Treatment of BV in infected pregnant women who are at high risk for premature labor has decreased the incidence of this complication. Currently, according to the US Food and Drug Administration (FDA), oral metronidazole is contraindicated in the first trimester of pregnancy but can be used in the second trimester. However, intravaginal metronidazole (0.75%) gel is designated a category B drug by the FDA, allowing its use throughout pregnancy. 345 and6 However, this and other alternative pharmacotherapies are less effective (T§bJ.e...104:2). A large randomized clinical trial is currently under way to determine whether all asymptomic pregnant women should be treated for BV.
Overall cure rates 4 weeks after treatment did not differ significantly between a 7-day regimen of either oral metronidazole, metronidazole vaginal gel, or clindamycin vaginal cream. Metronidazole vaginal gel has the benefit of fewer side effects (i.e., gastrointestinal disturbance and unpleasant taste). 4 All patients on oral metronidazole should avoid alcohol during and for 24 h, and in some cases longer, after treatment because of the disulfiram-like reaction that can occur. Based on frequency of cure rates, alternative treatments are not as efficacious.
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