What patient education is necessary for Bacterial Vaginosis (BV) treatment with Flagyl (Metronidazole)?

Patient Education for Bacterial Vaginosis Treatment with Flagyl (Metronidazole)

Critical Alcohol Avoidance Warning

Patients must completely avoid all alcoholic beverages during treatment with metronidazole and for at least 24 hours (preferably one full day) after completing the last dose. 1, 2, 3 This combination can cause severe disulfiram-like reactions including abdominal cramps, nausea, vomiting, headaches, and flushing. 4, 3

Medication Administration Instructions

Oral Metronidazole (Most Common Regimen)

• Take 500 mg by mouth twice daily for 7 days 1
• Complete the entire course even if symptoms improve early 3
• Skipping doses or stopping early decreases effectiveness and increases bacterial resistance 3

If Prescribed Vaginal Gel Instead

• Apply one full applicator (5g) of 0.75% metronidazole gel intravaginally once or twice daily for 5 days, depending on your prescription 1, 5
• The vaginal gel achieves less than 2% of the blood levels compared to oral medication, minimizing systemic side effects 1

What to Expect During Treatment

Common Side Effects

• Mild gastrointestinal upset (nausea, stomach discomfort) 1
• Unpleasant metallic taste in mouth 1
• These effects are generally mild and do not require stopping treatment 1

When to Contact Your Provider

• If headaches or hot flashes become bothersome, alternative treatments are available 2
• If you develop signs of yeast infection (increased itching, thick white discharge), as candidiasis may become more prominent during treatment and requires separate antifungal therapy 3

Sexual Activity and Partner Management

Your sexual partner does NOT need treatment. 1 Multiple clinical trials demonstrate that treating partners does not improve cure rates or prevent recurrence. 1

However, you should know that:

• Unprotected sexual intercourse during treatment may reduce cure rates 6
• Consider abstaining or using barrier protection until treatment is complete 6

Contraceptive Considerations

If using vaginal clindamycin cream as an alternative (not metronidazole gel): The cream is oil-based and can weaken latex condoms and diaphragms. 1 Metronidazole gel does not have this interaction.

Important Behavioral Recommendations

• Avoid douching during and after treatment - this is significantly associated with treatment failure 6
• Women using intrauterine devices (IUDs) may have lower cure rates (57% vs 88% in non-users) 7

Follow-Up Care

• No follow-up visit is necessary if your symptoms completely resolve 1
• Recurrence is common - up to 50% of women experience BV again within one year 8
• If symptoms return, contact your provider for retreatment with a recommended regimen 1
• Do not attempt to self-treat with over-the-counter products 1

Special Warnings

Drug Interactions

• If you take warfarin or other blood thinners, metronidazole can increase bleeding risk - your provider may need to monitor your blood clotting times 3
• If you take lithium, metronidazole can increase lithium levels and cause toxicity - blood tests may be needed 3
• Phenytoin, phenobarbital, and cimetidine can interact with metronidazole metabolism 3

Disulfiram (Antabuse)

Do not take metronidazole if you have used disulfiram within the past two weeks - this combination can cause severe psychotic reactions. 3

Understanding Your Condition

• BV is NOT a sexually transmitted infection, though it involves changes in vaginal bacteria 1
• This medication treats bacterial infections only - it will not work for viral infections 3
• BV can be associated with complications during pregnancy and after gynecologic procedures, which is why treatment is important even if symptoms are mild 1

Pregnancy Considerations

If you are pregnant or become pregnant during treatment, inform your provider immediately. Multiple studies show metronidazole is safe during pregnancy, but the dosing regimen may need adjustment. 1