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What is Dalacin cream?

Dalacin cream is clindamycin 2% used vaginally for 7 days to treat bacterial vaginosis (BV). Clindamycin is an antibiotic which kills anaerobic (not needing oxygen) bacteria like those causing BV. In BV, anaerobic bacteria take over in the vagina, disrupting the usual bacterial balance. Killing the anaerobic bacteria allows lactobacilli to flourish again which restores the natural balance.

Using Dalacin cream

Dalacin cream is inserted into the vagina using the disposable applicator provided, at bedtime for 7 days. A 3-day course may be effective, but the British Association for Sexual Health and HIV (BASHH) recommend a full 7-day course.

To use the applicator:

• Wash your hands before and after using Dalacin cream.
• Remove the cap from the tube of Dalacin cream.
• Screw a new applicator onto the tube.
• Gently squeeze the tube at the bottom to fill the applicator with Dalacin cream. The applicator is full (5gm dose) when the plunger no longer moves.
• Unscrew the applicator, and replace the tube cap.
• Holding the applicator barrel, gently insert the applicator into the vagina towards the lower back, as far as it goes without discomfort.
• Holding the applicator barrel steady, push the plunger in completely to release the cream at the top of the vagina.
• Remove the applicator and dispose of it wrapped in tissue, in a bin. Do not throw it in a toilet.
• Use a new applicator each night.
• Use only once daily and complete the 7-day course.

Dalacin cream has a cure rate of 70%-80%, but in some women BV can be a recurrent condition requiring multiple courses of treatment.

Cautions when using Dalacin cream

• Do not use if there is a known allergy to clindamycin or lincomycin.
• Do not use if there is a history of inflammatory bowel disease (Crohn's disease, ulcerative colitis) or antibiotic colitis.
• Avoid sexual intercourse during BV infection and treatment.
• Latex condoms and diaphragms may be weakened by Dalacin cream and should not be relied on for contraception until 5 days after last use of Dalacin cream.
• Possible allergy or skin reaction to other ingredients. See patient leaflet for more details.
• It is better not to use Dalacin cream during the monthly period (menses).
• Do not use other vaginal products (tampons, creams, etc) during treatment with Dalacin cream.

Dalacin and pregnancy

There is no data about the safety of Dalacin in the first trimester of pregnancy (before 13 weeks) and manufacturers recommend only using it in the second and third trimesters (after 13 weeks).

Dr Fox does not prescribe for pregnant women. Please consult your GP or midwife.

Dalacin and breastfeeding

Very little clindamycin from Dalacin vaginal cream is expected to get into breast milk but clinical trials have not actually been done. Clindamycin in tablets may potentially cause gut problems in the breastfed baby, so the manufacturers advise caution, even if using the cream.

Dr Fox does not prescribe for breastfeeding women. Please consult your GP.

Possible side effects

As with all medication, some people, but not everyone, may experience side effects.

Stop using Dalacin cream and consult a doctor if you develop severe, persistent or bloody diarrhoea which may be a sign of the uncommon but serious pseudomembranous colitis.

Other side effects which have been reported include: vaginal thrush (candida), urinary tract infection, altered sense of taste, stomach pain, diarrhoea.

Blood liver test results may be affected - advise your doctor that you are using Dalacin cream.

Interactions

Very little Dalacin cream is absorbed into the body, but it may interact with the antibiotic erythromycin, and anticoagulants (blood thinners) like warfarin which require regular blood test monitoring.

If you are having an operation tell your doctor that you are using Dalacin, as there is a possibility of it reacting with the anaesthetic.

Alternative treatments for bacterial vaginosis

There are several alternative prescription treatments for BV. Always use medication according to the regime actually prescribed for you.

Metronidazole tablets

• 400mg tablets twice a day for 5-7 days.
• 500mg tablets twice a day for 5-7 days.
• One dose of 2 grams (5 x 400mg tablets or 4 x 500mg tablets) all at once.

Clindamycin tablets

• 300mg tablets twice a day for 7 days.
• Usually reserved for pregnancy.

Zidoval gel

Every night for 5 nights.

Other measures to relieve symptoms and reduce risk of getting bacterial vaginosis

• Take a shower instead of a bath.
• Use only water and a plain soap or aqueous cream to wash genital area.
• Do not use vaginal douching, vaginal washes, or vaginal deodorants.
• Do not use antiseptic, perfumed soap, bubble baths, shampoo, or shower gel in the bath.
• Do not use strong detergent to wash underwear.
• Do not smoke.

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