In a randomized, double-blind study, 48 women with symptomatic bacterial vaginosis were assigned to receive either 5 g of 2% clindamycin vaginal cream daily or 500 mg metronidazole oral tablets twice a day for 7 days. After completion of therapy, there was no significant difference in cure rates (clindamycin 72% versus metronidazole 87%). One month later, 61% of the patients in each group were still cured. Adverse reactions were mild in both groups. We conclude that clindamycin cream is a safe, well tolerated, and effective alternative to oral metronidazole for treatment of bacterial vaginosis.