BERNALILLO, N.M. – Intravaginal high-dose metronidazole and miconazole may be better than metronidazole gel for keeping recurrent bacterial vaginosis at bay, according to the results of a small pilot study from Wayne State University in Detroit.
Eighteen women with refractory bacterial vaginosis (BV) were cured there with a 7-day course of the suppository, an ovule containing 750 mg metronidazole – far more than in a typical Metrogel (metronidazole gel) application – and 200 mg miconazole. The women were then switched to a twice-weekly maintenance regimen.
Dr. Tina Aguin
The 10 who returned for a checkup 1 month later were in remission, with no symptoms, no clue cells, a negative amine test result, and no more than one of four Amsel criteria. Nine of the 10 were still in remission at the 3-month checkup, at which time treatment was discontinued, senior author Dr. Jack Sobel reported at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.
Although the regimen wasn’t compared directly with Metrogel maintenance, Dr. Sobel said that based on his earlier work, he’d expect twice-weekly Metrogel maintenance to keep about 6 or 7 women out of 10 in remission (Am. J. Obstet. Gynecol. 2006;194:1283-9).
The team used a product called Neo-Penotran Forte, a combination metronidazole/miconazole ovule not generally available in the United States. However, a similar suppository "can be made up by any compounding company," said Dr. Sobel, chief of Wayne State’s division of infectious diseases. The medication was well tolerated in the study.
Unfortunately and as is often the case with BV, "these patients recurred and recurred rapidly after stopping maintenance therapy," said coauthor and ob.gyn. Tina Aguin, also of Wayne State.
Six of nine patients relapsed within 3 months. "The bottom line is we are able to control people with intravaginal high-dose metronidazole maintenance, but we are not curing anyone," she said.
Dr. Aguin and Dr. Sobel said they had no relevant financial disclosures.