{"doi":"10.1001/jamanetworkopen.2024.8606","title":"Dequalinium Chloride—An Emerging Option in the Sparse Landscape of Bacterial Vaginosis Therapies","abstract":"Bacterial vaginosis (BV) is characterized by a vaginal microbiota low in lactobacilli; it affects one-quarter to one-third of reproductive-age cisgender women. 1 Approximately one-half of cases are symptomatic, with abnormal vaginal discharge and/or amine or fishy vaginal odor. 1 BV contributes to adverse sexual and reproductive outcomes, including HIV and/or sexually transmitted infection (STI) acquisition and preterm birth, and symptoms can negatively impact psychosocial well-being and sexual satisfaction. 1The BV treatment landscape has not appreciably changed in decades: in the US, metronidazole and clindamycin are recommended as first-line treatments for symptomatic BV, and secnidazole and tinidazole are used as alternatives.Although these treatments are effective in the short term, up to 60% of women experience BV recurrence within 1 year of treatment. 2Some have frequent recurrences, and options are limited for these individuals and may involve onerous suppressive regimens with twice-weekly application of intravaginal antibiotics for extended time periods.Suppressive vaginal metronidazole fails for 25% of patients and leads to secondary vulvovaginal candidiasis (VVC) in up to 40%, and many patients have BV recurrence after stopping suppressive therapy. 3It is imperative that we expand the toolkit of available BV treatments.Alternatives that are at least as effective as nitroimidazoles and clindamycin would be welcome additions.Treatments that effect a lasting cure would be paradigm-shifting.One option may be dequalinium chloride (DQC), a locally delivered antiseptic with broad antibacterial and antifungal activity. 4Its antibacterial activity is attributed to interaction with the bacterial cytoplasmic membrane and perturbation of cellular permeability, protein denaturation and subsequent alteration of ribosomal protein synthesis, and nucleic acid precipitation. 4A prior trial 5 reported that intravaginal DQC was noninferior to intravaginal clindamycin for BV treatment (discussed later), motivating Raba and colleagues 6 to evaluate its efficacy vs metronidazole.In a European, phase 4, multicenter, triple-blinded, randomized trial including 147 women, Raba et al 6 found that intravaginal DQC (10 mg tablet daily for 6 days) was noninferior to oral metronidazole (500 mg twice daily for 7 days) for treating BV defined by all four Amsel criteria. 6Clinical cure rates in both groups were 92.8% to 93.2% upon completing treatment, and DQC tolerability was significantly higher than for metronidazole. 6Notably, 27.9% of participants had a Nugent score of 3 or lower at enrollment (indicating non-BV microbiota) despite all 4 Amsel criteria being present; although there is some variation in the literature, this discrepancy is greater than the approximately 10% reported in a sentinel study. 7However, these participants were evenly distributed across groups. 6e trial by Raba et al 6 is the second to compare DQC with standard-of-care BV treatment.In 2012, Weissenbacher and colleagues 5 reported that intravaginal DQC was noninferior to intravaginal clindamycin (2% cream for 7 days) in a trial of 315 participants.Like Raba et al, 6 they enrolled women presenting with 4 Amsel criteria from multiple European clinical sites.Clinical cure rates for DQC and antibiotic groups at early and late time points were somewhat lower than in the trial by Raba et al, which may reflect slightly different clinical cure definitions and outcome assessment timing (7 and 20-40 days after starting treatment for Raba et al, 6 and 7 and 25 days after completing treatment for Weissenbacher et al 5 ).It is encouraging that both trials demonstrated noninferiority using the same 15% noninferiority margin and showed 75% to 80% clinical cure up to 5 weeks after DQC. 5,","journal":"JAMA Network Open","year":2024,"id":459482,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9549,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":271536,"name":"Susan Tuddenham","orcid":"0000-0001-5910-956X","position":1,"is_corresponding":false},{"id":228204,"name":"Rebecca M. Brotman","orcid":"0000-0001-8762-6214","position":2,"is_corresponding":false},{"id":490002,"name":"Kayla A. Carter","orcid":"0000-0002-4836-0932","position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":null,"created_at":"2026-07-19T02:03:59.428859Z","pmid":"38696175","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}