Q2.10

Question of the Week

The use of the metronidazole gel is not recommended for the treatment of vaginal trichomoniasis because of poor efficacy.  Why is the topical form of the medication less efficacious?

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7 Responses

  1. topically applied antimicrobials won’t achieve therapeutic levels in the vaginal region (includes urethra, and perivaginal glands). This leads to resistant strains to the antibiotic. One also must consider poor and inappropriate use of the gel intravaginally. The oral form is self explanatory, whereas the absorption of the gel really depends on its relative use.

  2. Oral therapy with 2g of metronidazole is preferred because systemic drug therapy reaches the urethra and periurethral glands which are resevoris of organisms. Single dose oral treatment cure rat is roughly 85%. Topical vaginal metronidazole does not reach the peirurethral gland and urethra. Topical treatment cure rate is 50%.

  3. The gel is not absorbed as well as the highly bioavailable and well absorbed oral pill. The Pill also gets metabolized in the liver into an active metabolite. Not so much for the gel which does not get to the liver.

    The gel is fine to use, it just isnt as great as the pill.

  4. because PO therapy is able to achieve therapeutic drug levels in the urethra and periurethral glands, which can serve as resovoirs for trichomonas.

  5. The pH is usually higher vaginally with BV, making the topical form less absorbed and less effective.

  6. therapeutic levels not achieved in urethra and perivaginal glands

  7. Trich can colonize the urethra and associated glands, where topical gels are less effective.

    http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5106a1.htm

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