title: Efficacy of the combination of 2 g oral tinidazole and acidic buffering vaginal gel in comparison with vaginal clindamycin alone in bacterial vaginosis: a randomized, investigator-blinded, controlled trial.
abstract: OBJECTIVE
  To evaluate the efficacy of tinidazole (T) (Trimonase, Mipharm, Italy) and an acidic vaginal gel (Miphil) (M) in comparison with vaginal clindamycin (CL) (Cleocin Pharmacia Upjohn) in BV.
  
  
  METHODS
  A multicentre, randomised, investigator-blinded, controlled trial.
  
  
  METHODS
  64 women with BV were enrolled. Thirty-two were allocated to receive oral T 2g, single dose, and 32 were assigned to CL 2% for 7 consecutive days. After week 1, T group were treated with an acidic vaginal gel, 2g every 3 days, for additional 3 weeks, whereas CL group did not received any additional treatment. Patients were evaluated at week 1 and 4. Vaginal pH, the BV-blue test (Gryphus Diagnostics, USA) and the whiff test were performed at baseline and at week 4.
  
  
  METHODS
  Clinical cure rate; normalisation of vaginal pH (pH<4.5); and laboratory cure rate (defined as a clinical cure rate and a negative results of BV-blue and whiff test).
  
  
  RESULTS
  At baseline, vaginal pH values were (mean+/-S.D.) 5.4+/-0.7 and 5.3+/-0.5 in T and CL groups, respectively. Six patients (2 in T group and 4 in CL group) withdrew from the study due to side effects. At week 1, the clinical cure rates were 84% in both T and CL treated group (P=N.S.). At week 4, clinical cure rates were 94% in T+M group and 77% in CL group (P=N.S.). The laboratory cure rates were 81% in T+M group and 59% in CL group (P<0.04). Vaginal pH normalisation (i.e. pH <4.5) was achieved in 78% and in 38% of T+M and CL groups, respectively (P<0.0007).
  
  
  CONCLUSIONS
  In the short term, 2g single oral dose tinidazole was at least as effective as 7-day of vaginal clindamycin. The sequential treatment of tinidazole and acidic vaginal gel was superior to vaginal clindamycin in lowering vaginal pH and achieving a higher laboratory tests normalization rate at 1-month follow-up.
authors.affiliation: R&D Mipharm, Via B. Quaranta 12, 20141 Milan, Italy. massimo.milani@mipharm.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Milani
authors.forename: Eliana
authors.initials: E
authors.lastname: Barcellona
authors.forename: Antonella
authors.initials: A
authors.lastname: Agnello
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D002021:Buffers; D002981:Clindamycin / Q000627:therapeutic use*; D005260:Female; D005782:Gels; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D014011:Tinidazole / Q000008:administration & dosage*; D016896:Treatment Outcome; D016585:Vaginosis, Bacterial / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D002021:Buffers; D005782:Gels; D014011:Tinidazole; D002981:Clindamycin