Obstetrics & Gynecology
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
- High-dose metronidazole (750 mg to 1 g) taken orally 3 times daily for 7 days.
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