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

Main Article Content

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

Abstract

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.

Article Details

CC, I., TK, N., G, B., RN, O., JO, A., & KT, W. (2020). Oral Clindamycin and Metronidazole in the treatment of bacterial vaginosis in pregnant black women: Comparison of efficacy and pregnancy outcome. Clinical Journal of Obstetrics and Gynecology, 3(1), 001–006. https://doi.org/10.29328/journal.cjog.1001040
Research Articles

Copyright (c) 2020 Ijeoma CC, et al.

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Hodiwala AB, Koli A. Bacterial vaginosis (Review article). Int J Curr Microbiol App Sci. 2015; 4: 530-538.

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

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

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

Adinma JI, Okwoli NR, Unaeze A, Unaeze N. Prevalence of Gardnerella vaginalis in pregnant Nigerian women. Afr J Reprod Health. 2001; 5: 50-55.

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

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.

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

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

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

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

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

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

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

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

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

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

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/

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

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.

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.

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

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

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

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

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

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

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

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

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

Larsson PG. Treatment of bacterial vaginosis. Int J STD AIDS. 1992; 3: 239-247. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1504154

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

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

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.

Centers for Disease Control and Prevention, CDC. Division of STD Prevention: 2017. www.cdc.gov/std.2010.CDCSTDtreatmentguidelines.www.cdc.gov/std/treatment/2010.

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

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

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