Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial*1

Abstract

Vaginal clindamycin did not decrease the rate of preterm deliveries or peripartum infections, but recurrent or persistent BV increased the risk for these complications.

Oral colonization of Gram-negative anaerobes as a risk factor for preterm delivery

“…The successful use of antibiotics for treatment to reduce the risk for adverse pregnancy outcomes in mothers with either BV or periodontal disease, yielded conflicting results 33,[177][178][179][180][181][182][183][184][185] and in fact, one study 185 demonstrated an increase in PTB following metronidazole administration.…”

Management of Abnormal Vaginal Flora as a Risk Factor for Preterm Birth

“…Although all in the same line, these aberrations were all studied form a different perspective. Most studies used Nugent's or Spiegel's score on Gram stains to detect an association between bacterial vaginosis (BV) and intermediate flora with adverse pregnancy outcome (Hay et al, 1994;Elliot et al, 1990;Lee et al, 2009;Thorp et al, 2008;Cauci et al, 2002c;Hauth et al, 2003;Kekki et al, 2001;Kiss et al, Klebanoff et al, 2005;McDonald et al, 1997;Oakeshott et al, 2004;Verstraelen et al, 2007), but similar findings could be obtained with clinical Amsel criteria to diagnose BV (Honest et al, 2004;Rouse et al, 2009), abnormal lactobacillary grades on both Pap smears, gram stains, and wet mount preparations (Hay et al, 1994;Donders et al, 1993b;Mass et al, 1999;Donders et al, 2009) and with other abnormalities of the bacterial flora than full BV Donders et al, E pub ahead of print 2010;Donders et al, 2009). As is generally acknowledged, Nugent score above 7 on Gram stained specimens corresponds well with BV, and is nowadays accepted as golden standard for the diagnosis of BV in most clinical trials.…”

The Effect of Treating Bacterial Vaginosis on Preterm Labor

“…In 2001, Kekki et al 14 performed a multicenter, randomized, double-blind, placebo-controlled trial (level I) which showed that the treatment of BV in early pregnancy with vaginal clindamycin for 7 days did not decrease the rate of preterm deliveries or peripartum infections. In 375 randomized subjects, preterm delivery occurred in 5% of the clindamycin group and 4% of the placebo group (OR, 1.3; 95% CI, 0.5-3.5).…”

“…The efficacy of intravaginal clindamycin can be as high as 90% in studies on non-pregnant women, and is similar to that of oral metronidazole. The subjects included a low-risk population of healthy women with singleton pregnancies and without a history of preterm delivery 14 . The results are similar to the conclusion of McGregor et al 13 that topical treatment in early pregnancy reduced vaginal fluid mucinase and sialidase, but failed to reduce the rate of preterm births 14 .…”

“…The subjects included a low-risk population of healthy women with singleton pregnancies and without a history of preterm delivery 14 . The results are similar to the conclusion of McGregor et al 13 that topical treatment in early pregnancy reduced vaginal fluid mucinase and sialidase, but failed to reduce the rate of preterm births 14 . A recent randomized controlled trial by Kurkinen-Raty et al 15 assessed the efficacy of vaginal clindamycin in reducing preterm birth (level I).…”