title: The treatment of bacterial vaginosis in pregnancy with clindamycin to reduce the risk of infection-related preterm birth: a response to the Danish Society of Obstetrics and Gynecology guideline group's clinical recommendations.
abstract: Preterm birth is the major cause of perinatal mortality and morbidity worldwide. Infection/inflammation is responsible for a significant percentage of preterm birth, particularly at early gestations. A recent clinical recommendation by a guidelines group of the Danish Society of Obstetrics and Gynecology advised against the use of clindamycin for the treatment of bacterial vaginosis in pregnancy to reduce the risk of spontaneous preterm birth based on lack of evidence of efficacy. We believe that the evidence for the use of clindamycin for this indication is robust and that this recommendation was reached erroneously on the basis of flawed inclusion criteria: the inclusion of an unpublished study with poorly diagnosed bacterial vaginosis and the exclusion of an important pivotal study on the use of clindamycin in early pregnancy for the prevention of preterm birth. Had these errors been corrected, the conclusions would have been different.
authors.affiliation: Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK.|Department of Gynecology and Obstetrics, Odense University Hospital, Research Unit of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Ronald F
authors.identifier: http://orcid.org/0000-0001-7906-2826
authors.initials: RF
authors.lastname: Lamont
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Keelan
authors.affiliation: Department of Obstetrics and Gynecology, Skaraborg Hospital, University of Linköping, Skövde, Sweden.
authors.forename: Per G
authors.initials: PG
authors.lastname: Larsson
authors.affiliation: Department of Gynecology and Obstetrics, Odense University Hospital, Research Unit of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.|Center for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.
authors.forename: Jan S
authors.identifier: http://orcid.org/0000-0001-5222-2535
authors.initials: JS
authors.lastname: Jørgensen
mesh_terms: D000022:Abortion, Spontaneous / Q000382:microbiology / Q000517:prevention & control; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002981:Clindamycin / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008795:Metronidazole / Q000494:pharmacology / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D047928:Premature Birth / Q000382:microbiology / Q000517:prevention & control*; D012107:Research Design; D016585:Vaginosis, Bacterial / Q000150:complications / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002981:Clindamycin
keywords: Antibiotics; bacterial vaginosis; clindamycin; infection; preterm birth; preterm labor; prevention