From the Guidelines
The recommended dose of Metrogel (Metronidazole) for treating Bacterial Vaginosis is 0.75% gel, one full applicator (5 g) intravaginally, once a day for 5 days.
Treatment Options
- Metronidazole 500 mg orally twice a day for 7 days
- Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days
- Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days as stated in the guidelines by the Centers for Disease Control and Prevention 1.
Important Considerations
- Patients should be advised to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter.
- The recommended metronidazole regimens are equally efficacious, while the vaginal clindamycin cream appears less efficacious than the metronidazole regimens 1.
- Alternative regimens, such as metronidazole 2 g orally in a single dose, have lower efficacy for BV treatment 1.
- No data support the use of non-vaginal lactobacilli or douching for the treatment of BV 1.
- Follow-up visits are unnecessary if symptoms resolve, but recurrence of BV is not unusual 1.
The FDA Drug Labels for metronidazole (TOP) do not address this question.
From the Research
Dosing of Metrogel (Metronidazole) for Bacterial Vaginosis
- The dose of Metrogel (Metronidazole) used to treat Bacterial Vaginosis varies, with studies examining different concentrations and treatment durations 2, 3, 4, 5.
- A study comparing once-daily and twice-daily dosing of 0.75% metronidazole gel for 5 days found that both regimens were effective in treating bacterial vaginosis, with cure rates of 77% and 80%, respectively 2.
- Another study found that 0.75% metronidazole vaginal gel twice daily for 5 days was similar in efficacy to oral metronidazole treatment, with cure rates of 83.7% and 85.1%, respectively 3.
- A dose-ranging study examined the efficacy of metronidazole vaginal gel 1.3% for 1,3, or 5 days, and found that all three regimens were effective in treating bacterial vaginosis, with therapeutic cure rates ranging from 25.0% to 32.7% 4.
- An early study found that intravaginal 0.75% metronidazole gel was effective in treating bacterial vaginosis, with a clinical cure rate of 87% in a placebo-controlled trial and 91% in a crossover trial 5.
- A pilot study also explored the use of high-dose intravaginal metronidazole (750 mg suppository daily for 7 days) as a maintenance therapy to reduce recurrence rates of bacterial vaginosis, and found that it was associated with rare clinical recurrence during the treatment period 6.