What is the recommended dose and frequency of Metrogel (Metronidazole) for the treatment of Bacterial Vaginosis (BV)?

From the Guidelines

For the treatment of Bacterial Vaginosis (BV), the recommended dose and frequency of Metrogel (Metronidazole) is one full applicator (5 g) intravaginally, once a day for 5 days. This recommendation is based on the guidelines provided by the Centers for Disease Control and Prevention, as stated in the study published in MMWR Recommendations and Reports 1. The study suggests that Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days, is an effective treatment for BV.

Some key points to consider when prescribing Metrogel for BV include:

• Patients should be advised to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter, as metronidazole can cause a disulfiram-like reaction (nausea, vomiting, headache) 1.
• Clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms, so patients should be aware of this potential interaction 1.
• The recommended metronidazole regimens are equally efficacious, and the vaginal clindamycin cream appears less efficacious than the metronidazole regimens 1.
• Alternative regimens, such as Metronidazole 2 g orally in a single dose, or Clindamycin 300 mg orally twice a day for 7 days, may be considered, but have lower efficacy for BV 1.

It's essential to note that the study published in 2002 1 provides the most relevant and up-to-date guidelines for the treatment of BV, and its recommendations should be prioritized in clinical practice. Other studies, such as those published in 1998 1, may provide additional information, but their recommendations may not be as current or relevant.

In terms of the mechanism of action, Metronidazole works by directly killing anaerobic bacteria that cause BV by interfering with their DNA synthesis, helping to restore normal vaginal flora 1. If symptoms persist after treatment, patients should follow up with their healthcare provider as an alternative regimen may be needed.

From the FDA Drug Label

The recommended dose is one applicator full of metronidazole vaginal gel (approximately 5 grams containing approximately 37.5 mg of metronidazole) intravaginally once or twice a day for 5 days. For once-a-day dosing, metronidazole vaginal gel should be administered at bedtime. The recommended dose and frequency of Metrogel (Metronidazole) for the treatment of Bacterial Vaginosis (BV) is:

• Dose: One applicator full of metronidazole vaginal gel (approximately 5 grams containing approximately 37.5 mg of metronidazole)
• Frequency: Intravaginally once or twice a day
• Duration: For 5 days 2

From the Research

Recommended Dose and Frequency of Metrogel (Metronidazole) for Bacterial Vaginosis (BV)

• The recommended dose and frequency of Metrogel (Metronidazole) for the treatment of Bacterial Vaginosis (BV) is as follows:
  • 0.75% metronidazole vaginal gel, applied once daily for 5 days 3
  • 0.75% metronidazole vaginal gel, applied twice daily for 5 days 4, 5
  • 1.3% metronidazole vaginal gel, applied once daily for 1,3, or 5 days 6
• Oral metronidazole is also an option, with a recommended dose of 500 mg orally twice daily for 7 days 4, 7
• The choice of treatment regimen may depend on individual patient factors, such as pregnancy status and medical history 7

Efficacy and Safety of Metrogel (Metronidazole) for BV

• Studies have shown that metronidazole vaginal gel and oral metronidazole are effective and safe for the treatment of BV 3, 4, 5
• The efficacy of 0.75% metronidazole vaginal gel and oral metronidazole is similar, with cure rates ranging from 70-85% 4, 5
• Metronidazole vaginal gel 1.3% has been shown to have similar efficacy and safety to 0.75% metronidazole vaginal gel 6
• Common side effects of metronidazole include gastrointestinal complaints, such as nausea and diarrhea, as well as vaginal candidiasis 4, 5