Antimicrobials effective for bacterial vaginosis in non-pregnant women

January 01, 0001

Antimicrobials effective for bacterial vaginosis in non-pregnant women

Clinical Question:How effective are antimicrobial agents for bacterial vaginosis (BV) in non-pregnant women?

Bottom line: Clindamycin cream (NNT* 3), clindamycin ovules and tablets, topical metronidazole (NNT 3), oral metronidazole and oral and intravaginal lactobacillus are effective for eradicating symptoms of BV. Intravaginal lactobacillus (NNT 3) performed better than topical metronidizole at four-week follow-up. Oral metronidazole tends to cause a higher rate of adverse events, such as metallic taste and nausea and vomiting, than clindamycin. Oral lactobacillus combined with metronidazole is more effective than metronidazole alone. Hydrogen peroxide douche and triple sulphonamide therapy are ineffective for treatment of BV. * NNT = number needed to treat to benefit one individual

Caveat: Only one trial involved asymptomatic women and the result was inconclusive. There was insufficient evidence to reach a conclusion on the effectiveness of other promising drugs.

Context: Biologics are a group of disease-modifying anti-rheumatic drugs that suppress the immune system and reduce inflammation in the joints. Suppressing the immune system can make it slightly harder to "fight off" infections but also helps to stabilise an overactive immune system. The aim of treatment is to help prevent damage to the joints by reducing inflammation.

Cochrane Systematic Review: Oduyebo OO et al. The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women. Cochrane Reviews 2009, Issue 3. Article No. CD006055. DOI: 10.1002/14651858.CD006055.pub2. This review contains 24 studies involving 4422 participants.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 218, February 2010.
Written by Brian R McAvoy. Published by the Cochrane Primary Care Group

Category: X. Female Genital System, Breast. Keywords: bacterial vaginosis, treatment, antimicrobials, metronidazole, clindamycin
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 4 May 2010

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Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.