How to choose drugs for the treatment of bacterial vaginosis

In life, many female friends have experienced symptoms of bacterial vaginosis. The occurrence of bacterial vaginosis may affect women's fertility, and may also cause women to experience vulvar itching, burning pain, restlessness, and abnormal leucorrhea. So how to choose drugs for the treatment of bacterial vaginosis?

1. Metronidazole (metronidazole, metronidazole) 500mg, orally, twice a day, for 7 days. Or metronidazole 2g, single dose once orally; Metronidazole is the first choice for BV treatment, with strong anti-anaerobic activity and anti-Gardnerella activity, but no anti-Lactobacillus activity. Randomized surveys and studies have shown that the cure rate of a 7-day treatment regimen is 95%, and the cure rate of a 2g single-dose treatment regimen is 84%.

Intolerance to oral metronidazole can be replaced by vaginal metronidazole gel. Vaginal metronidazole suppository 500mg, inserted once a night for 7 days, cure rate 71-79%; or 0.75 metronidazole gel 5g, inserted twice a day for 7 days, cure rate 87% to 91%. Do not drink alcoholic beverages while taking metronidazole to avoid sulfur withdrawal-like effects. Metronidazole is contraindicated in the first 3 months of pregnancy because it may cause teratogenic effects. Oral tinidazole has similar efficacy to metronidazole and fewer side effects.

2. Clindamycin 300mg, twice a day, for 7 days. The cure rate is over 94%. This drug has good anti-anaerobic activity, moderate anti-Gardnerella and Mycoplasma hominis activity, and is the first effective alternative to metronidazole. It is suitable for pregnant women, or those who are allergic or intolerant to metronidazole, or those who have failed metronidazole treatment. Local treatment can use 2 Clindamycin vaginal cream 5g, once before going to bed every night for 7 days, or twice a day for 5 days; the cure rate is 92%~94%.

3. Ampicillin 0.5g, taken orally, 4 times a day for 7 days, is about 40% to 50% effective. This drug has good activity in killing BV-related microorganisms, but also has the effect of killing lactobacilli.

4. Lactobacillus preparations: Each contains 108-109 colony-forming units, one is inserted into the vagina twice a day for a total of 6 days, and the cure rate is 52%. However, there are also studies that use lactic acid gel (pH 3.8) or lactic acid suppositories (pH 3.3) to adjust the vaginal pH to achieve the purpose of treatment, which shows that it is ineffective.

5. The treatment of BV patients with HIV infection is generally the same as that of BV patients without HIV infection.