Written by Babatunde Carew
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Dequalinium chloride was noninferior to metronidazole for treatment of bacterial vaginosis (BV), with fewer side effects.
Synopsis
This phase 4, multicenter, triple-blind, double-dummy, parallel, noninferiority randomized clinical trial compares the efficacy of dequalinium chloride, a broad-spectrum antiseptic, with oral metronidazole for treating bacterial vaginosis (BV). In a cohort of 147 premenopausal women, the study found that dequalinium chloride was noninferior to metronidazole. Cure rates were similar for both treatments (92.8% for dequalinium chloride vs. 93.2% for metronidazole), but dequalinium chloride showed better tolerability and fewer adverse effects. The trial’s results suggest that dequalinium chloride could be considered a first-line treatment for BV, helping reduce antibiotic use. Despite similar efficacy to metronidazole, the study highlights the need for alternative treatments due to rising antibiotic resistance. [AI-generated]
Bobby’s Commentary: Topical BV treatment?
If you have never heard of dequalinium chloride before now, that at least makes two of us. While it has been widely used in Europe for decades and is recommended by some international guidelines as an alternative treatment for BV and inflammatory vaginitis, it is not yet approved for clinical use in the United States. With the publication of this study, there now exist multiple trials that demonstrate dequalinium chloride is noninferior to the usual first-line treatments for BV (metronidazole and clindamycin). As concerns about antibiotic resistance rise, I am excited to (eventually) have an option to treat BV that can reduce antibiotic use, with evidence supporting its efficacy, safety, and tolerability. I will be interested to see future studies highlighting the use of dequalinium chloride for treatment of other common vaginal infections.
Editor’s note: Dequalinium chloride is a 10mg intravaginal tablet and has antibacterial and antifungal activity, which is good, since up to 40% of women develop vulvovaginal candidiasis with vaginal metronidazole treatment. Finally, dequalinium appears to be safe in pregnancy, though larger studies are needed. At least 181 women have received dequalinium in a research setting during pregnancy, and all had good pregnancy outcomes. ~Clay Smith
Source
Efficacy of Dequalinium Chloride vs Metronidazole for the Treatment of Bacterial Vaginosis: A Randomized Clinical Trial. JAMA Netw Open. 2024 May 1;7(5):e248661. doi: 10.1001/jamanetworkopen.2024.8661. PMID: 38696172; PMCID: PMC11066704.
