Metronidazole 0.75% Gel Dosing for Bacterial Vaginosis
For bacterial vaginosis treatment, one full applicator (5g) of metronidazole 0.75% gel should be administered intravaginally once daily for 5 nights. 1
Correct Dosing Information
- According to the FDA label, one applicator full of metronidazole vaginal gel (approximately 5 grams containing approximately 37.5 mg of metronidazole) should be administered intravaginally once daily for 5 days 1
- For once-a-day dosing, metronidazole vaginal gel should be administered at bedtime (nocte) 1
- The 5g refers to the amount of gel in each application, not the total tube size 1
Evidence Supporting Once-Daily Dosing
- Clinical studies have demonstrated that once-daily dosing of 0.75% metronidazole gel for 5 days yields efficacy equivalent to twice-daily dosing 2
- Once-daily administration showed cure rates of 77% at the first follow-up visit, comparable to 80% for twice-daily administration 2
- The Centers for Disease Control and Prevention guidelines support once-daily dosing of metronidazole gel 0.75% for 5 days as an effective treatment option 3
Important Clinical Considerations
- Patients should be advised to avoid consuming alcohol during treatment with metronidazole and for 24 hours afterward due to potential disulfiram-like reactions 3, 4
- Follow-up visits are unnecessary if symptoms resolve, but patients should return if symptoms recur 3, 4
- Routine treatment of sex partners is not recommended as clinical trials indicate that a woman's response to therapy is not affected by partner treatment 3, 5
Alternative Treatment Options
- Oral metronidazole 500 mg twice daily for 7 days is another first-line treatment option with similar efficacy 3, 5
- Clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days is an effective alternative treatment 3, 4
- For patients with allergy or intolerance to metronidazole, clindamycin cream or oral clindamycin is the preferred alternative 3, 4