Oral Treatment of Bacterial and/or Yeast Vaginal Infections
Frederick R. Jelovsek MD
\"What oral medication would you recommend for bacterial and yeast infection?\". Anonymous
This question does not clarify the intent of the request for oral medications. Both bacterial and yeast vaginitis are usually treated with vaginal topical medications. Some women prefer pills by mouth just because of the messiness of vaginal preparations. In other cases, the vaginal treatments may not have worked and the questioner is asking about 2nd choice therapeutic regimens to take by mouth.
It may also be that some oral medications are not tolerated due to side effects and the purpose of the question is to discover alternative oral medicines effective against the organisms. Finally the questioner may not be clear about the diagnosis since bacterial vaginosis and yeast vaginitis do not occur together very often. Thus it is mandatory to be sure of the diagnosis before initiating treatment.
How often is a vaginitis caused by both yeast and bacteria?
It is uncommon to have simultaneous infection with both candida (yeast) and bacteria giving a bacterial vaginosis. It is thought that some of the substances (amines) produced by bacterial vaginosis actually inhibit yeast growth and that is why they do not occur together very often (1). When women with active yeast infections are cultured for other bacteria, there are also much less of certain bacteria (peptostreptococcus species and anaerobic gram-positive cocci and/or bacilli) that would tend to be associated with bacterial vaginosis (2). Therefore the environments of yeast vaginitis and bacterial vaginitis are substantially different and thus they do not often occur together.
Nothing is an absolute in medicine however, and yeast vaginitis can occur along with bacterial vaginosis, especially recurrent bacterial infections (3). Even the situation of taking antibiotics for a bacterial vaginosis and a subsequent yeast vaginitis may be explained by the particular antibiotic used to treat bacterial vaginosis.
What is the best oral treatment for bacterial vaginitis?
The best treatment is metronidazole orally (Flagyl®) 500mg twice a day for 7 days. This has about a 95% cure. Metronidazole, 2000 mg orally as a single dose (4, 500mg tablets) has an 84% cure. Another pill by mouth is clindamycin (Cleocin®) 300 mg orally twice a day for 7 days which is 94% effective. Even though these oral medications have very high cure rates, metronidazole vaginal cream 0.75% (Metrogel®) 1 applicator intravaginal each day for 3 days (75% cure) is probably now the most commonly prescribed treatment for bacterial vaginosis because metronidazole occasionally produces nausea and clindamycin will sometimes swing a woman over into a yeast infection rather than a bacterial infection or it may also cause loose stools.