Oral metronidazole Flagyl

a. Oral metronidazole is equally effective as topical therapy. Oral metronidazole has a 90% cure rate.

b. Dosage is 500 mg bid or 250 mg tid for 7 days. A single 2-g dose is slightly less effective (69-72%) and causes more gastrointestinal upset. All alcohol products should be avoided because nausea and vomiting (disulfiram reaction) may occur.

3. Routine treatment of sexual partners is not necessary, but it is sometimes helpful for patients with frequent recurrences.

4. Persistent cases should be reevaluated and treatment with clindamycin, 300 mg PO bid for 7 days along with treatment sexual partners.

5. Pregnancy. Clindamycin is recommended, either intravaginally as a daily application of 2% cream or PO, 300 mg bid for 7 days. After the first trimester, oral or topical therapy with metronidazole is acceptable.

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