Antimicrobials effective for bacterial vaginosis in non-pregnant women

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.
Review CD#: 
CD006055
PEARLS No: 
218
Date: 
November, 2009
Authored by: 
Brian R McAvoy