What education should be provided to a patient with a bacterial vaginosis (BV) infection regarding metronidazole (Flagyl) treatment?

Patient Education for Bacterial Vaginosis Treatment with Metronidazole

Critical Alcohol Warning

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

Medication Instructions

• Take metronidazole 500 mg by mouth twice daily for 7 days as prescribed 1, 2
• Complete the entire course of therapy even if symptoms improve early, as skipping doses or stopping early may decrease treatment effectiveness and increase bacterial resistance 3
• Common side effects include mild gastrointestinal upset and an unpleasant metallic taste in the mouth 2

Sexual Activity and Partner Management

• Sexual partners do not require treatment, as multiple clinical trials demonstrate that treating partners does not improve cure rates or prevent recurrence 1, 2
• You may resume sexual activity once treatment is completed and symptoms have resolved 2
• If using vaginal clindamycin cream as an alternative treatment, be aware it can weaken latex condoms and diaphragms, though metronidazole gel does not have this interaction 1, 2

Understanding Your Condition

• Bacterial vaginosis is not a sexually transmitted infection, but rather involves changes in the normal vaginal bacterial balance 2
• Treatment is important even with mild symptoms, as BV is associated with adverse pregnancy outcomes (including preterm delivery) and increased risk of postoperative infections after gynecologic procedures 1, 2
• Candida (yeast) infections may become more prominent during metronidazole therapy and would require separate treatment with antifungal medication 3

Follow-Up and Recurrence

• No follow-up visit is necessary if symptoms completely resolve 1, 2
• Recurrence is common, with up to 50% of women experiencing BV again within one year 2, 4
• If symptoms return, contact your provider for retreatment—do not self-treat with over-the-counter products 2
• For recurrent BV, extended treatment courses may be recommended 4

Special Pregnancy Considerations

• If you are pregnant or become pregnant during treatment, inform your provider immediately, as the dosing regimen may need adjustment 2
• Metronidazole is safe during pregnancy, though different doses may be used (typically 250 mg three times daily for 7 days in the second trimester) 1, 2
• During the first trimester, clindamycin vaginal cream may be preferred over metronidazole 1

Important Drug Interactions

• Metronidazole can potentiate the anticoagulant effect of warfarin and other blood thinners, requiring monitoring of prothrombin time 3
• If taking lithium, phenytoin, phenobarbital, or cimetidine, inform your provider as dose adjustments may be needed 3
• Do not take disulfiram within two weeks of metronidazole therapy due to risk of psychotic reactions 3