Obstetrics & Gynecology

Answer 4 High-dose metronidazole (750 mg to 1 g) taken orally 3 times daily for 7 days. Metronidazole resistance is increasing and can usually be overcome by high-dose metronidazole, as used in the treatment of amebiasis. However, adverse reactions are of particular concern at such high doses. These reactions include nausea with or without headache, anorexia, vomiting, abdominal cramps, metallic taste in the mouth, candidal overgrowth, a disulfuram-like reaction when taken with alcohol, the potentiation of anticoagulation effects of coumarin-type agents, and the alteration of drug metabolisms that decrease microsomal enzymes. No fetal toxicity has been demonstrated in pregnancy; however, many clinicians resist the use of metronidazole during pregnancy, particularly in the first trimester. Topical clotrimazole suppositories used twice daily for 7 days have been found to provide temporary relief in approximately 50% of parturients. Similarly, clotrimazole is used in patients with a definite history of allergic reactions to metronidazole. Douching with povidone-iodine produces symptomatic relief but not necessarily a cure for this type of vaginitis. Click here to return to the questions

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