Comments on: Metronidazole v’s clindamycin for treatment of bacterial vaginosis when pregnant in 1st trimester?

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By: gangadharan_nair

gangadharan_nair — Mon, 28 Sep 2009 12:49:17 +0000

Pregnant women with BV more often have babies who are born premature or with low birth weight (low birth weight is less than 5.5 pounds).
BV is treatable with antibiotics prescribed by a health care provider. Two different antibiotics are recommended as treatment for BV: metronidazole or clindamycin. Either can be used with non-pregnant or pregnant women, but the recommended dosages differ.
The bacteria that cause BV can sometimes infect the uterus (womb) and fallopian tubes (tubes that carry eggs from the ovaries to the uterus). This type of infection is called pelvic inflammatory disease (PID). PID can cause infertility or damage the fallopian tubes enough to increase the future risk of ectopic pregnancy and infertility. Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube which can rupture.
Bacterial vaginosis. For this type of vaginitis, your doctor may prescribe metronidazole (Flagyl, MetroGel) or clindamycin (Cleocin) as tablets or vaginal gels or creams.
To treat bacterial vaginosis, a woman takes an antibiotic either by mouth or by a gel inserted into the vagina. Because poor pregnancy outcomes are associated with bacterial vaginosis and because screening (that is, testing for the condition in people who have no symptoms) and treatment for the condition are easy to perform, some experts favor screening all pregnant women for bacterial vaginosis. However, it is unclear whether screening pregnant women for bacterial vaginosis and treating those with the condition actually improve pregnancy outcomes.
Common adverse drug reactions (≥1% of patients) associated with systemic metronidazole therapy include: nausea, diarrhea, and/or metallic taste in the mouth. Intravenous administration is commonly associated with thrombophlebitis. Infrequent adverse effects include: hypersensitivity reactions (rash, itch, flushing, fever), headache, dizziness, vomiting, glossitis, stomatitis, dark urine, and/or paraesthesia. Metronidazole can cause cancer in laboratory animals. Talk to your doctor about the risks and benefits of using this medication.
Common adverse drug reactions (ADRs) associated with clindamycin therapy—found in over 1% of patients—include: diarrhea, pseudomembranous colitis, nausea, vomiting, abdominal pain or cramps, rash, and/or itch. High doses (both intravenous and oral) may cause a metallic taste, and topical application may cause contact dermatitis.

By: BJC

BJC — Mon, 28 Sep 2009 12:49:17 +0000

You need to have this discussion with your gynecologist and ask her/him why she is choosing Clindamycin vs metro. There may be a very valid reason for the choice of clindamycin.

Metronidazole 500mg orally 2x/day for 7 days is, however, the preferred treatment for bacterial vaginosis during pregnancy, while Clindamycin 300mg orally 2x/day for 7 days is an alternative regimen. I am not sure why it would be prescribed every 4 weeks???

Based on multiple studies, most recently assesed by meta-analysis, the evidence supports the safety and lack of teratogenicity (ability to cause birth defects) for oral (systemic) metronidazole during pregnancy.

It is important to note that clindamycin has been associated with an increased risk of pseudomembranous colitis and should only be used when alternatives are not possible.

And TOPICAL (cream) clindamycin should not be used during pregnancy because it has not been shown to be effective and topical applications have been associated with adverse outcomes in the newborn when used in pregnancy.

Please speak to your gynecologist and ask about why clindamycin is being recommended.