European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume 141, Issue 2 , Pages 158-162 , December 2008

Intravaginally applied metronidazole is as effective as orally applied in the treatment of bacterial vaginosis, but exhibits significantly less side effects

  • M. Brandt

      Affiliations

    • Representing the participating gynecologists of the Professional Association of Gynecologists Thuringia, D-99096 Erfurt, Germany
    • ,
  • C. Abels

      Affiliations

    • Dr. August Wolff GmbH & Co. KG Arzneimittel, D-33611 Bielefeld, Germany
    • Corresponding Author InformationCorresponding author at: Dr. August Wolff GmbH & Co. KG Arzneimittel, Medical Affairs, Sudbrackstrasse 56, D-33611 Bielefeld, Germany. Tel.: +49 521 8808 451; fax: +49 521 8808 474.
    • ,
  • T. May

      Affiliations

    • GBP, D-33617 Bielefeld, Germany
    • ,
  • K. Lohmann

      Affiliations

    • Dr. August Wolff GmbH & Co. KG Arzneimittel, D-33611 Bielefeld, Germany
    • ,
  • I. Schmidts-Winkler

      Affiliations

    • Dr. August Wolff GmbH & Co. KG Arzneimittel, D-33611 Bielefeld, Germany
    • ,
  • U.B. Hoyme

      Affiliations

    • Department of Gynecology and Obstetrics, HELIOS-Klinikum Erfurt, D-99089 Erfurt, Germany

Received 18 March 2008 ,Revised 9 June 2008 ,Accepted 11 July 2008.

References 

  1. Hay PE, Taylor-Robinson D. Defining bacterial vaginosis: to BV or not to BV, that is the question. Int J STD AIDS. 1996;7:233–235
  2. Eckert LO. Clinical practice. Acute vulvovaginitis. N Engl J Med. 2006;21(355):1244–1252
  3. Leitich H, Bodner-Adler B, Brunbauer M, Kaider A, Egarter C, Husslein P. Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol. 2003;189/1:139–147
  4. Donders GGG, Van Bulck B, Caudron J, Londers L, Vereecken A, Spitz B. Relationship of bacterial vaginosis and mycoplasmas to the risk of spontaneous abortion. Am J Obstet Gynecol. 2000;183:431–437
  5. Larsson PG, Forsum U. Bacterial vaginosis—a disturbed bacterial flora and treatment enigma. APMIS. 2005;113/5:305–316
  6. Boris J, Pahlson C, Larsson P-G. Six years observation after successful treatment of bacterial vaginosis. Infect Dis Obstet Gynecol. 1997;5:297–302
  7. Beigi RH, Austin MN, Meyn LA, Krohn M, Hillier SL. Antimicrobial resistance associated with the treatment of bacterial vaginosis. Am J Obstet Gynecol. 2004;191:1124–1129
  8. Centers for Disease Control and Prevention, Guidelines and treatment of sexually transmitted diseases: MMWR Recommendations and Report 2006, 55(RR11):1–94.
  9. AWMF-Reg.-Nr. 015/028, Empfehlungen zur bakteriellen Vaginose in Gynäkologie und Geburtshilfe, www.leitlinien.net; 2006.
  10. Matilde Sanchez M, Chen X. Choosing the analysis population in non-inferiority studies: per protocol or intent-to-treat. Stat Med. 2006;25:1169–1181
  11. Brittain E, Lin D. A comparison of intent-to-treat and per-protocol results in antibiotic non-inferiority trials. Stat Med. 2005;24:1–10
  12. Larsson PG, Bergman B, Forsum U, Pahlson C. Treatment of bacterial vaginosis in women with vaginal bleeding complications or discharge and harbouring Mobiluncus. Gynecol Obstet Invest. 1990;29:296–300
  13. Hillier SL, Lipinski C, Briselden AM, Eschenbach DA. Efficacy of intravaginal 0.75% metronidazole gel for the treatment of bacterial vaginosis. Am J Obstet Gynecol. 1993;81:963–967
  14. Livengood CH, McGregor JA, Soper DE, Newton E, Thomason JL. Bacterial vaginosis: efficacy and safety of intravaginal metronidazole treatment. Am J Obstet Gynecol. 1994;170:759–764
  15. Soper DE, Livengood C, Sheehan KL, Fenner DE, Martens MG, Nelson AL, et al. Safety and efficacy of MetroGel-Vaginal(R) in the treatment of bacterial vaginosis: a multicenter, randomized, single-blind, parallel comparison. Prim Care Update Ob Gyns. 1998;5:150
  16. Livengood CH, Soper DE, Sheehan KL, Fenner DE, Martens MG, Nelson AL, et al. Comparison of once-daily and twice-daily dosing of 0.75% metronidazole gel in the treatment of bacterial vaginosis. Sex Transm Dis. 1999;26:137–142
  17. Hanson JM, McGregor JA, Hillier SL, Eschenbach DA, Kreutner AK, Galask RP, et al. Metronidazole for bacterial vaginosis, a comparison of vaginal gel vs. oral therapy. J Reprod Med. 2000;45:889–896
  18. Voorspoels J, Casteels M, Remon JP, Temmerman M. Local treatment of bacterial vaginosis with a bioadhesive metronidazole tablet. Eur J Obstet Gynecol Reprod Biol. 2002;105:64–66
  19. Cunningham FE, Kraus DM, Brubaker L, Fischer JH. Pharmacokinetics of intravaginal metronidazole gel. J Clin Pharmacol. 1994;34(11):1060–1065
  20. Sobel JD, Ferris D, Schwebke J, et al. Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol. 2006;194(5):1283–1289
  21. Swedberg J, Steiner JF, Tackwell KR, Batts DH. Comparison of single-dose vs one-week course of metronidazole for symptomatic bacterial vaginosis. JAMA. 1985;254:1046–1049
  22. Schmitt C, Sobel JD, Merlwether C. Bacterial vaginosis: treatment with clindamycin cream versus oral metronidazole. Obstet Gynecol. 1992;85:1077–1080
  23. Paavonen J, Mangioni C, Martin MA, Wajszczuk CP. Vaginal clindamycin and oral metronidazole for bacterial vaginosis: a randomized trial. Obstet Gynecol. 2000;96:256–260
  24. Alper MM, Barwin BN, McLean WM, McGilveray IJ, Sved S. Systemic absorption of metronidazole by the vaginal route. Obstet Gynecol. 1985;65:781–784
  25. Edelman DA, North BB. Treatment of bacterial vaginosis with intravaginal sponges containing metronidazole. J Reprod Med. 1989;34:341–344
  26. Ferris DG, Litaker MS, Woodward L, Mathis D, Hendrich J. Treatment of bacterial vaginosis: a comparison of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream. J Fam Pract. 1995;41/5:443–449

PII: S0301-2115(08)00291-1

doi: 10.1016/j.ejogrb.2008.07.022

European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume 141, Issue 2 , Pages 158-162 , December 2008

Article Tools

* Image Usage & Resolution