MULTICENTER COMPARISON OF CLOTRIMAZOLE VAGINAL TABLETS, ORAL METRONIDAZOLE, AND VAGINAL SUPPOSITORIES CONTAINING SULFANILAMIDE, AMINACRINE HYDROCHLORIDE, AND ALLANTOIN IN THE TREATMENT OF SYMPTOMATIC TRICHOMONIASIS

Background and Objectives: Trichomonas vaginalis is a common vaginal p athogen. Oral metronidazole is the drug of choice for the treatment of trichomoniasis. Oral metronidazole, however, may cause unpleasant sid e effects and is contraindicated during the first trimester of pregnan cy, In vitro studies and preliminary clinical data have suggested that intravaginal clotrimazole may be effective against this pathogen. Goa ls: To compare the efficacy of clotrimazole vaginal tablets, oral metr onidazole, and vaginal suppositories containing sulfanilamide, aminacr ine, and allantoin (AVC suppositories) in the treatment of women with symptomatic trichomoniasis. Study Design: In a multicenter, open-label trial conducted in 1982 and 1983, 168 symptomatic women with microsco pically evident vaginal trichomoniasis were randomized to receive any of 2 g of metronidazole as a single oral dose, two 100-mg clotrimazole vaginal tablets once a day for 7 days, or vaginal suppositories conta ining 1.05 g of sulfanilamide, 14 mg of aminacrine hydrochloride, and 140 mg of allantoin (AVC suppositories) twice a day for 7 days. Wet mo unts and cultures were repeated at 1 to 2 and 4 to 6 weeks after compl etion of treatment. Results: The numbers of patients who had positive cultures after treatment were 40/45 (88.9%) in the clotrimazole group, 35/43 (81.4%) in the AVC suppository group, and 9/45 (20%) in the met ronidazole group (P < 0.001), All treatments were associated with a re duction in reported symptoms. Oral metronidazole was more effective in reducing symptoms than either of the topical preparations, Adverse ev ents, mostly mild or moderate in severity, were reported by 7 (14.6%) of 48 patients who had received oral metronidazole and 4 (7.8%) of 51 women who used AVC suppositories, There were no adverse events reporte d by the 50 women who used clotrimazole vaginal tablets, Conclusions: Oral metronidazole was more effective in eradicating T. vaginalis than clotrimazole vaginal tablets or AVC vaginal suppositories, All three regimens reduced symptoms; oral metronidazole was more effective in re ducing symptoms than either topical preparation.