A Cochrane review [Abstract] 1 included 24 studies with a total of 4422 subjects. Most trials examined symptomatic women only. Clindamycin cream showed a lower rate of treatment failure than placebo (RR 0.25, 95% CI 0.16 to 0.37; 4 trials, almost 300 patients). Clindamycin and metronidazole showed identical rates of treatment failure, irrespective of regimen type, at two and four-week follow up (RR 1.01, 95% CI 0.69 to 1.46; RR 0.91, 95% CI 0.70 to 1.18, respectively; 6 trials, over 1100 patients). Clindamycin tended to cause a lower rate of adverse events (RR 0.75, 95% CI 0.56 to 1.02; 4 trials, n=927); metallic taste, and nausea and vomiting were more common in the metronidazole group (RR 0.08, 95% CI 0.1 to 0.59 and RR 0.23, 95% CI 0.10 to 0.51, respectively). Clindamycin showed a lower rate of clinical failure than triple sulfonamide cream (RR 0.46, 95% CI 0.29 to 0.72; 1 trial, n= 153). Hydrogen peroxide douche showed a higher rate of clinical failure (RR 1.75, 95% CI 1.02 to 3.00) and adverse events (RR 2.33, 95% CI 1.21 to 4.52; 1 trial, n=142) than a single 2 g dose of metronidazole.
An RCT 2 including 114 women assessed the efficacy and tolerability of oral metronidazole and tinidazole.The cure rates for metronidazole 500 mg twice daily 5 days vs 1 tablet tinidazole 500 mg once daily + one placebo for 5 days were at first week 91.2% vs 96.5%, and at 4 weeks 75% vs 94.5%, respectively.
Another Indian RCT 3 compared oral single dose of metronidazole (2 g), tinidazole (2 g), secnidazole (2 g), and ornidazole (1.5 g) in women with bacterial vaginosis (n=344). Cure rate of nitroimidazoles in bacterial vaginosis at one week were for metronidazole 88.4%, tinidazole 100%, secnidazole 90.7%, and ornidazole 100%, and at 4. week 77.9%, 97.7%, 80.2%, and 100%, respectively.
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