title: High-dose vaginal metronidazole for recurrent bacterial vaginosis--a pilot study.
abstract: 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.
  
  
  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.
authors.affiliation: Departments of 1Obstetrics and Gynecology, 2Biochemistry and Molecular Biology, and 3Infectious Diseases, Wayne State University School of Medicine, Detroit, MI.
authors.forename: Tina J
authors.initials: TJ
authors.lastname: Aguin
authors.forename: Robert A
authors.initials: RA
authors.lastname: Akins
authors.forename: Jack D
authors.initials: JD
authors.lastname: Sobel
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use*; D008825:Miconazole / Q000627:therapeutic use; D010865:Pilot Projects; D012008:Recurrence; D016896:Treatment Outcome; D016585:Vaginosis, Bacterial / Q000188:drug therapy*; D015003:Yeasts / Q000302:isolation & purification
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole; D008825:Miconazole