Medical Pharmacology Chapter 35  Antibacterial Drugs

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Sexually Transmitted Diseases:  Drug Treatment

  • Vaginal Infections

    • Trichomoniasis

      • Primary drug choice:

        • Metronidazole (Flagyl) (2 g, oral, 1dose)

        • Clear treatment of choice

        • For metronidazole (Flagyl)-resistant strains: treat with metronidazole (Flagyl) for extended periods and with higher doses

      • Alternative agent:

        •  Metronidazole (Flagyl) (lower dosage, extended treatment)

    • Bacterial vaginosis

      • Responsible organisms:

        • Over growth with Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus, other anaerobes

        • Normal Lactobacillus species replaced by the above organisms

      •  Clinical comments:

        • Associated with premature labor & delivery complications

        • Symptomatic bacterial vaginosis and pregnancy: treat it

      • Primary drug choice:

        •  Metronidazole (Flagyl) Or

        •  Metronidazole (Flagyl) gel (0.75%) Or

        •  Clindamycin (Cleocin) (2% cream)

      • Alternative agents:

        •  Metronidazole (Flagyl) lower dosage

        •  Clindamycin (Cleocin), Laurel

        •  Metronidazole (Flagyl) (higher dosage: two grams, oral, 1 dose)

    • Vulvovaginal candidiasis

      • Primary drug choices-- intravaginal

        •  Butoconazole (Femstat), clotrimazole (Mycelex), miconazole (Monistat), terconazole (Terazol), tioconazole (Vagistat)

        • Or oral --fluconazole (Diflucan)

      • Alternative agent:

        •  Nystatin (Mycostatin) -- 2 week treatment protocol

      •  Clinical comments:

        • Recurrence: frequent

        •  With culture-proven recurrent infection:

          •  6-month prophylactic oral ketoconazole (Nizoral) or oral fluconazole (Diflucan) had been shown effective

        •  Possible increased risk of azole-resistant Candida glabrata caused vulvovaginal candidiasis

         

        Reference: "Drugs for Sexually Transmitted Infections", The Medical Letter, vol. 41 (issue 1063), September, 24, 1999, Published by the Medical Letter, Inc, New Rochelle, N.Y.

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