterial vaginosis (95 percent confidence interval; range: 2 to 686).6

In pregnant women, bacterial vaginosis is associated with the presence of fetal fibronectin. Women with fetal fibronectin have a 16-fold increase in clinical chorioamnionitis and a sixfold increase in neonatal sepsis.7 The microorganisms found in bacterial vaginosis are also commonly found in the amniotic fluid of women with amniotic fluid infection.8 Women with bacterial vaginosis have an odds ratio of 1.85 (confidence interval: 1.16 to 2.9) for intra-amniotic infection.9 Bacterial vaginosis in women at 23 to 26 weeks of gestation is associated with intra-amniotic fluid infection at term.10

The odds ratio for premature rupture of the membranes is 7.3 in women with bacterial vaginosis.11 Bacterial vaginosis has been associated with low birth weight12 and preterm birth, with odds ratios for preterm birth estimated to be from 1.8413 to 2.8.14

The increased frequency of bacterial vaginosis in unmarried, low-income black women and in women with previous low-birth-weight infants may account for some of the racial gap in preterm births; however, bacterial vaginosis remains a risk factor for preterm low birth weight when variables are adjusted for race.15

Another diagnostic criterion for bacterial vaginosis is the presence of clue cells on wet mount. Clue cells are vaginal epithelial cells that have a stippled appearance due to adherent coccobacilli (Figure 1). The edges of the cells are obscured and appear fuzzy compared with the normally sharp edges of vaginal epithelial cells. To be significant for bacterial vaginosis, more than 20 percent of the epithelial cells on the wet mount should be clue cells.

An alternative diagnostic criterion utilizes Gram staining of vaginal secretions.17 The loss of lactobacillus morphotypes and increase in Gardnerella and Bacteroides morphotypes and curved gram-variable rods, when combined with the pH, correlates well with Amsel's criteria for diagnosis of bacterial vaginosis.18 Gram stain may not be useful in determining eradication of the infection because of its high proportion of indeterminate results.19 Because the predictive value of a positive culture for G. vaginalis is less than 50 percent, culture is not recommended as a diagnostic tool.20

Some controversy remains over the sexual transmission of bacterial vaginosis. While it occurs more commonly in women with more than one sexual partner, bacterial vaginosis can also occur in women who are not yet sexually active.21 Treatment of male partners has not resulted in improved cure rates or a reduced rate of recurrence.22 Increased rates of infection with Chlamydia trachomatis and Neisseria gonorrhoeae have been reported in women with bacterial vaginosis, but increased rates of syphilis and Trichomonas infection have not been reported.23

When prescribing metronidazole, the physician should stress to patients the importance of abstinence from all forms of alcohol, as a disulfiram-type reaction can occur. Metronidazole has been shown to interfere with the metabolism of warfarin (Coumadin) and anticonvulsants; consequently, dosages of these agents may need to be reduced. Patients taking barbiturates may require a higher dosage of metronidazole. Clindamycin is also an effective treatment for bacterial vaginosis but is more expensive and is associated with diarrhea and, infrequently, colitis. In nonpregnant women, topical clindamycin 2 percent vaginal cream or metronidazole vaginal gel have rates of cure similar to those for oral treatment. Studies have shown no benefit from treating the sexual partner.

The clinical definition of bacterial vaginosis also includes women without symptoms.35 Researchers from one study29 reported a 50 percent reduction in preterm birth and premature rupture of the membranes associated with bacterial vaginosis after women with the infection had been treated with oral clindamycin. In view of potentially serious sequelae, the question of whether to screen for bacterial vaginosis in pregnancy has been raised.16 Further study is needed to determine if screening for vaginal infections should become a routine part of prenatal care.

To help clear up your infection completely, it is very important that you keep using this medicine for the full time of treatment , even if your symptoms begin to clear up after a few days. If you stop using this medicine too soon, your symptoms may return. Do not miss any doses. Also, continue using this medicine even if your menstrual period starts during the time of treatment.

Bacterial vaginosis is a common condition. It is a bacterial infection of the vagina and is caused by an overgrowth of normal bacteria. The main symptom is a vaginal discharge, often with a noticeable fishy smell. The infection may clear without treatment, or it can be treated with an antibiotic cream such as clindamycin. Clindamycin cream is applied into the vagina using an applicator.

Clindamycin is a medicine which is also available as a skin preparation for the treatment of acne, and as capsules to take by mouth to treat serious infections. There are two separate medicine leaflets available which provide more information about these uses of clindamycin, called Clindamycin skin preparations for acne and Clindamycin capsules for infection.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start using clindamycin cream, it is important that your doctor knows:

  • processing.... Drugs & Diseases > Obstetrics & Gynecology Bacterial Vaginosis Medication Updated: Jan 28, 2022 Author: Philippe H Girerd, MD; Chief Editor: Michel E Rivlin, MD more...

  • Share Print Feedback Close Facebook Twitter LinkedIn WhatsApp Email webmd.ads2.defineAd(id: 'ads-pos-421-sfp',pos: 421); Sections Bacterial Vaginosis Sections Bacterial Vaginosis Overview Practice Essentials

  • Background Pathophysiology Etiology Epidemiology Prognosis Patient Education Show All Presentation History

  • Physical Examination Show All DDx Workup Laboratory Studies

  • Other Tests Show All Treatment Approach Considerations

  • Medical Care Diet and Activity Show All Guidelines Medication Medication Summary

  • Antibiotics Show All Follow-up Further Outpatient Care

Deterrence/Prevention Show All Questions & Answers Tables References Medication Medication Summary Antibiotics are the mainstay of therapy for bacterial vaginosis. Medications include metronidazole (Flagyl), clindamycin (Cleocin) oral or vaginal suppositories, and metronidazole vaginal gel (MetroGel-Vaginal). Metronidazole and clindamycin are the preferred medications used to treat Gardnerella infections. See Medication for specific information on these medications. 041b061a72


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