Bacterial Vaginosis 

Patient Population: Pediatric

This and other STI sections are not meant to be comprehensive references for all STI treatment but primarily focused on the most commonly used initial empiric antimicrobial therapy. Users should refer to linked resources (SFDPH City Clinic protocols, CDC guidelines) or other local resources to provide patients and their partners appropriate counseling and follow-up. For non-adolescent age patients, patients with STIs not addressed in these guidelines, or patients with contraindications to the listed therapies, we recommend referring to the linked resources, or Lexi-Comp for medication information, or consulting ID/ASP for individualized recommendations. 

Condition Major Pathogens  First Choice Therapy Alternative Therapy Comments
Bacterial vaginosis, treatment in symptomatic patients  Anaerobic bacteria 

500 mg enterally bid x 7 days 


Metronidazole gel
0.75% one applicator (5 g) intravaginally at bedtime daily    

Other treatment options exist for patients with contraindications to metronidazole; refer to CDC guidelines linked below, or SFDPH City Clinic protocol linked in comments 

Refer to SFDPH City Clinic STI protocols section on bacterial vaginosis for recommended evaluation, additional STI testing, counseling (including to avoid alcohol consumption during treatment), and follow up 

Duration: 7 days for systemic treatment (enteral), 5 days for intravaginal treatment 


Workowski KA, et al. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70:1-187.

Pediatric Empiric Antimicrobial Therapy Guidelines

This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.  

For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK. 

The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.