Treatment considerations for bacterial vaginosis and the risk of recurrence.
BACKGROUND
Recommended regimens for the treatment of bacterial vaginosis (BV) have similar efficacy; thus, the choice of treatment should consider additional factors such as risk of BV recurrence and side effect profile. The purpose of this study was to investigate BV recurrence rates and rates of acquiring vulvovaginal candidiasis (VVC) after different BV treatments in a commercially insured population.


METHODS
Private administrative insurance claims from 2004 to 2006 were used. Study subjects were continuously enrolled females 12-50 years of age who filled prescriptions for BV treatment (n=32,268). The four BV treatments (single-dose clindamycin vaginal cream (2%), multiple-dose clindamycin vaginal regimens, vaginal metronidazole, and oral metronidazole) were compared for rates of recurrent BV and VVC after treatment using multivariate analyses. Covariates included sociodemographic and clinical characteristics.


RESULTS
Overall, the rate of BV recurrence (2.7%), and VVC posttreatment (2.9%) were low. Women who were treated with single-dose clindamycin vaginal cream (2%) showed no significant difference from women treated with oral metronidazole in the likelihood of BV recurrence. However, women who received other vaginal treatments were significantly more likely to experience BV recurrence compared with women who received oral metronidazole (p<0.01). Moreover, women who were treated with single-dose clindamycin vaginal cream (2%) and vaginal metronidazole were significantly less likely to have VVC compared with those treated with oral metronidazole (p<0.01).


CONCLUSIONS
This study suggests that single-dose clindamycin vaginal cream (2%) may be a good alternative to oral metronidazole for the treatment of BV, given the low rates of recurrence and subsequent VVC demonstrated in this analysis.
Chen
Judy Y
JY
Health Benchmarks, Inc., IMS Health, Woodland Hills, California 91367, USA. judy.chen@us.imshealth.com
Tian
Haijun
H
Beigi
Richard H
RH
D000282:Administration, Intravaginal; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002181:Candidiasis, Vulvovaginal / Q000453:epidemiology / Q000382:microbiology; D002981:Clindamycin / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014621:Vagina / Q000382:microbiology; D016585:Vaginosis, Bacterial / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D016387:Women's Health; D055815:Young Adult
D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002981:Clindamycin