Use of antibiotics in the treatment for bacterial vaginosis

Sir: Doctors tend to use antibiotics relatively freely in possible and doubtful infections. However, it is recognized that the widespread use of antibiotics can encourage an increase in resistant organisms in communities. ¹

In a recently published article in the Lancet ² , authors in a seven-year follow-up study found an increased risk of cerebral palsy at seven years in the children of women with intact membrane who received antibiotics for spontaneous preterm labour. Common antibiotics, that is erythromycin and co-amoxiclav, were implicated. In a previous study, the researchers showed that the risk of neonatal necrotizing enterocolitis was increased when co-amoxiclav was used. ³ Metronidazole has been associated with an increased risk of preterm delivery when given prophylactically to high-risk women ⁴ and vaginally administered clindamycin may be a better choice in bacterial vaginosis (bv).

In the light of these findings, our guidelines ⁵ for bv should be reviewed. Although the criteria for the diagnosis of bv are fairly strict, they are, alas, subjective to clinical judgement. In our clinical practice, we treat bv fairly casually and pregnancy is no exception (since metronidazole has been shown to be safe in pregnancy).

Good clinical practice dictates that clinicians should treat only when clear evidence of benefit is available. NICE in their recent guidelines⁷ restrict the use of antibiotics for self-limiting respiratory tract infection.

As the danger of missing a diagnosis of bv leads to only minimal complications, I feel strongly that antibiotics should be given when the diagnosis is certain and only after proper counselling. Vaginally administered clindamycin should be the first choice when treating symptomatic bv in pregnant women.