Dawaa Reference

infectious

Bacterial vaginosis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Vaginitis - disease-level clinical article (vaginitis-nonspecific-clinical.txt) · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Recommended Regimens · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Recommended Regimens (2% cream) and Alternative Regimens (300 mg oral)

Verified against3 documents
  • Vaginitis - disease-level clinical article (vaginitis-nonspecific-clinical.txt)
  • CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Recommended Regimens
  • CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Recommended Regimens (2% cream) and Alternative Regimens (300 mg oral)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Foul-smelling vaginal discharge is the most common complaint [vaginal discharge]
  • The odor tends to get stronger after intercourse
  • Painful urination, painful sex, or vaginal itching can accompany the discharge [burning on passing urine · itching]
  • Many affected women have no symptoms at all

Signs — what you find (3)

  • On exam the discharge looks thin and grayish-white, spread evenly along the vaginal walls
  • Checking cervical friability and motion tenderness helps exclude other causes of discharge
  • Fever or pelvic pain on exam should prompt a look for a more serious cause [abdominal pain · fever · pelvic pain]

Tests (10)

  • A vaginal fluid pH reading over 4.5 supports the diagnosis
  • Finding clue cells on a wet-mount slide is a reliable diagnostic sign
  • A fishy odor after adding potassium hydroxide to the sample is a positive whiff test
  • At least 3 of the 4 Amsel criteria must be met to confirm the diagnosis
  • A modified version accepting only 2 of the Amsel findings has been shown to be equally accurate
  • The Amsel criteria run about 70% sensitive and 94% specific
  • Wet-mount detection of clue cells covering 20% or more of cells meets one Amsel criterion
  • Gram stain scoring (Nugent method, 0 to 10) is mainly a research tool and rarely used clinically
  • Self-collected swabs, or any swab taken without a speculum exam, give unreliable results
  • Relying on culture, history alone, or a Pap smear to make the diagnosis is discouraged

If not this — what else fits (8)

  • Atrophic vaginitis
  • Candidiasis
  • Cervicitis
  • Chlamydia infection
  • Desquamative inflammatory vaginitis
  • Gonorrhea
  • Trichomoniasis
  • Pelvic inflammatory disease

SourceStatPearls "Bacterial Vaginosis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Alternative when a nitroimidazole cannot be used | Alternative oral nitroimidazole

MAIN TREATMENT

1

METRONIDAZOLE

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg BID orally x 7 days

Paediatric dose

Pre-pubertal bacterial vaginosis is rare; evaluate for child abuse

Dose source

Vaginitis - disease-level clinical article (vaginitis-nonspecific-clinical.txt), Recommended Regimens According to the Centers for Disease Control and Prevention, Bacterial vaginosis: "Metronidazole 500 mg orally twice daily for 7 days". This is the held copy of the CDC 2021 regimen; the CDC guideline itself is not cached here.

Why

Gold-standard oral nitroimidazole regimen with high cure rate

Cautions
  • Common side effects include metallic taste, nausea, and dark urine.
  • PREGNANCY - the CDC 2021 guideline puts no trimester restriction on it: "Pregnant women can be treated with any of the recommended regimens for nonpregnant women", and "metronidazole therapy poses low risk during pregnancy" because "no evidence of teratogenicity or mutagenic effects among infants has been reported". Two trials proved 250 mg three times daily effective in pregnancy; 500 mg twice daily "can also be used". BREASTFEEDING - lower doses "are considered compatible with breastfeeding", and after a single 2 g dose some clinicians defer the feed for 12-24 hours.
  • ALCOHOL - the CDC 2021 guideline reviewed the evidence and found abstinence unnecessary. It found "no in vitro studies, animal models, reports of adverse effects, or clinical studies providing convincing evidence of a disulfiram-like interaction between alcohol and metronidazole", notes that "Metronidazole does not inhibit acetaldehyde dehydrogenase, as occurs with disulfiram", and concludes: "Thus, refraining from alcohol use while taking metronidazole (or tinidazole) is unnecessary."
Egyptian brands
Egyptian brandManufacturerIndicative price
DUMOZOL 500MG 20 F.C. TABS.MINA PHARM > ALPHARMA-DENMARK7.00 EGP (0.35/unit)
ZOLGUARD 500MG 20 TAB.UNIPHARMA CO. > UNIPHARMA9.00 EGP (0.45/unit)
NITROFECTAZOLE 500 MG 20 F.C. TABS.GYPTO PHARMA10.50 EGP (0.53/unit)
FLAGICURE FORTE 500 MG 20 F.C. TABKAHIRA23.00 EGP (1.15/unit)
TRICHOGYL 500MG 12 F.C.TAB.EL NASR15.00 EGP (1.25/unit)
FLAGELLAT FORTE 500MG 20 F.C.TABS.MUP30.00 EGP (1.50/unit)
GEDAZOLE 500MG 20 TAB.JEDCO INT. CO. FOR PHARMACEUTICALS34.00 EGP (1.70/unit)
METROGYPTON 500 MG 20 F.C. TABS.GYPTO PHARMA34.00 EGP (1.70/unit)
DUMOZOL 125MG/5ML SUSP. 125ML? strength differs? different route - not oral solidMINA PHARM > ALPHARMA-DENMARK5.75 EGP
METROZOLE 125MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidMEMPHIS19.50 EGP

ALTERNATIVE WHEN A NITROIMIDAZOLE CANNOT BE USED

2

CLINDAMYCIN

Alternative when a nitroimidazole cannot be used

2nd line

Strength300 mg

Formoral.solid

Adult dose and duration

300 mg BID orally (or 2% vaginal cream at bedtime for 7 days) x 7 days

Paediatric dose

Specialist pediatric evaluation required

Choice

Reach for this one on allergy or intolerance, not on preference. The CDC's wording is that intravaginal clindamycin cream is preferred in case of allergy or intolerance to metronidazole or tinidazole - so if those can be taken, they come first.

Dose source

CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Recommended Regimens (2% cream) and Alternative Regimens (300 mg oral)

Why

Alternative oral treatment for patients allergic or intolerant to metronidazole

Cautions
  • Vaginal cream formulation may weaken latex condoms.
  • Discontinue immediately if severe diarrhea occurs.
  • There is a risk of Clostridioides difficile pseudomembranous colitis.
Egyptian brands
Egyptian brandManufacturerIndicative price
ADCOCLINDACE 300 MG 16 CAPS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.50/unit)
CLINACYN 300MG 16 CAPS.SIGMA > EGYPTIAN PHARMACISTS COMPANY31.50 EGP (1.97/unit)
CLINDAM 300 MG 16 CAPS.SIGMA > OCTOBER PHARMA75.00 EGP (4.69/unit)
MEPACLIND 300MG 8 CAPS.MEPACO38.00 EGP (4.75/unit)
CLINDACINE ART 300 MG 12 CAPS.RAMEDA > ART PHARMA76.00 EGP (6.33/unit)
ALFACLINDAMYCIN 300 MG 10 CAPS.ATCO PHARMA > ROTABIOGEN69.00 EGP (6.90/unit)
DALACIN C 300MG 10 CAPS.PFIZER114.00 EGP (11.40/unit)
KLENDABIOTICAM 1 % TOP. SOLUTION? strength differs? different route - not oral solidPANAX PHARMA8.50 EGP
ADCOCLINDACE 10MG/ML TOP. SOL.? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)12.00 EGP

ALTERNATIVE ORAL NITROIMIDAZOLE - choose one

3

SECNIDAZOLE

Alternative oral nitroimidazole

2nd line

Formoral.solid

Adult dose and duration

2 g by mouth as a single dose - Single dose

Paediatric dose

Bacterial vaginosis is a disease of women of reproductive age; the guideline sets no paediatric dose.

Choice

Alternatives, and secnidazole is usually the better buy. It finishes in one dose against tinidazole's two to five days, for a few pounds more. Take tinidazole when cost decides it - a course is about 8 EGP - or when secnidazole is not on the shelf.

Dose source

CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Alternative Regimens - verbatim: "Secnidazole 2 g oral granules in a single dose"

Why

One dose, taken in front of you if need be. On a disease whose 7-day courses are often not finished, that is the practical advantage, and a course is a few tens of pounds.

Cautions
  • The guideline names oral granules. Egypt sells secnidazole as 500 mg and 1 g tablets instead, so the 2 g dose is four 500 mg tablets or two 1 g tablets taken together.
  • Avoid in pregnancy and breastfeeding. The CDC says data are insufficient on secnidazole in pregnancy and that its use should be avoided - metronidazole is the option there.
  • One dose does not shorten the follow-up: symptoms that persist or return need the diagnosis confirmed again rather than a repeat prescription.
Egyptian brands
Egyptian brandManufacturerIndicative price
SECNIDA-MISR 500MG 4 TAB.MISR11.00 EGP (2.75/unit)
SENIDAL 500MG 4 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS11.00 EGP (2.75/unit)
EUROZOLE 500MG 4 TAB.EUROPEAN EGYPTIAN PHARM. IND.11.50 EGP (2.88/unit)
FLAGENTYL 500MG 4 F.C. TABS.SANOFI21.60 EGP (5.40/unit)
FLADAZOLE 500MG 4 TAB.AMOUN26.00 EGP (6.50/unit)
OPINIDAZOLE 1000MG 8 F.C.TAB.EL-OBOUR84.00 EGP (10.50/unit)
AMEBAZOL 1 GM 2 F.C. TABS.EGYPHAR27.00 EGP (13.50/unit)
CIPAZOLE FORT 1 GM 2 TAB.SIGMA > ASPIN PHARMACEUTICAL27.00 EGP (13.50/unit)
4

TINIDAZOLE

Alternative oral nitroimidazole

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

2 g once daily for 2 days, or 1 g once daily for 5 days x 2 days at 2 g, or 5 days at 1 g

Paediatric dose

Bacterial vaginosis is a disease of women of reproductive age; the guideline sets no paediatric dose.

Dose source

CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Alternative Regimens - verbatim: "Tinidazole 2 g orally once daily for 2 days" and "Tinidazole 1 g orally once daily for 5 days"

Why

The cheapest course on the card - four 500 mg tablets is about 8 EGP - and a shorter one than the seven days of metronidazole.

Cautions
  • Not in pregnancy. The CDC is explicit that animal data show moderate risk and that tinidazole should be avoided in pregnancy; metronidazole is the one with the safety record there.
  • Egyptian packs are 500 mg tablets, so the 2 g dose is four tablets taken together and the 1 g dose is two.
  • Where metronidazole or tinidazole cannot be used at all, the CDC prefers intravaginal clindamycin cream.
Egyptian brands
Egyptian brandManufacturerIndicative price
FASIGYN 500 MG 4 TABS.PFIZER8.35 EGP (2.09/unit)
PROTOZOLE 500 MG 12 F.C.TABS.MUP39.00 EGP (3.25/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.