Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2026
Oral metronidazole vs. clindamycin to treat bacterial vaginosis in pregnancies at risk for preterm labour.
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Nachum Zohar, Soltsman Sofia, Narane Aiman, Lauz Najwa, Petrusyevich Tatyana, Wattad Malak, Colodner Raul, Peretz Avi, Yefet Enav
Аннотация
OBJECTIVES: Bacterial vaginosis (BV) and abnormal vaginal flora (AVF) are associated with maternal discomfort and preterm labour. Oral metronidazole and clindamycin are acceptable treatments during pregnancy for their eradication; however, direct comparative data between them during pregnancy are lacking. We compared the efficacy of metronidazole and clindamycin in eradicating BV/AVF among women at high risk for preterm labour.
METHODS: In this multicentre randomized controlled trial, pregnant women at high risk for preterm labour were screened for BV/AVF using the Nugent criteria on vaginal smears. BV/AVF were defined as Nugent scores ≥4. Women diagnosed with BV/AVF were randomly allocated to receive either oral metronidazole 500 mg twice daily or oral clindamycin 300 mg twice daily for 1 week. After treatment, a repeat vaginal smear was obtained. If BV/AVF persisted, the alternative treatment was administered for an additional week, after which eradication was reassessed by vaginal smear. The primary outcome was the rate of BV/AVF eradication after first-line treatment.
RESULTS: Of the 914 women screened, 170 (19%) tested positive for BV/AVF, and 82 and 84 women were analysed in the metronidazole and clindamycin groups, respectively. There were no significant differences between the metronidazole and clindamycin groups in the rate of BV/AVF eradication after first-line treatment (48 [60%] vs. 47 [56%]), total eradication rate after second-line treatment (63 [77%] vs. 63 [79%]), or the rate of preterm delivery/late miscarriage (30% vs. 24%), respectively. Among women who received metronidazole or clindamycin (as first- or second-line treatment), adverse effects were reported in 36 of 115 (31%) and 31 of 117 (26%), respectively, and treatment discontinuation because of adverse effects occurred in only 3% and 5%, respectively (p >0.05 for all comparisons).
CONCLUSIONS: In pregnant women at high risk for preterm labour, oral metronidazole and clindamycin for the treatment of BV/AVF demonstrated similar efficacy, adverse effect profiles, and preterm delivery rates.
METHODS: In this multicentre randomized controlled trial, pregnant women at high risk for preterm labour were screened for BV/AVF using the Nugent criteria on vaginal smears. BV/AVF were defined as Nugent scores ≥4. Women diagnosed with BV/AVF were randomly allocated to receive either oral metronidazole 500 mg twice daily or oral clindamycin 300 mg twice daily for 1 week. After treatment, a repeat vaginal smear was obtained. If BV/AVF persisted, the alternative treatment was administered for an additional week, after which eradication was reassessed by vaginal smear. The primary outcome was the rate of BV/AVF eradication after first-line treatment.
RESULTS: Of the 914 women screened, 170 (19%) tested positive for BV/AVF, and 82 and 84 women were analysed in the metronidazole and clindamycin groups, respectively. There were no significant differences between the metronidazole and clindamycin groups in the rate of BV/AVF eradication after first-line treatment (48 [60%] vs. 47 [56%]), total eradication rate after second-line treatment (63 [77%] vs. 63 [79%]), or the rate of preterm delivery/late miscarriage (30% vs. 24%), respectively. Among women who received metronidazole or clindamycin (as first- or second-line treatment), adverse effects were reported in 36 of 115 (31%) and 31 of 117 (26%), respectively, and treatment discontinuation because of adverse effects occurred in only 3% and 5%, respectively (p >0.05 for all comparisons).
CONCLUSIONS: In pregnant women at high risk for preterm labour, oral metronidazole and clindamycin for the treatment of BV/AVF demonstrated similar efficacy, adverse effect profiles, and preterm delivery rates.