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High-Dose Vaginal Metronidazole for Recurrent Bacterial Vaginosis—A Pilot Study

Aguin, Tina J. MD1; Akins, Robert A. PhD2; Sobel, Jack D. MD3

Journal of Lower Genital Tract Disease: April 2014 - Volume 18 - Issue 2 - p 156–161
doi: 10.1097/LGT.0b013e31829a5558
Original Articles

Objective: The purpose of this study was to evaluate high-dose intravaginal metronidazole, with or without miconazole, in enhancing cure rates in women with recurrent BV.

Materials and Methods: A total of 43 women with symptomatic recurrent BV were enrolled in a 4-arm study comparing 500 mg versus 750 mg of metronidazole, with or without miconazole, intravaginally for 7 days. Test of cure by saline wet mount and 10% potassium chloride microscopy, pH, Gram stain for Nugent score, and yeast culture were performed 3 times after treatment: 3 to 7 days, 30 to 35 days, and 60 to 70 days.

Results: Overall cure rate for the entire group was 92.6% at visit 2, 62.1% at visit 3, and 51.4% at visit 4. At visit 2, there was no difference in cure rates among patients who received metronidazole 750 mg ± miconazole daily (90.5%) compared with metronidazole 500 mg ± miconazole daily (85%). At visit 3, there was a significant improvement in cure rates among patients who received metronidazole 750 mg ± miconazole daily (78.9%) compared with metronidazole 500 mg ± miconazole daily (44.4%) (p < .05). At visit 4, a significant difference in clinical cure rates persisted among patients who received metronidazole 750 mg ± miconazole daily (68.4%) compared with of metronidazole 500 mg ± miconazole daily (33.3%; p < .05). Poor responses (Nugent score > 4 or pH > 4.4) at the first visit alter treatment-predicted recurrence. The addition of miconazole did not enhance BV response rates.

Conclusions: Cure rates for BV were high in this refractory cohort and seemed dose dependent.

For women with recurrent and refractory bacterial vaginosis, cure rates with high-dose metronidazole were high and rates seemed dose dependent.

Departments of 1Obstetrics and Gynecology, 2Biochemistry and Molecular Biology, and 3Infectious Diseases, Wayne State University School of Medicine, Detroit, MI

Reprint requests to: Jack D. Sobel MD, Department of Infectious Diseases, Wayne State University School of Medicine, or Harper Hospital, 3990 John R, Room 5934, Detroit, MI 48201. E-mail: Jsobel@med.wayne.edu

The authors have declared they have no conflicts of interest.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology