Template:BV Antibiotics: Difference between revisions

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====First Line Therapy<ref>Workoski KA and Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommen and Reports. 2015; 64(3):1-140.</ref>====
====First Line Therapy<ref name="CDC Sexually Transmitted Infections Treatment Guidelines, 2021">CDC Sexually Transmitted Infections Treatment Guidelines, 2021.[https://www.cdc.gov/mmwr/volumes/70/rr/pdfs/rr7004a1-H.pdf]</ref>====
*[[Metronidazole]] 500 mg PO BID for 7 days OR
*[[Metronidazole]] 500 mg PO Twice Daily for 7 days OR
*[[Metronidazole]] gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days OR
*[[Metronidazole]] gel 0.75%, one full applicator (5 g) intravaginally, Daily for 5 days OR
*[[Clindamycin]] cream 2%, one full applicator (5 g) intravaginally qHS for 7 days
*[[Clindamycin]] cream 2%, one full applicator (5 g) intravaginally Nightly for 7 days
Metronidazole does not cause a disulfiram-like reaction with alcohol.<ref name="Is combining metronidazole and alcohol really hazardous?">Is combining metronidazole and alcohol really hazardous?[http://www.ncbi.nlm.nih.gov/pubmed/25223673]</ref>


====Alternative Regimin====
====Alternative Regimin====
*[[Tinidazole]] 2 g PO qd for 2 days OR
*[[Tinidazole]] 1 g PO qd for 5 days OR
*[[Clindamycin]] 300 mg PO BID for 7 days OR
*[[Clindamycin]] 300 mg PO BID for 7 days OR
*[[Clindamycin]] ovules 100 mg intravaginally qHS for 3 days (do not use if patient has used latex condom in last 72 hrs)
*[[Clindamycin]] ovules 100 mg intravaginally qHS for 3 days (do not use if patient has used latex condom in last 72 hours)
Other regimens have been studied and have varying efficacy compared to placebo but due to cost and availability do not represent alternatives outside of absolute contraindications to preferred regimens.
 
 


====Pregnant====
====Pregnant====
*[[Metronidazole]] 250mg PO q8h x 7 days<ref name="cdc">CDC Pregnancy BV Treatment Guidelines.[http://www.cdc.gov/std/treatment/2010/vaginal-discharge.htm#a1 cdc.gov]</ref>
*[[Metronidazole]] 500mg PO Twice a day x 7 days<ref name="CDC Sexually Transmitted Infections Treatment Guidelines, 2021">CDC Sexually Transmitted Infections Treatment Guidelines, 2021.[https://www.cdc.gov/mmwr/volumes/70/rr/pdfs/rr7004a1-H.pdf]</ref>
*[[Metronidazole]] 2g PO x 1 dose is also acceptable<ref name="cdc" />
*[[Metronidazole]] 250mg PO Three times a day has also been studied<ref name="Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis">Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis[http://www.ncbi.nlm.nih.gov/pubmed/7491136]</ref><ref name="Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebo-controlled, double-blind study">Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebo-controlled, double-blind study[http://www.ncbi.nlm.nih.gov/pubmed/8059811]</ref>
* Multiple studies have not demonstrated teratogenicity from metronidazole use<ref name="cdc" />
* Although metronidazole crosses the placenta, no evidence of teratogenicity or mutagenic effects among infants has been reported in multiple cross-sectional, case-control, and cohort studies of pregnant women<ref name="CDC Sexually Transmitted Infections Treatment Guidelines, 2021">CDC Sexually Transmitted Infections Treatment Guidelines, 2021.[https://www.cdc.gov/mmwr/volumes/70/rr/pdfs/rr7004a1-H.pdf]</ref>


====Prophylaxis ([[Sexual Assault]])====
====Prophylaxis ([[Sexual Assault]])====
*[[Metronidazole]] 2 g PO x 1 OR
*[[Metronidazole]] 500mg PO Twice a day x 7 days<ref name="Sexual Assault and Abuse and STIs – Adolescents and Adults">Sexual Assault and Abuse and STIs – Adolescents and Adults[https://www.cdc.gov/std/treatment-guidelines/sexual-assault-adults.htm]</ref>
*[[Tinidazole]] 2 g PO x 1

Latest revision as of 20:05, 1 October 2025

First Line Therapy[1]

  • Metronidazole 500 mg PO Twice Daily for 7 days OR
  • Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, Daily for 5 days OR
  • Clindamycin cream 2%, one full applicator (5 g) intravaginally Nightly for 7 days

Metronidazole does not cause a disulfiram-like reaction with alcohol.[2]

Alternative Regimin

  • Clindamycin 300 mg PO BID for 7 days OR
  • Clindamycin ovules 100 mg intravaginally qHS for 3 days (do not use if patient has used latex condom in last 72 hours)

Other regimens have been studied and have varying efficacy compared to placebo but due to cost and availability do not represent alternatives outside of absolute contraindications to preferred regimens.


Pregnant

  • Metronidazole 500mg PO Twice a day x 7 days[1]
  • Metronidazole 250mg PO Three times a day has also been studied[3][4]
  • Although metronidazole crosses the placenta, no evidence of teratogenicity or mutagenic effects among infants has been reported in multiple cross-sectional, case-control, and cohort studies of pregnant women[1]

Prophylaxis (Sexual Assault)

  1. ↑ 1.0 1.1 1.2 CDC Sexually Transmitted Infections Treatment Guidelines, 2021.[1]
  2. ↑ Is combining metronidazole and alcohol really hazardous?[2]
  3. ↑ Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis[3]
  4. ↑ Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebo-controlled, double-blind study[4]
  5. ↑ Sexual Assault and Abuse and STIs – Adolescents and Adults[5]
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