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Treatment options for bacterial vaginosis (nonpregnant)

Treatment options for bacterial vaginosis (nonpregnant)
Drugs of choice (nonpregnant)
Metronidazole 500 mg orally twice daily for 7 days or
Metronidazole gel 0.75% 5 g* (one full applicator) intravaginally once daily for 5 days or
Clindamycin 2% cream 5 g (one full applicator) intravaginally at bedtime for 7 days
Alternatives
Clindamycin 300 mg orally twice daily for 7 days or
Clindamycin ovule (vaginal suppository) 100 mg intravaginally once daily for 3 days or
Tinidazole 2 g orally for 2 days or
Tinidazole 1 g orally once daily for 5 days or
Secnidazole 2 g packet orally once
Although data are limited, metronidazole 750 mg extended release tablets once daily for 7 days or a single vaginal dose of clindamycin 2% bioadhesive cream (United States trade name: Clindesse) 5 g, one full applicator, also appear to be effective. Tinidazole and secnidazole are alternative therapies as they tend to be less available and more costly.

* 5 grams of metronidazole 0.75% vaginal gel contains 37.5 mg of metronidazole.

¶ 5 grams of clindamycin 2% vaginal cream contains 100 mg of clindamycin.
Adapted from: Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70:1.
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