Monday 22 February 2010, 12:35PM
PEARLS No. 218, November 2009, written by Brian R
McAvoy
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
BV is a very common cause of symptomatic and asymptomatic vaginal
infection. It has been associated with a high incidence of
obstetric and gynaecologic complications and an increased risk of
transmission of human immunodeficiency virus.
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.