Metronidazole Combined with Nystatin (Vagitories) in the Prevention of Bacterial Vaginosis after Initial Treatment with Oral Metronidazole

Pulkkinen, Pekka; Saranen, Martti; Kaaja, Risto

doi:10.1159/000292622

Cited by 9 publications

(4 citation statements)

References 9 publications

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“…Our efficacy results were in line with those of two previously published trials in which metronidazole gel was used to suppress recurrent BV [7,29]. However, we used fewer doses (twice weekly vs. 3 times monthly) than in Sobel's et al, and unsurprisingly the adverse effects particularly vaginal candidiasis was uncommon.…”

Section: Discussionsupporting

confidence: 88%

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Metronidazole Vaginal Gel 0.75% (Zidoval TM) for Suppresion of Recurrent Bacterial Vaginosis (BV): A Pilot Clinical Trial

Isaac¹,

Muthre²

2015

Clin Microbiol

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Objectives: A pilot efficacy and tolerability trial of suppressive metronidazole vaginal gel in reducing recurrent symptomatic relapses of bacterial vaginosis (BV). Study design: A prospective open labeled study. Women with recurrent BV were assigned to metronidazole gel 3 times monthly for 24 weeks. The mean episodes of relapses of recurrence of BV after metronidazole suppression was compared to historical mean obtained from the same participants by a paired-sample T test. An exit interview was used to record patient satisfaction. Results: The mean symptomatic relapses of BV was 0.44 (SD1.09). Historically, participants had a mean of 6.5 (SD3.09) by clinical or laboratory criteria, and a mean of 3.75 (1.06) by laboratory criteria only. Compared with each of the historical means by paired-sample T test, the difference is significant in both at P<0.0001. Adverse effects were uncommon. Conclusions: Suppressive therapy of BV with metronidazole gel for 3 days after the menstrual cycle resulted in significant reduction in symptomatic relapses. Adverse effects were uncommon. A randomized controlled trial is needed to further validate these results.

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Section: Discussionsupporting

confidence: 88%

“…In another study by Pulkkinen et al BV relapse was prevented with a combination of metronidazole and nystatin vaginal pessaries (used for 3 nights after menses for 6 menstrual cycles). This combination prevented relapse for six months in 32/32 (100%) compared to 26/34 (76%) given placebo pessaries [29][30][31].…”

Section: Introductionmentioning

confidence: 99%

Metronidazole Vaginal Gel 0.75% (Zidoval TM) for Suppresion of Recurrent Bacterial Vaginosis (BV): A Pilot Clinical Trial

Isaac¹,

Muthre²

2015

Clin Microbiol

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“…The timing would depend on the relationship of BV to the menstrual cycle in the individual woman. This approach has been reported to work in a smallscale study of women with an intrauterine contraceptive device (IUCD) 10 . As patients who present with frequent relapses of BV are relatively few, a multicentre collaboration is required.…”

Section: Discussionmentioning

confidence: 99%

Sex, thrush and bacterial vaginosis

1997

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Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of childbearing age. In some women it shows a relapsing and remitting course with apparently spontaneous onset and resolution. There are intermediate patterns of vaginal flora in which lactobacilli and other species co-exist. We asked women with recurrent BV to prepare vaginal smears daily, and to record symptoms, time of menstruation, sexual activity and use of douches or medication. We Gram-stained the smears and assigned a Nugent score for BV, and noted the presence of candida, pus cells, sperm and blood. Eighteen women collected daily vaginal smears for up to 10 months. Forty months of slides were collected in total. Bacterial vaginosis arose spontaneously on 23 occasions. We saw candida arise 11 times. Bacterial vaginosis appeared after candida on 9 of these 11 episodes. We saw BV regress spontaneously 13 times. Nine of these resolutions occurred within 48 h of unprotected sexual intercourse: BV only arose on one occasion within 48 h of unprotected intercourse. The intermediate pattern was seen for up to 10 days, and occurred as BV began or resolved in some women, and sometimes resolved without developing into BV. Bacterial vaginosis arose most often in the first 7 days of a menstrual cycle, and resolved spontaneously most often in mid-cycle. In women with recurrent BV, BV arises most often around the time of menstruation and resolves spontaneously in mid-cycle. Recurrences often follow an episode of candidiasis, and BV often regresses after unprotected sexual intercourse.

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“…If there is a history of candidiasis, I add regular topical or systemic treatment for it. This approach is supported by one study in which 66 women were treated for BV with 2 G oral metronidazole, followed by maintenance with metronidazole-nystatin or placebo vaginal suppositories applied at bedtime for 3 days after menstruation, over 6 consecutive menstrual periods [44]. After 6 months of follow-up, the overall cumulative objective cure rate in those receiving the active agent was 100%, compared with 76% in the placebo group.…”

Section: Treatmentmentioning

confidence: 99%

Recurrent bacterial vaginosis

Hay

2000

Curr Infect Dis Rep

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Bacterial vaginosis (BV) is a common cause of vaginal discharge in women of childbearing age. In some individuals, it recurs frequently after treatment, frustrating both the patient and the physician. Standard BV treatment--metronidazole or clindamycin, administered either intravaginally or orally--is followed by relapse in approximately 30% of cases, within one month. Our inability to prevent relapse reflects our lack of understanding of how BV originates. BV has been associated with infectious morbidity in obstetrics and gynecology. Recent studies have found it to be a risk factor for HIV spread. These findings increase the need for us to be able to control recurrent BV and reduce its prevalence in the general population.

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Metronidazole Combined with Nystatin (Vagitories) in the Prevention of Bacterial Vaginosis after Initial Treatment with Oral Metronidazole

Cited by 9 publications

References 9 publications

Metronidazole Vaginal Gel 0.75% (Zidoval TM) for Suppresion of Recurrent Bacterial Vaginosis (BV): A Pilot Clinical Trial

Metronidazole Vaginal Gel 0.75% (Zidoval TM) for Suppresion of Recurrent Bacterial Vaginosis (BV): A Pilot Clinical Trial

Sex, thrush and bacterial vaginosis

Recurrent bacterial vaginosis

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