Abstract

Research Article

Oral Clindamycin and Metronidazole in the treatment of bacterial vaginosis in pregnant black women: Comparison of efficacy and pregnancy outcome

Ijeoma CC*, Nyengidiki TK, Bassey G, Ogu RN, Alegbeleye JO and Wariso KT

Published: 10 January, 2020 | Volume 3 - Issue 1 | Pages: 001-006

Bacterial vaginosis (BV) is associated with adverse pregnancy outcomes with various treatment options.

Objective: To compare the efficacy and effect on pregnancy outcome of Metronidazole and Clindamycin in women with bacterial vaginosis in Port Harcourt, Nigeria.

Methodology: Randomized controlled study of 136 pregnant women diagnosed with BV at the University of Port Harcourt Teaching Hospital. A structured proforma was used to obtain socio-demographic characteristics and other relevant data. Treatment was with either oral Metronidazole or oral Clindamycin for seven days. A secondary test and evaluation of the effect on adverse pregnancy outcomes were determined. Data analysis was done using the SPSS statistical package version 22.0

Results: BV prevalence was 23%, with similar cure rates with both medications. The failure rates of clindamycin and metronidazole were 10.4% and 13% respectively (p = 0.639). The mean gestational age at delivery in the metronidazole treated group was 38.67 weeks ± 1.69 compared to 38.68 weeks ± 1.64 in the oral clindamycin group (p = 0.96). Pre-labour rupture of membranes and preterm delivery rates with both medications were similar (p = 0.73; OR 1.3; 95% CI 0.3-4.9) and (p = 0.73; OR 1.3; 95% CI 0.3-4.9) respectively.

Conclusion: Both medications have comparable efficacy and similar pregnancy outcomes in the treatment of bacterial vaginosis in low-risk asymptomatic pregnant Nigerian women and thus can be used interchangeably.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001040 Cite this Article Read Full Article PDF

Keywords:

Supplementation; Calcium, Pre-eclampsia; Primigravid; Eclampsia

References

  1. Hodiwala AB, Koli A. Bacterial vaginosis (Review article). Int J Curr Microbiol App Sci. 2015; 4: 530-538.
  2. Anukam K, Osazuwa E, Ahonkhai I, Ngwu M, Osemene G, et al. Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteiri RC-14: randomized, double-blind, placebo-controlled trial. Microbes and Infection. 2006; 8: 1450-1454. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16697231
  3. Allsworth J, Peipert J. Prevalence of Bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey Data. Obstet Gynecol. 2007; 109: 114-120. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17197596
  4. Denney JM, Culhane JF. Bacterial vaginosis: A problematic infection from both a perinatal and neonatal perspective. Semin Fetal Neonatal Med. 2009; 14: 200-203. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19362525
  5. Adinma JI, Okwoli NR, Unaeze A, Unaeze N. Prevalence of Gardnerella vaginalis in pregnant Nigerian women. Afr J Reprod Health. 2001; 5: 50-55.
  6. Ibrahim SM, Bukar M, Galadima GB, Audu BM, Ibrahim HA. Prevalence of bacterial vaginosis in pregnant women in Maiduguri, North-Eastern Nigeria. Niger J Clin Pract. 2014; 17: 154-158. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24553023
  7. Bennett P. Preterm Labour. In: Edmonds DK (ed). Dewhurst’s textbook of Obstetrics and Gynaecology 8th Edition. West Sussex: Wiley-Blackwell publishers. 2012; 338-355.
  8. Wristrom J, Noriby SR, Myhrea EB, Ekrisson S, Granstrom G, et al. Frequency of antibiotics associated diarrhoea in 2462 antibiotic treated hospitalized patients, a prospective study. J Antimicrob Chemother. 2000. 47: 43-50. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11152430
  9. Rao PS, Devi S, Shriyan A, Rajaram M, Jagdishchandra K. Diagnosis of bacterial vaginosis in the rural setup: comparison of clinical algorithm, smear scoring and culture by semiquantitative technique. Indian J Med Microbiol. 2004; 22: 47-50. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17642686
  10. Leitich H, Brunbauer M, Bodner-Adler B, Kaider A, Egarter C, et al. Antibiotic treatment of bacterial vaginosis in pregnancy: A meta-analysis. Am J Obstet Gynecol. 2003; 188: 752-758. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12634652
  11. Ferris DG, Litaker MS, Woodward L, Mathis D, Hendrich J. Treatment of bacterial vaginosis: a comparison of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream. J Fam Pract.1995; 41: 443-449. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7595261
  12. Andres FJ, Parker R, Hosein I, Benrubi GI. Clindamycin vaginal cream versus oral metronidazole in the treatment of bacterial vaginosis: a prospective double-blind clinical trial. South Med J. 1992; 85: 1077-1080. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1439943
  13. Chen JY, Tian H, Beigi RH. Treatment considerations for bacterial vaginosis and the risk of recurrence. J Women’s Health (Larchmt). 2009; 18: 1997-2004. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20044862
  14. Fischbach F, Petersen EE, Weissenbacher ER, Martius J, Hosman J, et al. Efficacy of Clindamycin vaginal cream versus oral Metronidazole in the treatment of bacterial vaginosis. Obstet Gynecol. 1993; 82: 405-410. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8355942
  15. Schmitt C, Sobel JD, Meriwether C. Bacterial vaginosis: treatment with Clindamycin cream versus oral Metronidazole. Obstet Gynecol. 1992; 79: 1020-1023. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1579299
  16. Paavonen J, Mangioni C, Martin MA, Wajszczuk CP. Vaginal Clindamycin and oral Metronidazole for bacterial vaginosis: a randomized trial. Obstet Gynecol. 2000; 96: 256-260. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10908773
  17. Joesoef MR, Schmid GP, Hillier SL. Bacterial vaginosis: a review of treatment options and potential clinical indication for therapy. Clin Infect Dis. 1999.28: S57-65. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10028110
  18. Zhong B. How to calculate sample size in Randomized Controlled Trials? J Thoracic Dis. 2009; 1: 51-54. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256489/
  19. Greaves WL, Chungafung J, Morris B, Haile A, Townsend JL. Clindamycin versus Metronidazole in the treatment of bacterial vaginosis. Obstet Gynaecol.1998; 72: 799-802. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3050654
  20. Ajani G, Oduyebo O, Haruna M, Elikwu C. Nugent scores of pregnant women in a tertiary institution in Nigeria. Adv Microbiol. 2012; 2: 531-536.
  21. Awoniyi AO, Komolafe OI, Bifarin O, Olarinde O. Bacterial vaginosis among pregnant women attending a primary health centre in Ile-Ife, Nigeria. Global Adv Res J Medicine Med Sci. 2015; 4: 57-60.
  22. Olowe OA, Makanjuola OB, Adekanle DA. Prevalence of vulvovaginal candidiasis, trichomoniasis, and bacterial vaginosis among pregnant women receiving antenatal care in South-Western Nigeria. Eur J Microbiol Immunol. 2014; 4: 193-197. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25544891
  23. Demba E, Morison L, Van der Loeff MS, Awasana AA, et al. Bacterial vaginosis, vaginal flora patterns, and vaginal hygiene practices in patients presenting with vaginal discharge syndrome in Gambia, West Africa. BMC Infect Dis. 2005; 5: 12. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15757510
  24. Morris MC, Rogers, PA, Kinghorn GR. Is bacterial vaginosis a sexually transmitted infection? Sex Transm Infect. 2001; 77: 63-68. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11158694
  25. Holzman C, Leventhal JM, Qiu H, Jones NM, Wang J, et al. Factors linked to bacterial vaginosis in non-pregnant women. Am J Public Health. 2001; 91: 1664-1670. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11574333
  26. Govender L, Hoosen AA, Moodley J, Moodley P, Sturm AW. Bacterial vaginosis and associated infections in pregnancy. Int J Gynaecol Obstet. 1996; 55: 23-28. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8910078
  27. Thomas T, Choudhri S, Kariuki C, Moses S. Identifying cervical infection among pregnant women in Nairobi, Kenya: Limitations of risk assessment and symptom-based approaches. Genitourin Med. 1996; 72: 334-338. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8976848
  28. Schneider H, Coetzee DJ, Fehler HG, Bellingan A, Dangor Y, et al. Screening for sexually transmitted diseases in rural South African women. Sex Transm Infect. 1998; 74 Suppl 1: S147-152. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10023366
  29. Hanson JM, McGregor JA, Hillier SL, Eschenbach DA, Kreutner AK, et al. Metronidazole for the treatment of bacterial vaginosis. A comparison of vaginal gel vs. oral therapy. J Reprod Med. 2000; 45: 889-896. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11127100
  30. Joesoef MR, Schmid GP, Hillier SL. Bacterial Vaginosis: Review of treatment Option and potential clinical indication for therapy. Clin Infect Dis .1999; 28(Suppl1): S57-65. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10028110
  31. Larsson PG. Treatment of bacterial vaginosis. Int J STD AIDS. 1992; 3: 239-247. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1504154
  32. Joesoef MR, Schmid GP. Bacterial vaginosis: a review of treatment options and potential clinical indications for therapy. Clin Infect Dis. 1995; 20(suppl 1): S72-79. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10028110
  33. Ugwumadu A, Manyonda I, Reid F, Hay P. Effect of early oral clindamycin on late miscarriage and Preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomized controlled trial. Lancet. 2003; 361(9362): 983-988. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12660054
  34. Kiss H, Petricevic L, Husslein P. Prospective randomized controlled trial of an infection screening programme to reduce the rate of preterm delivery. BMJ. 2004; 329(7462): 371. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15294856.
  35. Centers for Disease Control and Prevention, CDC. Division of STD Prevention: 2017. www.cdc.gov/std.2010.CDCSTDtreatmentguidelines.www.cdc.gov/std/treatment/2010.
  36. ACOG Committee on Practice Bulletins--Gynecology. Clinical management guidelines for Obstetrician-Gynaecologists, Number 72, May 2006: Vaginitis. Obstet Gynecol. 2006; 107: 1195-1206. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16648432
  37. Morency AM, Bujold E. The effect of second-trimester antibiotic therapy on the rate of preterm birth. J Obstet Gynaecol Can. 2007; 29: 35-44. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17346476
  38. Shennan A, Crawshaw S, Briley A, Hawken J, Seed P, et al. A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PRIMET Study. Br J Obstet Gynaecol. 2006; 113: 65-74. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16398774

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