Treatment of Resistant Bacterial Vaginosis

Critical Management Principles

The Centers for Disease Control and Prevention recommends that patients avoid all alcohol during metronidazole treatment and for 24 hours after completion to prevent disulfiram-like reactions 1, 2
The Centers for Disease Control and Prevention advises against treating male sex partners as it does not affect cure rates, relapse rates, or recurrence 1, 4, 5, 2, 6
Follow-up visits are unnecessary if symptoms resolve, but for recurrent symptoms, alternative treatment regimens should be used rather than repeating the same failed therapy 1, 5, 2, 6

The Centers for Disease Control and Prevention recommends clindamycin 300 mg orally twice daily for 7 days or clindamycin cream 2% intravaginally at bedtime for 7 days for patients with metronidazole allergy or documented resistance 1
The Centers for Disease Control and Prevention warns that oil-based clindamycin formulations weaken latex condoms and diaphragms 1, 2

For pregnant women with resistant BV, the Centers for Disease Control and Prevention prefers systemic therapy to address possible subclinical upper tract infection, with metronidazole 250 mg orally three times daily for 7 days 5, 2
Treatment is particularly important in high-risk women (prior preterm birth) to prevent adverse pregnancy outcomes 5, 2