Azithromycin for Bacterial Vaginosis – Quick Guide

Bacterial vaginosis (BV) affects millions of women each year. It’s caused by an imbalance of the natural bacteria in the vagina, leading to discharge, odor, and irritation. While metronidazole or clindamycin are usually first‑line, some doctors prescribe azithromycin when those options aren’t suitable.

How Azithromycin Works on BV

Azithromycin is a macrolide antibiotic that stops bacteria from making proteins they need to grow. It targets many of the anaerobic bacteria linked to BV, especially Gardnerella vaginalis. Because it stays in body tissues for a long time, a single dose can be enough to clear the infection.

Dosage, Safety and When to Choose It

The typical regimen for BV is one 1‑gram tablet taken orally once. Some doctors split the dose into two 500‑mg pills taken 12 hours apart. The single‑dose approach makes it easy to finish the treatment and reduces the chance of forgetting a pill.

Side effects are usually mild: upset stomach, diarrhea, or a temporary metallic taste. Rarely, people experience allergic reactions like rash or breathing trouble. If you have liver disease, heart rhythm problems, or are pregnant, talk to your pharmacist before using azithromycin.

Why would a doctor pick azithromycin over metronidazole? It’s often chosen when a patient can’t tolerate nitroimidazoles due to nausea, alcohol‑related warnings, or previous allergic reactions. Azithromycin also doesn’t interact with alcohol the way metronidazole does.

Even though it works, azithromycin isn’t considered the best first choice because studies show slightly lower cure rates compared to metronidazole. If you’ve tried other antibiotics and they didn’t work, or if you have a specific intolerance, azithromycin becomes a solid backup.

To boost recovery, avoid douching, use cotton underwear, and limit sugary foods that feed harmful bacteria. Probiotic yogurt with live cultures can help restore good bacteria after the course ends.

If symptoms linger two weeks after finishing azithromycin, schedule a follow‑up appointment. Persistent BV may need a different antibiotic or a longer treatment plan.