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Antibiotics for Bacterial Vaginosis

Examples

Generic Name Brand Name
clindamycin Cleocin , Clindesse
metronidazole Flagyl , MetroGel-Vaginal
tinidazole Tindamax

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.)

How It Works

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

Why It Is Used

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.

How Well It Works

Women who aren't pregnant

Oral or vaginal metronidazole and vaginal clindamycin cream cure bacterial vaginosis in as many as 8 out of 10 cases.1

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

Women who are pregnant

Oral antibiotics, such as metronidazole, work well for treating bacterial vaginosis during pregnancy.2

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.

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 sexually transmitted infections (STIs) or pregnancy.

Oral medicines

Oral treatment can cause:

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

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

What To Think About

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.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for pregnant women

When you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

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

References

Citations

  1. Marrazzo J, Sobel J (2010). Vaginal infections. In SA Morse et al., eds., Atlas of Sexually Transmitted Diseases and AIDS, 4th ed., pp. 76–85. Philadelphia: Saunders.
  2. Brocklehurst P, et al. (2013). Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database of Systematic Reviews (1).

Credits

By Healthwise Staff
Sarah Marshall, MD - Family Medicine
Devika Singh, MD, MPH - Infectious Disease
Last Revised August 18, 2013

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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