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3 November 2004
Persistent Vaginal Infection Linked To Treatment 
A new study, appearing in the American Journal of Obstetrics and Gynecology, has compared the emergence of antibiotic resistance following treatment between two antibiotics routinely prescribed for a common vaginal infection. The researchers, from the Magee-Womens Research Institute, have found antibiotic-resistant bacteria more likely to develop with the drug clindamycin than metronidazole. Researchers studied women between the ages of 18 and 45 who were being treated for bacterial vaginosis, a common gynecological complaint that infects up to 50 percent of women. Bacterial vaginosis is characterized by an increase in vaginal alkalinity and substitution of certain beneficial bacteria with more toxic bacteria. Among the infection's more prominent symptoms is a milky, foul-smelling discharge. "Symptoms of discharge are one of the most common reasons women visit a gynecologist," said Sharon Hillier, senior author of the study. "For years, clinicians have thought of bacterial vaginosis infection as a minor problem, but studies have shown that women who have bacterial vaginosis are more likely to get herpes and other sexually transmitted diseases, including HIV." Women treated for bacterial vaginosis with clindamycin experienced more frequent increases in bacterial concentrations of E. coli than those who were treated with metronidazole. In addition, women treated with metronidazole showed more significant decreases in concentrations of other bacteria. "Fewer than 1 percent of bacterial samples we tested demonstrated resistance to metronidazole," said study co-author Richard Beigi. "In contrast, 12 percent demonstrated baseline clindamycin resistance, and 53 percent demonstrated resistance to clindamycin after therapy." Women treated with clindamycin (but not metronidazole) showed evidence of clindamycin-resistant bacteria that persisted for 90 days after treatment at rates as high as 80 percent, added Beigi. Metronidazole therapy resulted in increased colonization by protective Lactobacillus species in the week following therapy compared to the women treated with clindamycin. Dr. Hillier said she believes these study results have the possibility to significantly impact standard bacterial vaginosis treatment. "I think any time you find out that use of an antibiotic results in a huge antibiotic resistance, it's important," Hillier concluded.
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