What is the recommended treatment for bacterial vaginosis in pregnant patients at risk for preterm delivery?

The recommended treatment for bacterial vaginosis in pregnant patients at risk for preterm delivery is metronidazole 500mg orally, taken twice daily for 7 days. This treatment is effective because metronidazole targets anaerobic bacteria, which are typically involved in bacterial vaginosis infections. Studies have shown that treating bacterial vaginosis in pregnant patients can help reduce the risk of preterm delivery, making it particularly important in this population.

Metronidazole is also considered safe for use during pregnancy, especially beyond the first trimester, which aligns with the guidelines for treating bacterial vaginosis in pregnant women. This safety profile, combined with its efficacy, makes it the preferred choice in this scenario.

Other treatments for bacterial vaginosis, such as amoxicillin and cephalexin, are not as effective against the specific anaerobic pathogens responsible for the condition. Doxycycline is generally avoided in pregnancy due to its potential effects on fetal development, particularly on tooth enamel and bone growth. Thus, metronidazole is the evidence-based option for treating bacterial vaginosis in the context of pregnancy and preterm delivery risk.