title: Metronidazole for the treatment of vaginal infections.
abstract: BACKGROUND
  Metronidazole , undoubtedly the most widely known and used member of the nitroimidazole drug class, remains not only first line therapy for bacterial vaginosis (BV) and trichomoniasis, but serves as drug of first choice. Available and used both orally and topically with high efficacy rates, especially for trichomoniasis, nevertheless numerous unanswered questions remain regarding mechanism of action. Given the extraordinary global frequency of vaginitis due to BV and trichomoniasis, especially the high recurrence rate observed in BV, it is timely to critically examine the therapeutic role of metronidazole in management decisions.
  
  
  METHODS
  Search methodology used PUBMED literature review. In spite of many years of successful use, multiple questions exist regarding optimal dose and duration of therapy especially in the management of BV. Antimicrobial drug resistance remains uncommon in spite of extensive use. The use of metronidazole for vaginitis is reviewed in this article together with challenges to improving its more effective administration.
  
  
  CONCLUSIONS
  Currently metronidazole or the family of nitroimidazoles, represent the drugs of first choice for trichomonas vaginitis and first line therapy for BV. Drug resistance for both entities remains uncommon; however, in contrast to trichomoniasis where relapse is rare, high recurrence rates are common in women with BV. Metronidazole appears to allow persistence of vaginal microbiome microorganisms which translate into frequent relapses. In the absence of new therapeutic alternatives, strategies are being developed to enhance drug cure rates.
authors.affiliation: Jefferson Medical College, Department of Obstetrics and Gynecology , Philadelphia, PA , USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Sobel
authors.forename: Jack D
authors.initials: JD
authors.lastname: Sobel
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use*; D016896:Treatment Outcome; D014247:Trichomonas Vaginitis / Q000188:drug therapy; D016585:Vaginosis, Bacterial / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D000981:Antiprotozoal Agents; D008795:Metronidazole
keywords: antimicrobial resistance; bacterial vaginosis; metronidazole; trichomoniasis; vaginitis