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Metronidazole, sold under the brand name Flagyl among others, is an antibiotic and antiprotozoal medication. [11] It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vaginosis. [11] It is effective for dracunculiasis, giardiasis, trichomoniasis, and amebiasis. [11]
Treatment for both pregnant and non-pregnant women is usually with metronidazole, [32] by mouth once. [31] Caution should be used in pregnancy, especially in the first trimester. [33] Sexual partners, even if they have no symptoms, should also be treated. [23] Single oral dose of nitroimidazole is sufficient to kill the parasites. [34]
During pregnancy, paromomycin is the preferred treatment drug because of its poor intestinal absorption, resulting in less exposure to the foetus. [64] Alternatively, metronidazole can be used after the first trimester as there has been wide experience in its use for trichomonas in pregnancy. [20] [65]
Women should speak to their doctor or healthcare professional before starting or stopping any medications while pregnant. [1] Drugs taken in pregnancy including over-the counter-medications, prescription medications, nutritional supplements, recreational drugs, and illicit drugs may cause harm to the mother or the unborn child.
Usually treatment is with an antibiotic, such as clindamycin or metronidazole. [9] [6] These medications may also be used in the second or third trimesters of pregnancy. [6] The antiseptic boric acid can also be effective. [10] BV often recurs following treatment. [6] Probiotics may help prevent re-occurrence.
Metronidazole is an antibiotic with an off-label use in eradicating H. pylori for treating gastric ulceration. Resistance of metronidazole is above 15% worldwide. [32] It is likely to be resistant so is not the first line choice of treatment. [44]
Topical use is also one of the treatment options for some skin conditions including acne and cellulitis. [40] Advantages of topical application include achieving high and sustained concentration of antibiotic at the site of infection; reducing the potential for systemic absorption and toxicity, and total volumes of antibiotic required are ...
Treatment can include topical steroids to diminish the inflammation. Antibiotics to diminish the proportion of aerobic bacteria is still a matter of debate. The use of local antibiotics, preferably local non-absorbed and broad spectrum, covering enteric gram-positive and gram-negative aerobes, can be an option.