Which medications in the drug class Antibiotics are used in the treatment of Vaginitis?

Updated: Dec 04, 2018
  • Author: Hetal B Gor, MD, FACOG; Chief Editor: Michel E Rivlin, MD  more...
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Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

The use of antibiotic combinations usually is recommended for the treatment of serious gram-negative bacillary infections. This approach ensures coverage for a broad range of organisms and polymicrobial infections, prevents emergence of bacterial subpopulations that may be resistant to one of the antibiotic components, and provides additive or synergistic effects. Once organisms and sensitivities are known, however, antibiotic monotherapy is recommended.

Clindamycin (Cleocin)

Clindamycin is a lincosamide used to treat serious skin and soft tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). Clindamycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is widely distributed in the body without penetrating the central nervous system (CNS). It is protein-bound and is excreted by the liver and kidneys.

Clindamycin has been used as an alternative to metronidazole in pregnancy; however, intravaginal use is not recommended for pregnant women, because it has been associated with an increased risk of preterm delivery. Treatment of bacterial vaginosis with oral clindamycin during the second and third trimesters of pregnancy has been shown to reduce the occurrence of preterm birth.

For recurrent infections, administer a trial of alternative regimens.

Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin that has a broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. It arrests bacterial cell wall synthesis and inhibits bacterial growth by binding to 1 or more of the penicillin-binding proteins.

Erythromycin (E.E.S., Erythrocin, Ery-Tab)

Erythromycin is indicated for the treatment of infections caused by susceptible strains, including Staphylococcus aureus. It is an alternative for the treatment of chlamydial infection in pregnancy.

Metronidazole (Flagyl, MetroGel-Vaginal, Vandazole)

Metronidazole is active against various anaerobic bacteria and protozoa. It appears to be absorbed into the cells; the intermediate metabolized compounds that are formed bind DNA and inhibit protein synthesis, causing cell death.

Metronidazole is indicated for the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, Corynebacterium vaginitis, or anaerobic vaginosis). Treatment of bacterial vaginosis with oral metronidazole during the second and third trimester of pregnancy does not reduce the occurrence of preterm delivery.

Metronidazole is highly effective in treating trichomoniasis with 1 dose. Topical metronidazole is not effective therapy for trichomoniasis. The numbers of T vaginalis cases with metronidazole resistance are increasing.

Cefixime (Suprax)

Cefixime is an oral third-generation cephalosporin indicated for management of infections caused by susceptible gram-positive cocci and gram-negative rods. It is used to treat gonorrhea, tonsillitis, and pharyngitis.

Doxycycline (Doryx, Monodox, Vibramycin)

Doxycycline inhibits protein synthesis and thus bacterial growth by binding with the 30S and, possibly, 50S ribosomal subunits of susceptible bacteria.

Azithromycin (Zithromax, Zmax)

Azithromycin is used to treat mild-to-moderate infections caused by susceptible strains of microorganisms. It is indicated for chlamydial infections of the genital tract.

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