From the Guidelines
The recommended treatment for trichomoniasis in patients with alcoholism is metronidazole 2 grams as a single oral dose, or alternatively, tinidazole 2 grams as a single oral dose, with careful consideration of the potential interaction between these medications and alcohol 1. When treating patients with alcoholism for trichomoniasis, it is crucial to consider the potential risks associated with the interaction between metronidazole or tinidazole and alcohol.
- Patients must abstain from alcohol consumption during treatment and for at least 24 hours after completing metronidazole or 72 hours after tinidazole, as combining these medications with alcohol can cause a disulfiram-like reaction with symptoms including flushing, headache, nausea, vomiting, abdominal cramps, and hypotension.
- For patients unable to abstain from alcohol, supervised treatment in a controlled setting might be necessary.
- If oral therapy is not possible, metronidazole gel is not recommended as it has poor efficacy for trichomoniasis, with cure rates of less than 50% 1.
- Treatment of sexual partners is essential to prevent reinfection, and follow-up testing should be considered if symptoms persist.
- Patients should be counseled about the importance of completing the full course of treatment even if symptoms resolve quickly, and about abstaining from sexual activity until both they and their partners have completed treatment. The most recent and highest quality study, published in 2017, supports the use of metronidazole or tinidazole for the treatment of trichomoniasis, while also highlighting the importance of considering the potential interaction with alcohol 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment for Trichomonas in the Presence of Alcoholism
- There is no direct evidence in the provided studies regarding the treatment of trichomonas in the presence of alcoholism.
- However, the studies discuss the treatment of trichomoniasis using nitroimidazoles, such as metronidazole and tinidazole, which are effective against Trichomonas vaginalis 2, 3, 4, 5.
- Tinidazole is a promising agent for the treatment of trichomoniasis, with a single dose of 2 g showing high cure rates (>90%) 2, 4.
- Metronidazole is also effective, with a single dose of 2 g being the preferred treatment, although a 7-day dose may be more effective in some cases 6, 5.
- It is essential to note that the use of metronidazole and tinidazole in patients with severe hepatic impairment is not recommended due to the lack of data on their disposition in such patients 2.
- Alcoholism may be a concern in patients with hepatic impairment, and therefore, caution should be exercised when treating trichomoniasis in these patients, although there is no direct evidence to support this claim.
- The most commonly reported adverse effects of tinidazole and metronidazole include bitter taste, nausea, abdominal discomfort, anorexia, vomiting, and fatigue 2, 6.