From the Guidelines
For bacterial vaginosis (BV), the recommended metronidazole (Flagyl) dosing is 500 mg orally twice daily for 7 days. This recommendation is based on the guidelines from the Centers for Disease Control and Prevention, as outlined in the 2002 sexually transmitted diseases treatment guidelines 1. Alternatively, a single 2-gram oral dose can be used, though this has slightly lower cure rates, as noted in the 1998 guidelines for treatment of sexually transmitted diseases 1. Another option is metronidazole vaginal gel 0.75%, applied once daily for 5 days.
Key Considerations
- Treatment is important even for asymptomatic women to prevent complications like increased risk of STIs and pregnancy complications.
- Patients should avoid alcohol during treatment and for 24 hours afterward to prevent disulfiram-like reactions (nausea, vomiting, headache) 1.
- Sexual partners typically don't require treatment as BV isn't considered a sexually transmitted infection, though BV can recur.
- Side effects may include metallic taste, nausea, and gastrointestinal discomfort.
- Metronidazole works by disrupting bacterial DNA synthesis, effectively targeting the anaerobic bacteria that overgrow in BV while allowing restoration of normal vaginal flora.
Additional Options
- Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days, is another treatment option, though it appears less efficacious than the metronidazole regimens 1.
- Clindamycin 300 mg orally twice a day for 7 days, is an alternative regimen, as outlined in the 1998 guidelines 1.
From the Research
BV Flagyl Dosing
- The recommended dosing for Flagyl (metronidazole) in the treatment of bacterial vaginosis (BV) varies depending on the patient population and treatment regimen.
- For nonpregnant women, the preferred treatment is metronidazole (500 mg orally twice daily for 7 days) 2, 3.
- For pregnant women, the recommended dosing is metronidazole (250 mg orally three times a day for 7 days) 3.
- In cases of recurrent BV, an extended course of metronidazole treatment (500 mg twice daily for 10-14 days) is recommended 4.
- Alternative treatment regimens include single-dose metronidazole (2 g orally), 2% clindamycin vaginal cream (once daily for 7 days), and 0.75% metronidazole vaginal gel (twice daily for 5 days) 2, 5, 6.
- Once-daily dosing of 0.75% metronidazole gel 5 g for 5 days has been shown to be equivalent to twice-daily dosing in terms of efficacy, safety, and tolerance 6.