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Metronidazole is a nitroimidazole antibiotic that forms toxic free radicals inside anaerobic organisms, damaging their DNA. Vaginal application targets BV-associated bacteria (Gardnerella vaginalis, anaerobes) directly at the infection site with minimal systemic absorption compared to oral dosing.
Commercial 0.75% gel is available, but compounding offers custom concentrations, combination with boric acid for resistant BV, combination with nystatin for concurrent yeast infection, less-irritating bases for sensitive patients, and cost savings for maintenance therapy.
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Bacterial vaginosis is the most common vaginal infection in women of reproductive age, and metronidazole is a CDC first-line treatment. Recurrent BV affects up to 50% of women within 12 months of treatment, driving demand for maintenance therapy and combination approaches like compounded metronidazole/boric acid.
Bacterial vaginosis (BV), recurrent BV maintenance therapy, combination BV treatment with boric acid or nystatin, trichomoniasis (systemic route preferred).
Standard BV: 0.75% gel, one applicatorful vaginally once daily for 5 days. Recurrent BV suppressive: twice weekly for 4–6 months. Combination formulas: per prescribing physician.
Mild vaginal irritation, white or gray vaginal discharge, unpleasant metallic taste (less common with vaginal route). Candida overgrowth possible. Avoid alcohol during and 24 hours after treatment (disulfiram-like reaction).
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