Antibiotic consideration in bacterial vaginosis

Bacterial vaginosis (BV) is a syndrome characterized by the loss of indigenous vaginal lactobacilli and massive polymicrobial anaerobic vaginal overgrowth of elusive etiology. Although progress has occurred in defining the composition of the vaginal microbiome using DNA amplifications, rapidly accumulating data have not resulted in therapeutic advantage. Treatment options remain limited and outcome often unsatisfactory, particularly regarding the frequent recurrence of symptomatic disease, leading to enormous frustration among patients and practitioners. This review does not address the important issues of transmission, diagnosis, and complications of BV, but focuses on antimicrobial activity of current drugs and their limitations in vitro and in vivo. Recognizing these limitations should allow for either development of new antibiotics or for innovative use of currently available drugs in new study protocols. © 2009 Current Medicine Group, LLC.