Metronidazole Vaginal: MedlinePlus Drug Information

pronounced as (me troe ni’ da zole)

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Metronidazole is used to treat vaginal infections such as bacterial vaginosis (an infection caused from too much of certain bacteria in the vagina). Metronidazole is in a class of medications called nitroimidazole antimicrobials. It works by stopping the growth of bacteria.

Metronidazole comes as a gel to be used in the vagina. Metronidazole is usually used as a single dose at bedtime (Nuvessa) or once daily for 5 consecutive days at bedtime (MetroGel Vaginal, Vandazole). Metronidazole is also used twice daily for 5 days (MetroGel Vaginal). Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use metronidazole exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Be careful not to get metronidazole gel in your eyes, mouth, or on your skin. If you do get it in your eyes, wash them with cool water and contact your doctor.

Do not have vaginal intercourse or use other vaginal products (such as tampons or douches) during your treatment with the vaginal gel.

Metronidazole gel for the vagina comes with a special applicator. Read the instructions provided with it and follow these steps:

1. Fill the special applicator that comes with the gel to the level indicated.
2. Lie on your back with your knees drawn upward and spread apart.
3. Gently insert the applicator into your vagina and push the plunger to release all of the medication.
4. Withdraw the applicator and dispose of it properly. If you are instructed to reuse the applicator, wash it with soap and warm water.
5. Wash your hands promptly to avoid spreading the infection.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using metronidazole,

• tell your doctor and pharmacist if you are allergic to metronidazole, secnidazole (Solosec), tinidazole (Tindamax), any other medications, parabens, or any of the ingredients in metronidazole topical preparations. Ask your pharmacist for a list of the ingredients.
• tell your doctor if you are taking or have taken disulfiram (Antabuse). Your doctor may tell you not to use metronidazole if you are taking disulfiram or have taken it within the past 2 weeks.
• tell your doctor and pharmacist what prescription, nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants (‘blood thinners’) such as warfarin (Coumadin, Jantoven) and lithium (Lithobid).
• tell your doctor if you have or have ever had a central nervous system condition (diseases of the spinal cord or brain) or a blood disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using metronidazole, call your doctor.
• do not drink alcoholic beverages or take products with alcohol or propylene glycol while using this medication and for at least 3 days after your final dose. Alcohol and propylene glycol may cause nausea, vomiting, stomach cramps, headache, sweating, and flushing (redness of the face) when taken with metronidazole.

Metronidazole may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• stomach discomfort
• unusual taste
• headache
• nausea
• diarrhea
• vomiting

Some side effects can be serious.

If you experience any of the following symptoms, call your doctor immediately:

• vaginal irritation, discharge, or itching
• numbness, pain, burning, or tingling in your hands or feet
• seizures
• rash
• itching
• hives
• peeling or blistering skin

Metronidazole may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not freeze or refrigerate it.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

• MetroGel^® Vaginal
• Nuvessa^®
• Vandazole^®

Last Revised – 12/15/2017

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Infections of the Uterus After Delivery – Women’s Health Issues

By

Julie S. Moldenhauer

, MD, Children’s Hospital of Philadelphia

Reviewed/Revised Feb 2022 | Modified Sep 2022

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Infections that develop after delivery of a baby (postpartum infections Infections After Delivery Immediately after delivery, the woman’s temperature often increases. A temperature of 100.4° F (38° C) or higher during the first 12 hours after delivery could indicate an infection but may… read more ) usually begin in the uterus.

• Bacteria can infect the uterus and surrounding areas soon after delivery.

• Such infections commonly cause pain in the lower abdomen, fever, and a foul-smelling discharge.

• Diagnosis is usually based on symptoms and results of a physical examination.

• Antibiotics usually cure the infection.

After delivery, the uterus may become infected if the membranes containing the fetus (amniotic sac) are infected (called chorioamnionitis Intraamniotic Infection Intraamniotic infection is infection of the tissues around the fetus, such as the fluid that surrounds the fetus (amniotic fluid), the placenta, the membranes around the fetus, or a combination… read more ).

Uterine infections include

• Infection of the uterine lining (endometritis)

• Infection of uterine muscle (myometritis)

• Infection of the areas around the uterus (parametritis)

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Bacteria that normally live in the healthy vagina can cause an infection after delivery. Conditions that make a woman more likely to develop an infection include the following:

• A long delay (often more than 18 hours) between rupture of the membranes and delivery

• Prolonged labor Labor That Progresses Too Slowly Labor that progresses too slowly may involve slow movement of the fetus through the birth canal because the fetus is too large or is abnormally positioned, the birth canal is too small, or the… read more

• Repeated cervical examinations during labor

• Chorioamnionitis

• Internal monitoring of the fetus Fetal monitoring Labor is a series of rhythmic, progressive contractions of the uterus that gradually move the fetus through the lower part of the uterus (cervix) and birth canal (vagina) to the outside world… read more (which requires rupture of the membranes containing the fetus)

• Cesarean delivery Cesarean Delivery Cesarean delivery is surgical delivery of a baby by incision through a woman’s abdomen and uterus. In the United States, up to 30% of deliveries are cesarean. Doctors use a cesarean delivery… read more

• Placental fragments remaining in the uterus after delivery

• Manual removal of fragments remaining in the uterus after delivery

• Excessive bleeding after delivery Excessive Uterine Bleeding at Delivery Excessive bleeding from the uterus refers to loss of more than 2 pints of blood or symptoms of significant blood loss that occur within 24 hours of delivery. After the baby is delivered, excessive… read more (postpartum hemorrhage)

• Establishment of bacteria (colonization) in the lower part of the genital tract (vulva, vagina, or cervix)

• Bacterial vaginosis Bacterial Vaginosis (BV) Bacterial vaginosis is a common condition that occurs when the balance of bacteria in the vagina (vaginal microbiome) is altered. Bacterial vaginosis causes a thin, yellow-green or gray discharge… read more

• Anemia Anemia During Pregnancy Anemia occurs in up to one third of women during the 3rd trimester. The most common causes of anemia are Iron deficiency Folate deficiency (See also Anemia.) If women have a hereditary anemia… read more

• Diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are… read more

• Young age

• Low socioeconomic group

The chances of developing a uterine infection depend mainly on the type of delivery:

• Normal vaginal deliveries: 1 to 3%

• Cesarean deliveries that have been scheduled and are done before labor starts: 5 to 15%

• Cesarean deliveries that are not scheduled and are done after labor starts: 15 to 20%

Symptoms of uterine infections commonly include pain in the lower abdomen or pelvis, fever (usually within 1 to 3 days after delivery), paleness, chills, a general feeling of illness or discomfort, and often headache and loss of appetite. The heart rate is often rapid. The uterus is swollen, tender, and soft. Typically, there is a foul-smelling discharge from the vagina, which varies in amount. The discharge may or may not contain blood. But sometimes the only symptom is a low-grade fever.

When the tissues around the uterus are infected, they swell, causing significant discomfort. Women typically have severe pain and a high fever.

Some severe complications can occur but not often. They include the following:

• Inflammation of the membranes that line the abdomen (peritonitis Peritonitis Abdominal pain is common and often minor. Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem. The pain may be the only sign of the need for surgery… read more )

• Blood clots in the pelvic veins (pelvic thrombophlebitis Deep Vein Thrombosis (DVT) Deep vein thrombosis is the formation of blood clots (thrombi) in the deep veins, usually in the legs. Blood clots may form in veins if the vein is injured, a disorder causes the blood to clot… read more )

• A blood clot that travels to the lung and blocks an artery there (pulmonary embolism Pulmonary Embolism (PE) Pulmonary embolism is the blocking of an artery of the lung (pulmonary artery) by a collection of solid material brought through the bloodstream (embolus)—usually a blood clot (thrombus) or… read more )

• High blood levels of poisonous substances (toxins) produced by the infecting bacteria, which lead to sepsis Sepsis and Septic Shock Sepsis is a serious bodywide response to bacteremia or another infection plus malfunction or failure of an essential system in the body. Septic shock is life-threatening low blood pressure … read more (a bodywide infection) or septic shock

• A pocket of pus (abscess) in the pelvis

In sepsis and septic shock, blood pressure falls dramatically and the heart rate is very rapid. Severe kidney damage and even death may result.

An abscess in the pelvis may feel like a palpable lump or cause a fever and abdominal pain.

These complications are rare, especially when postpartum fever is diagnosed and treated promptly.

An infection of the uterus may be diagnosed based mainly on results of a physical examination. Sometimes an infection is diagnosed when women have had a fever for 24 hours after delivery and no other cause is identified.

Usually, doctors take a sample of urine analyze it (urinalysis) and send it to be cultured and checked for bacteria. Urine tests can help identify urinary tract infections.

Other tests are rarely needed but may include culturing a sample of tissue taken from the lining of the uterus and imaging tests, usually computed tomography, of the abdomen.

If the uterus is infected, women are usually given antibiotics by vein (intravenously) until they have had no fever for at least 48 hours. Afterward, most women do not need to take antibiotics by mouth.

Before a cesarean delivery, doctors may give women antibiotics shortly before surgery. Such treatment can help prevent infections of the uterus and the areas around it.

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METROMIZOL: quick relief from vaginal infections

A woman is the keeper of the hearth, mother… These words are so familiar to the ear that few people think about the value of women’s health, especially reproductive health. The female body is complex and unique. However, it is no secret to anyone that many of our compatriots pay little attention to their health. Every year, the number of inflammatory diseases of the female genital organs increases. Many factors leading to this are described: lifestyle, social causes, environmental problems, low level of culture, in particular sexual, and many others. Urogenital infections are one of the main causes leading to inflammatory diseases of the female reproductive system. They can be characterized by an erased or asymptomatic course, which significantly complicates their timely diagnosis and treatment. Therefore, a woman sometimes postpones a visit to the doctor until the last moment. And only when it becomes unbearable – he decides to go to the reception. There are many reasons for this, they are different for all women, but the result can be the same. Advanced stages of various diseases, long-term expensive treatment, serious complications… Thus, it is obvious that urogenital infections are not a harmless problem. And its solution largely depends on pharmacy pharmacists, who can help a woman with advice, as well as guide her in choosing drugs. This publication will focus on the drug METROMIZOL from the Indian company Elegant India, which is indicated for the local treatment of bacterial vaginitis, vulvovaginal candidiasis and mixed infections of the vulva and vagina.

The microflora of the vagina is relatively constant, it is regulated by the immune and endocrine systems. Normally, there are quite reliable mechanisms of protection against pathogenic pathogens in the vagina. There are also a number of factors that can disrupt protective mechanisms, thereby increasing the risk of developing inflammatory diseases of the vulva and vagina. In particular, hormonal changes during the menstrual cycle, during pregnancy, and various age periods are of great importance. A change in biocenosis may occur as a result of therapy with antibiotics, corticosteroids, cytostatics and other drugs, with vaginal douching (especially alkaline solutions), the use of intrauterine contraceptives, tampons, diaphragms, as well as with the frequent use of spermicides, promiscuity, etc. (Tikhomirov A.L. ., Lubnin D.M., 2003). These factors lead to an imbalance in the vaginal microflora, which leads to the growth of opportunistic, especially anaerobic, flora (L.A. Marchenko, L.M. Ilyina, 2004).

Vaginal infections occur as a result of vaginal dysbiosis. Usually, under this term, experts combine vaginitis and bacterial vaginosis, since they have similar manifestations in the form of pathological vaginal discharge associated with a microbial factor.

Vaginal infections due to a single pathogen are relatively rare. Only 10.5% of patients with an etiological factor in the development of an infectious process of the vulva and vagina can have one pathogen, while at the same time, various combinations of them – in 89.5% (Gorpinchenko I.I., Gurzhenko Yu.N., 2004). Therefore, vaginal infections are, for the most part, a mixed protozoal-fungal-bacterial process.

The goal of the treatment of vulvovaginal infections is primarily to eradicate their pathogens, and in the vast majority of cases it should begin empirically, immediately after a preliminary diagnosis has been established (Tikhomirov A. L. et al., 2003). Treatment must be comprehensive. Considering that it is mixed infections that are most often detected in patients, the combination of several active ingredients in one preparation, which allows achieving a therapeutic effect, is of great importance (Kostava M.N., 2000). In the treatment of vulvovaginitis of mixed etiology, combined preparations are successfully used, including an antifungal agent, an antiseptic and / or an antibacterial drug, which are characterized by high clinical efficacy (Sergeev Yu.V., Sergeev A. Yu., 2001).

When choosing a method of treatment for patients with vaginal infections, the route of administration of the drug is essential. Topical application of the drug, of course, has advantages. It is more preferable because topical preparations act directly in the focus, while the likelihood of adverse reactions is lower. Topical drugs can be prescribed for pregnant and breastfeeding women, as well as for extragenital pathology, when systemic drugs are contraindicated.

Recently introduced to the Ukrainian pharmaceutical market, the drug METROMIZOL by the Indian company “Elegant India” fully complies with the requirements. Thanks to the combination of two antimicrobial components ( metronidazole and miconazole ), the drug exhibits protozoacid, bactericidal and fungicidal effects. METROMIZOL is available in the form of vaginal tablets containing 100 mg of metronidazole and 100 mg of miconazole nitrate as active ingredients.

Metronidazole is a broad-spectrum antimicrobial agent with high activity against protozoa (in particular Trichomonas) and anaerobic bacteria. It easily penetrates into microbial cells, disrupts the synthesis of nucleic acids of microorganisms, which leads to the death of the latter. Metronidazole is not active against aerobic bacteria and fungi. However, this drawback is compensated for by the presence of nitrate in the miconazole preparation, which inhibits the growth of dermatomycetes, yeast and other pathogenic fungi, while exerting a bactericidal effect on some gram-positive bacteria. The mechanism of action of miconazole is to inhibit the synthesis of ergosterol, an essential component of the shell and plasma membranes of fungi and some bacteria (Shymanovsky N., 2003). The properties of miconazole have been actively studied since its appearance on the market. The results of comparative studies indicate that miconazole is more effective in candidiasis than clotrimazole (Saha K.C., 1989).

A well-chosen combination of components in the composition of METROMIZOL ensures its complex effect on various pathogens of vaginal infections. Therefore, the drug can be used for a number of common gynecological diseases: bacterial vaginosis and vaginitis, vulvovaginal candidiasis, as well as vaginitis caused by a mixed infection (Trichomonas, anaerobic pathogens, gardnerella, yeast-like fungi).

METROMIZOL does not have a systemic effect on the body – because of the low absorption, the concentration of its components in the systemic circulation is minimal. That is why women can use this drug even during periods of pregnancy and lactation. In addition, the use of METROMIZOL has advantages over other drugs. So, having hyperosmolar activity, it promotes the absorption of exudate. The drug is used once a day – one tablet of METROMIZOL is injected deep into the vagina with the help of an applicator at night. The duration of treatment is 10-12 days.

Returning to the role of a pharmacist, it should be noted that, dispensing with METROMIZOL, he must draw the patient’s attention to the need to continue therapy despite the improvement in the condition. A few hours after the start of therapy, the symptoms subside, but improvement does not mean a cure. The patient should also be informed that she should consult a doctor in cases where, 3 days after the start of therapy, there is no improvement in the condition or, on the contrary, it worsens, the symptoms do not disappear completely after the full course of therapy or resume 2 months after the end of treatment.

Thus, the new combination drug METROMIZOL is an effective, easy-to-use and affordable drug for the treatment of various vaginal infections, which is well tolerated and has a favorable safety profile. o

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of the APTEKA Weekly

Antibiotic treatment in gynecology

Antibiotic treatment in gynecology

microorganisms – causative agents of infection, which are in the growth stage. The antibacterial effect of antibiotics is due to their ability to inhibit vital processes occurring in target microorganisms: protein synthesis, DNA synthesis, cell wall synthesis.

Indications for use

Antibiotics in gynecology are used to treat various inflammatory processes, colpitis, erosion, thrombophlebitis, septic complications. They are also used to prevent postoperative complications. Antibacterial therapy, as part of complex treatment, begins at the stage of exacerbation of the inflammatory process. Antibiotics do not affect viruses, they are not used in the treatment of viral diseases.

Antibiotics are usually given intramuscularly or by mouth. They also use tampons, penicillin-ecmolin tablets (for the treatment of vulvovaginitis, endocervicitis), ointments and baths (for inflammatory processes on the external genitalia).

Antibiotics used in gynecology

Antibiotics of various groups can be used to treat gynecological diseases: penicillins, thienamycins, macrolides, monobactam cephalosporins, chloramphenicol, polymyxins, rifamycins, aminoglycosides and others. These drugs are effective in infections caused by gram-positive bacteria (staphylococci, pneumococci, streptococci, etc.), spirochetes and other pathogens.

The spectrum of antibiotics used in gynecology includes:

• ampiox-sodium,
• benzylpenicillin sodium salt,
• sultamicillin (unazine),
• phenoxymethylpenicillin,
• oxacillin sodium salt,
• cloxacillin (clobex),
• methicillin sodium salt,
• ampicillin,
• piteracillin (psipen, pipraks),
• amoxicillin,
• ticarcillin-clavulanic acid (timentin),
• carbenicillin (geopen),
• Azlocillin (Securopen),
• carfecillin,
• penamecillin (maripen).
• Clonacom-Rbacampicillin (Penbac),
• mezlocillin (baiben),
• flucloxacillin.

Antibiotics of the penicillin group are most commonly used to treat inflammatory processes in the female genital tract. The dosage of penicillins depends on the stage of development of the disease and the type of pathogen. Penicillin therapy is also used to treat many sexual diseases. In diseases accompanied by suppuration in the pelvis, streptomycin is injected into the inflammatory focus along with penicillin.

Rehabilitation course

After the patient has finished taking antibiotics, a rehabilitation course must be completed. This is due to the fact that these drugs adversely affect not only pathogens, but also beneficial bioflora, which directly affects the level of immunity. The recovery course consists in taking probiotics that restore the intestinal flora, vitamin therapy, and normalizing the diet.

Attention! Gynecological diseases cannot be diagnosed and treated on their own, as many of them are able to take a latent form, and then go into a chronic stage.