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Bacterial vaginosis - Evidence
Evidence on treating bacterial vaginosis prior to gynaecological procedures
- A BMJ Clinical Evidence review (search date: March 2004) identified three randomized controlled trials (RCTs) investigating whether treatment with antibiotics can reduce the rate of infectious morbidity in women with bacterial vaginosis (BV) after termination of pregnancy [Joesoef and Schmid, 2007]:
- The first RCT compared oral metronidazole (500 mg three times a day for 10 days) with placebo in 231 women with BV who were about to undergo surgical termination [Larsson et al, 1992]. It is not clear whether the women were symptomatic or asymptomatic:
- Among the 174 women with evaluable data for analysis, fewer of those taking oral metronidazole than those taking placebo developed pelvic inflammatory disease (3/84 [4%] vs. 11/90 [12%]; relative risk [RR] 0.29, 95% CI 0.08 to 1.01; p < 0.05).
- The second RCT compared intravaginal clindamycin 2% cream with placebo in 1655 women attending for surgical termination [Larsson et al, 2000]. Of the 1102 women evaluable for analysis, BV was identified in 220 (20%):
- Signs of post-termination infection in women with BV were three times more frequent in the placebo group than in the actively treated group, but the difference was not statistically significant (RR 3.3, 95% CI 0.7 to 16.1).
- When the results for women with intermediate flora and women with BV were combined, however, treatment with clindamycin significantly reduced the risk of infection (RR 0.24, 95% CI 0.07 to 0.86).
- The third RCT compared a single-dose metronidazole 2 g suppository with placebo in 273 women with bacterial vaginosis [Crowley et al, 2001]. It is not clear whether the women were symptomatic or asymptomatic:
- In intention-to-treat analysis, fewer women treated with metronidazole developed post-operative upper genital tract infection (12/142 [8.5%] with metronidazole vs. 21/131 [16%] with placebo; RR 0.53, 95% CI 0.27 to 1.03; p = 0.055).
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