Health Library Antibiotics for Bacterial VaginosisFrom Healthwise

These antibiotic medicines can be taken by mouth in pill form (orally) or inserted into the vagina in cream, gel, or suppository form (ovules). Vaginal creams and gels are used with an applicator that inserts the correct amount of medicine. (Tinidazole is only taken by mouth.)

Metronidazole, clindamycin, and tinidazole are antibiotics that destroy some of the bacteria that cause symptoms of bacterial vaginosis.

Oral medicine

Some women prefer oral medicine rather than vaginal administration.

Especially for pregnant women who are high-risk for preterm labor, only oral medicines are used to treat bacterial vaginosis. Some doctors recommend that all pregnant women avoid vaginal treatment.

Vaginal medicine

Vaginal medicines are less likely than the oral forms to cause systemic side effects, such as nausea and vomiting.

Women who aren't pregnant

Oral or vaginal metronidazole and vaginal clindamycin cream all work well for curing bacterial vaginosis.¹ Vaginal or oral metronidazole cures bacterial vaginosis in as many as 9 out of 10 cases.² Tinidazole also has cure rates like those of metronidazole.³ Oral clindamycin and clindamycin ovules have not been as well studied.

Although medicine usually cures bacterial vaginosis, it often comes back. Some doctors have women use medicine for a longer time to prevent this.

The CDC also recommends clindamycin cream 2% for 7 days, though they note that it might not be as effective as metronidazole.¹ Clindamycin's relapse rate is higher: 4 weeks after clindamycin treatment, 56% of women have recurring bacterial vaginosis.⁴ Clindamycin ovules are similarly effective.¹

Women who are pregnant

Oral antibiotics, such as metronidazole, work well for curing bacterial vaginosis during pregnancy.⁵

Vaginal medicines

Side effects of vaginal clindamycin and metronidazole are generally minor. The most common is a vaginal yeast infection during or after treatment.

The oil in clindamycin cream and ovules can weaken latex. This means condoms and diaphragms may break, and you may not be protected from STDs or pregnancy.

Oral medicines

Oral treatment can cause:

• Unpleasant metallic taste in the mouth (common with metronidazole or tinidazole.).
• Nausea.
• Vomiting.
• Diarrhea.

Completely avoid alcohol use (including alcohol-based nonprescription medicines, such as NyQuil) while you are taking metronidazole or tinidazole, because combining alcohol with these medicines may cause severe nausea and vomiting.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

During pregnancy

The Centers for Disease Control recommends treatment for bacterial vaginosis at any time during pregnancy.¹

Either oral metronidazole or oral clindamycin are used for treatment during the second and third trimester of pregnancy. Neither medicine is likely to cause any harm to the fetus.^{1, 2}

• Metronidazole has been well studied and is generally thought to be safe to use during pregnancy.
• Clindamycin vaginal cream is not recommended for bacterial vaginosis treatment in pregnant women. The cream form of clindamycin has been shown to have a slightly increased risk for preterm birth.²
• Tinidazole is not recommended for use during pregnancy.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Citations

1. Centers for Disease Control and Prevention (2006). Diseases characterized by vaginal discharge section of Sexually transmitted diseases treatment guidelines. MMWR, 55(RR-11): 49–56.
2. Hillier S, et al. (2008). Bacterial vaginosis. In KK Holmes et al., eds., Sexually Transmitted Diseases, 4th ed., pp. 737–768. New York: McGraw-Hill.
3. Abramowicz M (2007). Tinidazole (Tindamaz)—A new option for treatment of bacterial vaginosis. Medical Letter on Drugs and Therapeutics, 49(1269): 73–74.
4. Koumans EH, et al (2002). Indications for therapy and treatment recommendations for bacterial vaginosis in nonpregnant and pregnant women: A synthesis of data. Clinical Infectious Diseases, 35(Suppl 2): S152–S172.
5. McDonald HM, et al. (2007). Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database of Systematic Reviews (1).

Author:	Sandy Jocoy, RN	Last Updated: February 18, 2010
Medical Review:	Sarah Marshall, MD - Family Medicine Jeanne Marrazzo, MD, MPH - Infectious Disease
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