We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, LILACS, and African Healthline (December 2007); and proceedings of relevant international conferences (from 1981 to date).
SELECTION CRITERIA: Two authors independently assessed trial quality and extracted data from the original publications while the third author cross checked the data.
MAIN RESULTS: Twenty-four trials involving 4422 participants were reviewed. Most examined symptomatic women only. Only seven trials analysed results by intention to treat; we re-analysed the remainder.Compared with placebo,
clindamycin showed a lower rate of treatment failure (relative risk (RR) 0.25, 95% confidence interval (CI) 0.16 to 0.37).
Clindamycin and
metronidazole showed identical rates of treatment failure, irrespective of regimen type, at two and four-week follow up (RR 1.01, 95% CI 0.69 to 1.46; RR 0.91, 95% CI 0.70 to 1.18, respectively).
Clindamycin tended to cause a lower rate of adverse events (RR 0.75, 95% CI 0.56 to 1.02);
metallic taste, and
nausea and
vomiting were more common in the
metronidazole group (RR 0.08, 95% CI 0.1 to 0.59; RR 0.23, 95% CI 0.10 to 0.51, respectively). Given intravaginally as
gelatin tablets, lactobacillus was more effective than oral
metronidazole (RR 0.20, 95% CI 0.05 to 0.08). Similarly, oral lactobacillus combined with
metronidazole was more effective than
metronidazole alone (RR 0.33, 95% CI 0.14 to 0.77).
Clindamycin showed a lower rate of clinical failure than triple
sulfonamide cream (RR 0.46, 95% CI 0.29 to 0.72).
Hydrogen peroxide douche showed a higher rate of clinical failure (RR 1.75, 95% CI 1.02 to 3.00) and adverse events (RR 2.33, 95% CI 1.21 to 4.52) than a single 2 g dose of
metronidazole.
AUTHORS' CONCLUSIONS: