A Multi-center, Double-blind, Randomized Study, Comparing Clindamycin Phosphate Vaginal Cream 2% (Watson Laboratories, Inc.) to Clindesse® (Ther-Rx™, Clindamyin Phosphate Vaginal Cream 2%) and Both Active Treatments to a Placebo Control in the Treatment of Bacterial Vaginosis in Non-pregnant Women

A multi-center, double-blind, randomized, placebo controlled, parallel-group study, comparing Clindamycin phosphate vaginal cream 2% (Watson Laboratories, Inc.) to Clindesse® (Ther-Rx™, Clindamyin Phosphate Vaginal Cream 2%) and both active treatments to a placebo control in the treatment of bacterial vaginosis in non-pregnant women.

The study treatment period will be 1 day. Subject participation is 22-30 days. Expected study duration is 10 to 12 months. The study will enroll in up to 30 clinical sites.

Test Product: One single-dose, pre-filled disposable applicator delivering approximately 5 g of cream containing approximately 100 mg of clindamycin phosphate vaginal cream 2% (Watson Laboratories, Inc.)

Reference Product: One single-dose, pre-filled disposable applicator delivering approximately 5 g of cream containing approximately 100 mg of Clindesse® (clindamycin phosphate vaginal cream 2% ) (Ther-Rx™)

Placebo Control: One single-dose, pre-filled disposable applicator delivering approximately 5 g of cream containing vehicle of the test product (Watson Laboratories, Inc.)

Dose and Mode A single applicator of investigational product cream will be administered of Administration once intravaginally at any time of the day. The subject participation is 22-30 days (drug administration for 1 day).

Inclusion Criteria:

1. Subjects must be willing and able to understand and comply with the requirements of the protocol, including attendance at the required study visits and must provide the written informed consent prior to any study related procedure being performed.

2. Healthy non-pregnant female aged ≥ 18 years with no known medical conditions that, in the investigator's opinion, may interfere with study participation or may interfere with the evaluation of bacterial vaginosis.

3. Female subjects of childbearing potential (excluding women who are surgically sterilized or postmenopausal for at least 1 year), in addition to having a negative urine pregnancy test must be willing to use an acceptable form of birth control during the study from the day of the first dose administration to the Visit 2 Test-of-cure. For the purpose of this study the following are considered acceptable methods of birth control:

   • Oral or injectable contraceptives
   • Contraceptive patches
   • Depo-Provera® (stabilized for at least 3 months); Implanon™ (contraceptive implant), or abstinence with one of the above-listed methods of birth control should the Subject become sexually active.
   • A sterile sexual partner is NOT considered an adequate form of birth control.
   • Willing to refrain from sexual intercourse on study days 1-7 and for 48 hours prior to Visit 2 Test-of-cure.

4. Willing to refrain from using any vaginal product (e.g., spermicide, tampon, douche, diaphragm, or condom) other than study product, on study Days 1-7, for 48 hours prior to the first dose of study product, and for 48 hours prior to Visit 2 Test-of-cure.

5. Diagnosis of bacterial vaginosis, defined as the presence of all of the following:

   • Clinical diagnosis of bacterial vaginosis (e.g., thin, homogenous vaginal discharge associated with minimal or absent pruritus or inflammation AND
   • Saline wet mount of vaginal discharge demonstrating the proportion of clue cell to be ≥ 20% of the total epithelial cells AND
   • Vaginal pH > 4.5, using pH paper that measures from 4.0-6.0 AND
   • Positive "whiff test" after addition of a drop of 10% KOH to vaginal discharge)
   • Gram stain Nugent score ≥ 4 on first day of dosing (study day 1) (per Table 1 below).
   • Table 1: Nugent Scoring System (0-10) for Gram-stained Vaginal Smears (a)
   • Score (b) Lactobacillus morphotypes Gardnerella and Bacteroides spp. morphotypes Curved gram-variable rods
   • 0 4+ 0 0
   • 1 3+ 1+ 1+ or 2+
   • 2 2+ 2+ 3+ or 4+
   • 3 1+ 3+
   • 4 0 4+

Source: Nugent, R. P., M. A. Krohn, and S. L. Hillier. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation. J. Clin. Microbial. 1991; 29: 297-301.

• Morphotypes are scored as the average number seen per oil immersion field. Note that less weight is given to curved gram-variable rods. Total score = lactobacilli + G. vaginalis and Bacteroides spp/ + curved rods.
• 0, No morphotypes present; 1, <1 morphotype present; 2, 1 to 4 morphotypes present; 3, 5 to 30 morphotypes present; 4, 30 or more morphotypes present.

Exclusion Criteria:

1. Female subjects who are pregnant, nursing or planning to become pregnant during study participation.
2. Menstruating when diagnosis of bacterial vaginosis is determined at Baseline visit.
3. Primary or secondary immunodeficiency.
4. Severe liver disease.
5. History of regional enteritis, ulcerative colitis, or a history of "antibiotic-associated" colitis.
6. Evidence of any vulvovaginitis other than bacterial vaginosis. (e.g., candidiasis, Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex).
7. Subjects with visible signs of HPV infection, i.e. visible warts.
8. Subject with another vaginal or vulvar condition, which would confound the interpretation of clinical response.
9. Subject will be under treatment during the study period for cervical intraepithelial neoplasia (CIN) or cervical carcinoma.
10. History of hypersensitivity to clindamycin, lincomycin, or any of the components of the vaginal creams.
11. Use within 2 weeks prior to baseline of 1) topical or systemic antibiotics or 2) topical or systemic antifungal.
12. Use of spermicides, tampons, douches, diaphragms, condoms within 48 hours of the baseline visit.
13. Concurrent use of systemic corticosteroids or systemic antibiotics.
14. Unwilling or unable to comply with the protocol requirements.
15. Subjects who have participated in an investigational drug study (i.e., subjects have been treated with an investigational drug) within 30 days prior to baseline will be excluded from study participation. Subjects who are participating in non-treatment studies such as observational studies or registry studies can be considered for inclusion.
16. Subjects who have been previously enrolled in this study.