How to use Metronidazole vaginal cream 1.3%?

How to Use Metronidazole Vaginal Cream 1.3%

For bacterial vaginosis treatment, apply one full applicator (approximately 5 grams) of metronidazole vaginal cream 1.3% intravaginally once daily at bedtime for 5 days. 1

Application Instructions

1. Wash hands thoroughly before and after application
2. Remove the cap from the tube
3. Screw the applicator onto the tube
4. Squeeze the tube from the bottom to fill the applicator with the cream
5. Unscrew the applicator from the tube
6. While lying on your back with knees bent, gently insert the applicator into the vagina as far as it comfortably goes
7. Push the plunger to release the medication
8. Remove and discard the applicator after use

Important Treatment Considerations

• Timing: Apply at bedtime for best results 1
• Duration: Complete the full 5-day course even if symptoms improve 2
• Sexual activity: Abstain from sexual intercourse until completing the full treatment course to ensure effectiveness and minimize reinfection risk 2
• Alcohol restriction: Avoid alcohol during treatment and for 24 hours afterward to prevent disulfiram-like reactions (nausea, vomiting, flushing) 2

Efficacy and Alternatives

Metronidazole vaginal formulations are highly effective for bacterial vaginosis treatment, with cure rates of approximately 75-92.5% 3. This is comparable to oral metronidazole (84-90% cure rate) but with significantly fewer side effects 3.

Alternative treatments include:

• Oral metronidazole 500 mg twice daily for 7 days (95% cure rate) 2
• Clindamycin cream 2% intravaginally at bedtime for 7 days (comparable efficacy) 2

Common Side Effects and Precautions

• Local irritation or discomfort
• Vaginal candidiasis may develop after treatment (occurs in approximately 8-15% of patients) 4
• Less systemic side effects compared to oral metronidazole 3
• Significantly lower rates of nausea (10.2% vs 30.4%), abdominal pain (16.8% vs 31.9%), and metallic taste (8.8% vs 17.9%) compared to oral treatment 3

Follow-up Recommendations

• Follow-up visits are not necessary if symptoms resolve 2
• If symptoms persist or recur, consult your healthcare provider
• Pregnant women should have follow-up evaluation 1 month after treatment completion 2

Special Considerations

• For pregnant women: Metronidazole is contraindicated during the first trimester but may be safely used after 2
• Clindamycin cream 2% is the preferred treatment for bacterial vaginosis during the first trimester of pregnancy 2