First-lineFlagyl
Metronidazole
Nitroimidazole antibiotic
BV, trichomonas, anaerobic chorio/endometritis.
OralIVPV gel
First-line for
- Bacterial vaginosis
- Trichomonas vaginalis
- Anaerobic cover (endometritis, septic abortion)
Mechanism
Reduced under anaerobic conditions → DNA strand breaks.
Metro 'No alcohol'
- Disulfiram reaction — flushing, vomiting
Dosing
- BV
- 400 mg PO BD ×7 days OR 2 g PO stat
- Trichomonas
- 2 g PO stat (treat partner)
Contraindications
- CautionT1 (avoid high-dose stat); alcohol use
Side effects
- Metallic taste, nausea
- Peripheral neuropathy (prolonged)
Fetal & maternal notes
- • Compatible after T1; high-dose stat avoided T1.
- • Single dose during BF — interrupt 12–24 h.
Key interactions
Alcohol
AvoidDisulfiram-like reaction
Warfarin
Avoid↑ INR
Lithium / phenytoin
Caution↑ levels
Clinical pearls
- 💡 BV: oral & PV equally effective.
- 💡 Recurrent BV → 2× weekly suppression.
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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