Prescription Medication #2: Clindamycin

IMPORTANT: My reason for including entries about prescription medication is to simply share some basic information, and the experiences of those who used them. But nothing in this blog is a substitute for a discussion with your doctor, and reading the literature that you get from your doctor/pharmacist.

Currently, there are three types of antibiotics widely used to treat BV. I'm going to cover some basic information about each.

This is an overview of Clindamycin, which comes in three forms.

Clindamycin (oral)

• Description: oral capsules, typical regimen is 300 mg, 2x a day, for 7 days

• Cure Rate: 94%

• Pros: a broad-spectrum antibiotic, provides an alternative to patients who can't take Flagyl; does not cause nausea when consumed with alcohol

• Cons:
  
  • may cause overgrowth of Streptococcus (Strep) bacteria
  
  
  • From the literature that patients receive with this drug - "WARNING: This medicine should be used only for serious infections because infrequently there are severe, rarely fatal, intestinal problems (pseudomembranous colitis) that can occur."

Cleocin (vaginal cream)

• Description: 3- or 7-day vaginal ovules/suppositories

I don't know much more about Cleocin because it doesn't seem to be very widely prescribed.


Clindesse (vaginal cream)

• Description: one-dose vaginal cream

• Cure Rate: The company claimed 88% (PDF file), but was cited by the FDA (PDF file) for overstating that figure, among other claims: "The e-Pharm/alert e-mail is false or misleading because it overstates and misrepresents the efficacy of Clindesse, presents unsubstantiated superiority and patient compliance claims, and minimizes the risks and limitations to the indication associated with Clindesse."
  

• Pros: a broad-spectrum antibiotic, provides an alternative to patients who can't take Flagyl; does not cause nausea when consumed with alcohol; one-dose convenience

• Cons:
  
  • Clindesse can be systemically absorbed, and can cause all the side effects of oral Clindamycin, such as pseudomembranous colitis
  
  
  • From this source: "... clindamycin vaginal cream, which was frequently used for bacterial vaginosis during pregnancy, is no longer approved because it results in a strep vaginosis."

My Recommendation:

Should you use Clindamycin or Clindesse for BV? In short, no. Doctors used to prescribe it often, and may still do. But I keep finding more sources that say that it causes Strep bacteria overgrowth, and that is a real concern. Not to mention that Clindesse is apparently not very effective, and the company that makes it has overstated how well it works. So these are definitely more reasons to avoid it. Many women have used Clindamycin and Clindesse (myself included) in the past. But I think we need to stay away from it from now on.

Unless you have a very compelling reason to avoid Flagyl (e.g., an allergy), I would recommend that you avoid all forms of Clindamycin. (And wanting to not go without drinking alcohol for a week is not a compelling reason!)