What are the discharge instructions for a 53-year-old female patient with suspected bacterial vaginosis, being treated with metronidazole (Flagyl) and fluconazole (Diflucan), who is prone to yeast infections?

Discharge Instructions for Patient with Bacterial Vaginosis and Fluconazole Treatment

The patient should take metronidazole 500 mg orally twice daily for 7 days, avoid alcohol during treatment and for 24 hours afterward, and take the fluconazole as a single dose to prevent yeast infection. 1

Medication Instructions

Metronidazole (Flagyl)

• Take one 500 mg tablet by mouth twice daily for 7 days
• Take with food to minimize stomach upset
• Complete the entire course of antibiotics even if symptoms improve before finishing
• Do not consume alcohol during treatment and for 24 hours after completing treatment as this can cause severe nausea, vomiting, flushing, headache, and abdominal cramps 1

Fluconazole (Diflucan)

• Take as a single oral dose as prescribed
• This medication is preventive for yeast infection, which can occur after antibiotic treatment
• May be taken with or without food 2

Symptom Management

• Use unscented, hypoallergenic soap for bathing
• Wear cotton underwear and loose-fitting clothing
• Avoid douching, scented feminine hygiene products, and bubble baths
• Use unscented, white toilet paper
• Wipe from front to back after using the toilet

When to Return to Healthcare Provider

• If symptoms persist after completing the full course of metronidazole
• If symptoms worsen during treatment
• If you develop severe side effects from medications including:
  • Severe nausea or vomiting
  • Persistent diarrhea
  • Rash or hives
  • Severe headache
  • Numbness or tingling in extremities

Follow-Up Information

• Follow-up visits are not necessary if symptoms resolve completely 1
• Recurrence of bacterial vaginosis is common; return for evaluation if symptoms recur 1, 3
• No routine treatment of sexual partners is recommended as this has not been shown to reduce recurrence 1

Sexual Activity Guidelines

• Avoid sexual activity until treatment is complete and symptoms have resolved
• Consider using condoms to reduce risk of reinfection
• Note that oil-based products (including some vaginal medications) can weaken latex condoms 1

Important Considerations for This Patient

• Since this patient is prone to yeast infections, she should monitor for symptoms such as increased vaginal itching, thick white discharge, or burning with urination 4
• If yeast infection symptoms develop despite preventive fluconazole, contact healthcare provider for additional treatment options
• Bacterial vaginosis is not considered a sexually transmitted infection, but sexual activity can disrupt vaginal flora 3

Prevention of Recurrence

• Avoid potential triggers such as douching and scented feminine products
• Consider longer treatment courses if recurrence is frequent (10-14 days of metronidazole may be recommended for recurrent cases) 3
• Maintain good genital hygiene practices

Remember that bacterial vaginosis is a common condition that can be effectively treated with the prescribed medications. Complete the full course of antibiotics and follow these instructions to promote healing and prevent recurrence.