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July 1, 1992, Vol 268, No. 1 >
ARTICLE | July 1, 1992

Comparison of Different Metronidazole Therapeutic Regimens for Bacterial Vaginosis: Title and subTitle BreakA Meta-analysis FREE

Victor I. Lugo-Miro, MD; Mitra Green, MD; Lynnette Mazur, MD, MPH
[+] Author Affiliations

Reprint requests to Department of Pediatrics IPE-18-015, LBJ Hospital, 5656 Kelly St, Houston, TX 77026 (Dr Lugo-Miro).


JAMA. 1992;268(1):92-95. doi:10.1001/jama.1992.03490010094036
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Article
References

Objective.  —To evaluate the treatment of bacterial vaginosis with metronidazole to determine if there is a therapeutic regimen that is superior to all others with regard to cure and recurrence rates.

Data Sources.  —Computer-assisted literature search, Medical Subject Index review, and references cited in articles identified.

Study Selection.  —Clinical trials comparing different oral metronidazole regimens in which diagnostic criteria for bacterial vaginosis and criteria to detect cure to treatment were described.

Data Extraction.  —Articles that met inclusion criteria were critically appraised and those that passed were included in the analysis. Of 52 initial articles, 10 met criteria for inclusion and passed critical appraisal.

Data Synthesis.  —Patients were divided in groups according to the duration of therapy received: group A (n=413), 2-g single dose; group B (n=193), 2-g single daily dose for 2 days; group C (n=317), 5 days; and group D (n=280), 7 days. Cure rates on initial evaluation for the groups were 85%, 87%, 86%, and 87%, respectively. χ2 Contingency table analysis showed no significant difference in cure rates among the groups (P=.78). Only 465 of these patients were evaluated for recurrence of disease. There was no significant difference in cure rates after 4 weeks of therapy (P=.4).

Conclusions.  —A 2-g single-dose metronidazole regimen is as effective as a single daily dose given for 2 days or a 5-day course or a 7-day course.(JAMA. 1992;268:92-95)

REFERENCES

1 +
Hillier S, Holmes KK.  Bacterial vaginosis.  In: Holmes KK, Mardh PA, Sparling PF, Wiesner PJ, eds. Sexually Transmitted Diseases . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1984;:547-559.
2 +
Gardner H, Dukes CD.  Hemophilus vaginalis vaginitis. Am J Obstet Gynecol . 1955;;69:962-976.
3 +
Pheifer TA, Forsyth PS, Durfee MA, Pollock HM, Holmes KK.  Non-specific vaginitis: role of Hemophilus vaginalis and treatment with metronidazole. N Engl J Med . 1978;;298:1429-1434.
4 +
Eschenbach DA, Crithlow CW, Watkins H, et al.  A dose duration study of metronidazole for the treatment of non-specific vaginosis. Scand J Infect Dis Suppl . 1983;;40:73-80.
5 +
Blackwell AI, Fox AR, Phillips I, Barlow D.  Anaerobic vaginosis (non-specific vaginitis): clinical, microbiological and therapeutic findings. Lancet . 1983;;2:1379-1383.
6 +
Greenwood JR, Pickett MJ.  Transfer of Hemophilus vaginalis to a new genus, Gardnerella: G. vaginalis (Gardner and Dukes). Int J Syst Bact . 1980;;30:170-178.
7 +
Amsel R, Totten PA, Spiegel CA, Chen KCS, Eschenbach D, Holmes KK.  Non-specific vaginitis: diagnostic criteria and microbial and epidemiologic associations. Am J Med . 1983;;74:14-22.
8 +
Nelson MS.  Clinical diagnosis of bacterial vaginosis. Am J Emerg Med . 1987;;5:488-491.
9 +
Bump RC, Zuspan FP, Buesching WJ, Ayers LW, Stephens TJ.  The prevalence, six months persistence and predictive values of laboratory indicators of bacterial vaginosis (non-specific vaginitis) in symptomatic women. Am J Obstet Gynecol . 1984;; 150:917-924.
10 +
Baldson JM, Pead L, Taylor GE, Maskell R.  Corynebacterium vaginalis and vaginitis: a controlled trial of treatment. Lancet . 1980;;1:501-503.
11 +
Malouf M, Fortier M, Morin G, Dube JL.  Treatment of Hemophilus vaginalis vaginitis. Obstet Gynecol . 1981;;57:711-714.
12 +
Abramowicz M, ed.  Treatment of sexually transmitted diseases. Med Lett . 1986;;28:23-28.
13 +
Piot P.  Bacterial vaginosis: an evaluation of treatment. Scand J Urol Nephrol Suppl . 1984;;86: 229-235.
14 +
McCue JD.  Evaluation and management of vaginitis. Arch Intern Med . 1989;;149:565-568.
15 +
Centers for Disease Control.  1989 sexually transmitted diseases treatment guidelines. MMWR . 1989;; 38:36-37.
16 +
Jenicek M.  Meta-analysis in medicine. J Clin Epidemiol . 1989;;42:35-44.
17 +
Sacks HS, Berrier J, Reitman D, Ancona-Berk VA, Chalmers TC.  Meta-analysis of randomized controlled trials. N Engl J Med . 1987;;316:450-455.
18 +
Sackett DL.  How to read clinical journals: to distinguish useful from useless or even harmful therapy. Can Med Assoc J . 1981;;124:1156-1162.
19 +
Mohanty KC, Deighton R.  Comparison of 2 g single dose of metronidazole, nimorazole, and tinidazole in the treatment of vaginitis associated with Gardnerella vaginalis. J Antimicrob Chemother . 1987;;19:393-399.
20 +
Jerve F, Berdal TB, Boham P, et al.  Metronidazole in the treatment of non-specific vaginitis (NSV). Br J Vener Dis . 1984;;60:171-174.
21 +
Swedberg J, Steiner JF, Deiss F, Steiner S, Driggers DA.  Comparison of single dose versus one week course of metronidazole for symptomatic bacterial vaginosis. JAMA . 1985;;254:1046-1049.
22 +
Hagström B, Lindestedt J.  Comparison of two different regimens of metronidazole in the treatment of non-specific vaginitis. Scand J Infect Dis Suppl . 1983;;40:95-96.
23 +
Hovik P.  Nonspecific vaginitis in an outpatient clinic: comparison of three dose regimens of metronidazole. Scand J Infect Dis Suppl . 1983;;40:107-110.
24 +
Purdon A, Hanna JH, Morse PL, Paine DD, Engelkirk PG.  An evaluation of single dose metronidazole treatment for Gardnerella vaginalis vaginitis. Obstet Gynecol . 1984;;64:271-274.
25 +
Fredricsson B, Hagström B, Möller AK, Nord CE.  Bacterial vaginosis treated with metronidazole: effects on the vaginal microbiology flora by a single dose versus a five day regimen. Zentralbl Gynakol . 1986;;108:799-804.
26 +
Jones BM, Geary I, Alawattegama AB, King-horn GR, Duerden BI.  In-vitro and in-vivo activity of metronidazole against Gardnerella vaginalis, Bacteroides spp. and Mobiluncus spp. in bacterial vaginosis. J Antimicrob Chemother . 1985;;16:189-197.
27 +
Blackwell A, Fox A, Phillips I, Barlow D.  Metronidazole in the treatment of non-specific vaginitis: clinical and microbiological findings in ten patients given 2 grams of metronidazole. Scand J Infect Dis Suppl . 1983;;40:103-106.
28 +
Balsdon MJ.  Treatment of the Gardnerella vaginalis syndrome with a single 2 gram oral dose of metronidazole. Scand J Infect Dis Suppl . 1983;;40: 101-102.
29 +
Jerve F, Qvigstad E, Eng J.  Treatment of non-specific vaginitis with metronidazole. Scand J Infect Dis Suppl . 1983;;40:111-113.
30 +
Minkowski WL, Baker CJ, Alleyne D, Baghai M, Friedlander L, Schultz B.  Single oral dose metronidazole for Gardnerella vaginalis vaginitis in adolescent females. J Adolesc Health Care . 1983;; 4:113-116.
31 +
Petersen EE, Pelz K.  Diagnosis and therapy of nonspecific vaginitis. Scand J Infect Dis Suppl . 1983;;40:97-99.
32 +
Fredricsson B, Nord CE.  Influence of metronidazole treatment on the vaginal microbiological flora. Scand J Infect Dis Suppl . 1983;;40:91-94.

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1 +
Hillier S, Holmes KK.  Bacterial vaginosis.  In: Holmes KK, Mardh PA, Sparling PF, Wiesner PJ, eds. Sexually Transmitted Diseases . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1984;:547-559.
2 +
Gardner H, Dukes CD.  Hemophilus vaginalis vaginitis. Am J Obstet Gynecol . 1955;;69:962-976.
3 +
Pheifer TA, Forsyth PS, Durfee MA, Pollock HM, Holmes KK.  Non-specific vaginitis: role of Hemophilus vaginalis and treatment with metronidazole. N Engl J Med . 1978;;298:1429-1434.
4 +
Eschenbach DA, Crithlow CW, Watkins H, et al.  A dose duration study of metronidazole for the treatment of non-specific vaginosis. Scand J Infect Dis Suppl . 1983;;40:73-80.
5 +
Blackwell AI, Fox AR, Phillips I, Barlow D.  Anaerobic vaginosis (non-specific vaginitis): clinical, microbiological and therapeutic findings. Lancet . 1983;;2:1379-1383.
6 +
Greenwood JR, Pickett MJ.  Transfer of Hemophilus vaginalis to a new genus, Gardnerella: G. vaginalis (Gardner and Dukes). Int J Syst Bact . 1980;;30:170-178.
7 +
Amsel R, Totten PA, Spiegel CA, Chen KCS, Eschenbach D, Holmes KK.  Non-specific vaginitis: diagnostic criteria and microbial and epidemiologic associations. Am J Med . 1983;;74:14-22.
8 +
Nelson MS.  Clinical diagnosis of bacterial vaginosis. Am J Emerg Med . 1987;;5:488-491.
9 +
Bump RC, Zuspan FP, Buesching WJ, Ayers LW, Stephens TJ.  The prevalence, six months persistence and predictive values of laboratory indicators of bacterial vaginosis (non-specific vaginitis) in symptomatic women. Am J Obstet Gynecol . 1984;; 150:917-924.
10 +
Baldson JM, Pead L, Taylor GE, Maskell R.  Corynebacterium vaginalis and vaginitis: a controlled trial of treatment. Lancet . 1980;;1:501-503.
11 +
Malouf M, Fortier M, Morin G, Dube JL.  Treatment of Hemophilus vaginalis vaginitis. Obstet Gynecol . 1981;;57:711-714.
12 +
Abramowicz M, ed.  Treatment of sexually transmitted diseases. Med Lett . 1986;;28:23-28.
13 +
Piot P.  Bacterial vaginosis: an evaluation of treatment. Scand J Urol Nephrol Suppl . 1984;;86: 229-235.
14 +
McCue JD.  Evaluation and management of vaginitis. Arch Intern Med . 1989;;149:565-568.
15 +
Centers for Disease Control.  1989 sexually transmitted diseases treatment guidelines. MMWR . 1989;; 38:36-37.
16 +
Jenicek M.  Meta-analysis in medicine. J Clin Epidemiol . 1989;;42:35-44.
17 +
Sacks HS, Berrier J, Reitman D, Ancona-Berk VA, Chalmers TC.  Meta-analysis of randomized controlled trials. N Engl J Med . 1987;;316:450-455.
18 +
Sackett DL.  How to read clinical journals: to distinguish useful from useless or even harmful therapy. Can Med Assoc J . 1981;;124:1156-1162.
19 +
Mohanty KC, Deighton R.  Comparison of 2 g single dose of metronidazole, nimorazole, and tinidazole in the treatment of vaginitis associated with Gardnerella vaginalis. J Antimicrob Chemother . 1987;;19:393-399.
20 +
Jerve F, Berdal TB, Boham P, et al.  Metronidazole in the treatment of non-specific vaginitis (NSV). Br J Vener Dis . 1984;;60:171-174.
21 +
Swedberg J, Steiner JF, Deiss F, Steiner S, Driggers DA.  Comparison of single dose versus one week course of metronidazole for symptomatic bacterial vaginosis. JAMA . 1985;;254:1046-1049.
22 +
Hagström B, Lindestedt J.  Comparison of two different regimens of metronidazole in the treatment of non-specific vaginitis. Scand J Infect Dis Suppl . 1983;;40:95-96.
23 +
Hovik P.  Nonspecific vaginitis in an outpatient clinic: comparison of three dose regimens of metronidazole. Scand J Infect Dis Suppl . 1983;;40:107-110.
24 +
Purdon A, Hanna JH, Morse PL, Paine DD, Engelkirk PG.  An evaluation of single dose metronidazole treatment for Gardnerella vaginalis vaginitis. Obstet Gynecol . 1984;;64:271-274.
25 +
Fredricsson B, Hagström B, Möller AK, Nord CE.  Bacterial vaginosis treated with metronidazole: effects on the vaginal microbiology flora by a single dose versus a five day regimen. Zentralbl Gynakol . 1986;;108:799-804.
26 +
Jones BM, Geary I, Alawattegama AB, King-horn GR, Duerden BI.  In-vitro and in-vivo activity of metronidazole against Gardnerella vaginalis, Bacteroides spp. and Mobiluncus spp. in bacterial vaginosis. J Antimicrob Chemother . 1985;;16:189-197.
27 +
Blackwell A, Fox A, Phillips I, Barlow D.  Metronidazole in the treatment of non-specific vaginitis: clinical and microbiological findings in ten patients given 2 grams of metronidazole. Scand J Infect Dis Suppl . 1983;;40:103-106.
28 +
Balsdon MJ.  Treatment of the Gardnerella vaginalis syndrome with a single 2 gram oral dose of metronidazole. Scand J Infect Dis Suppl . 1983;;40: 101-102.
29 +
Jerve F, Qvigstad E, Eng J.  Treatment of non-specific vaginitis with metronidazole. Scand J Infect Dis Suppl . 1983;;40:111-113.
30 +
Minkowski WL, Baker CJ, Alleyne D, Baghai M, Friedlander L, Schultz B.  Single oral dose metronidazole for Gardnerella vaginalis vaginitis in adolescent females. J Adolesc Health Care . 1983;; 4:113-116.
31 +
Petersen EE, Pelz K.  Diagnosis and therapy of nonspecific vaginitis. Scand J Infect Dis Suppl . 1983;;40:97-99.
32 +
Fredricsson B, Nord CE.  Influence of metronidazole treatment on the vaginal microbiological flora. Scand J Infect Dis Suppl . 1983;;40:91-94.

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