Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

Vaginitis 1509

Tinadazole orally once

■Alternatives: Metronidazole gel – much less effective; generally not

recommended

■For recurrences: tinadazole, longer courses of Metronidazole

■In pregnancy: Metronidazole after 1st trimester OR Clotrimazole

vaginal tablets

Side Effects & Contraindications

■Clindamycin: side effects: diarrhea, C. difficile colitis, rash, GI

intolerance; caution in pregnancy but no risk with extensive

experience; vaginal cream not recommended in pregnancy because

of increased risk of premature delivery

■Fluconazole: side effects: GI intolerance, rash, diarrhea, eleva-

ted LFTs; drug interactions common (astemizole, calcium chan-

nel blockers, cisapride, coumadin, cyclosporine A, oral hypo-

glycemics, phenytoin, protease inhibitors, tacrolimus, terfenadine,

theophylline, trimetrexate, rifampin); avoid in pregnancy (C)

■Metronidazole: side effects: disulfiram-like reaction with alcohol, GI

distress, headache, metallic taste; pregnancy=B, avoid during 1st

trimester

Tinadazole: metallic taste, GI distress, fatigue, avoid in first trimester of

pregnancy (C)

■Topical imidazoles: side effects: local irritation, dyspareunia; avoid

in first trimester

follow-up

■Generally not necessary if symptoms resolve

■In pregnancy, repeat evaluation in 1 month to document successful

treatment

complications and prognosis

■BV

➣Cure rate with 7 day Metronidazole therapy 75–90%

➣In early pregnancy, associated with preterm delivery and late

miscarriage; some experts recommend BV screening at begin-

ning of 2nd trimester and treatment of asymptomatic infection

in high-risk women (those with prior preterm delivery)

➣BV associated with PID following invasive procedures (endome-

trial biopsy, IUD placement, dilatation and curettage, hysteros-

alpingography, hysterectomy, cesarean section)

■VVC

➣Treatment with azole regimen results in 80–90% cure