Bacterial vaginosis, the most common cause of vaginal discharge, is an unpleasant infection of the vaginal tract. Caused by an overgrowth of anaerobic bacteria, the disease produces a fishy-smelling white discharge. No over-the- counter medications can treat bacterial vaginosis, but there are prescription antibiotics available that cure the infection.
Oral Metronidazole
Oral metronidazole is sold under the brand name Flagyl and is typically prescribed in either a seven-day course of treatment or a single-day treatment. The seven-day treatment is generally either a 300-mg or 500-mg dose twice a day for a week. When given as a 1-day treatment, the patient takes four 500 mg tablets at once, for a total dose of 2 grams. A seven-day course of metronidazole is 84% to 96% effective at curing the disease, as reported in a November 1998 study titled "Clindamycin versus metronidazole in the treatment of bacterial vaginosis " in the journal Obstetrics & Gynecology. Metronidazole cannot be taken in conjunction with alcohol.
Oral Clindamycin
Oral clindamycin is prescribed as either a seven-day course of treatment or a five- day treatment and has the brand name Cleocin. The seven-day course is taken as a 5-gram dose at bedtime daily for a week. When prescribed as a five-day course, the dosage is 5 grams taken twice daily. Cleocin clears the infection successfully 94% of the time, as described in the 1998 Obstetrics & Gynecology study.
Topical Metronidazole
Topical metronidazole is available as a vaginal gel and has a 75% success rate at curing the infection, as reported in a November 1995 article "Treatment of bacterial vaginosis: a comparison of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream" in the Journal of Family Practice. It is used twice a day for 5 consecutive days. The gel is inserted into the vagina using a special applicator that comes with the medication. It should be used before bedtime for best results, since lying down will prevent the medication from dripping out of the vagina. Metronidazole may affect the absorption of other medications, such as anticoagulants, and certain vitamins. Women undergoing treatment with topical metronidazole should not drink alcohol. Mild side effects include redness, dryness, stinging and irritation.
Topical Clindamycin
The topical treatment using clindamycin is a 2% vaginal cream given in a single day, three-day or seven-day course. Pregnant women in their second or third trimester generally are prescribed the longer 7-day treatment course. About 86% of women using topical clindamycin successfully got rid of the infection, according to the November 1995 Journal of Family Practice study. A vaginal suppository of clindamycin inserted once daily for three days is another option for topical treatment of bacterial vaginosis. Mild dryness, itching, redness or irritation may occur as side effects of topical clindamycin.
References
- Drugs.com: clindamycin topical
- Medline Plus: Metronidazole Topical
- Barbara Majeroni, MD. "American Family Physician." Bacterial Vaginosis: An Update. American Academy of Family Physicians. March 1998
- CDC: Bacterial Vaginosis Fact Sheet
- "Journal of Family Practice "; Treatment of bacterial vaginosis: a comparison of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream; Ferris DG, et al.; November 1995
