JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v7i2.2626 jpsim.v7i2.2626 Original Research Efficacy of Probiotics with Metronidazole Versus Metronidazole Alone for the Treatment of Bacterial Vaginosis Anwar Seher Janjua Mahham Shahzad Quratulain anieeshahzed@gmail.com * Kanwal Sumera Tahir Muniba Akmal Noreen Fatima Jinnah Medical University/ Sir Ganga Ram Hospital, Lahore, Pakistan Akhtar Saeed Medical and Dental College, Lahore, Pakistan King Edward Medical University/ Lady Willingdon Hospital Lahore, Pakistan *Correspondence: Quratulain Shahzad (anieeshahzed@gmail.com) 03 06 2026 2026 7 2 131 135 15 11 2025 15 04 2026 04 05 2026 Copyright © 2026 The Author(s) 2026 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives

To assess the efficacy of probiotics with metronidazole versus metronidazole alone for the treatment of BV

 Methodology

A quasi-experimental study was carried out at Sir Ganga Ram Hospital in Lahore, from 1st October 2023 to 30th September 2024. The women diagnosed with BV (50 in each group) received either tablet metronidazole 400mg twice daily for 7 days, or the same metronidazole regimen combined with an oral probiotic twice daily for 21 days. All women were evaluated for cure, defined as complete resolution of symptoms (Amsel’s criteria ≤ 1), on day 8 and 22 of treatment. Chi-square test was employed to compare the cure rates between the two treatment groups.

 Results

Mean age (30.34 ± 8.51 vs. 30.10 ± 7.53 years), BMI (26.01 ± 3.74 vs. 25.80 ± 3.33 kg/m²), and proportions of primiparous (44.0% vs. 48.0%) and multiparous women (56.0% vs. 52.0%) were comparable between groups (all p-values >0.05). The cure rate in metronidazole with probiotics group was significantly higher than in metronidazole alone group at day 8 (46.0% vs. 26.0%, p-value 0.037); and day 22 of treatment (74.0% vs. 50.0%, p-value 0.013). Nausea (8.0% vs. 6.0%), vomiting (4.0% vs. 2.0%), and metallic taste (6.0% vs. 4.0%), were slightly more frequent in metronidazole alone group. Abdominal discomfort (0.0% vs. 4.0%) and allergic reactions (0.0% vs. 4.0%) occurred only in metronidazole with probiotics group. However, no statistically significant differences were found (all p-values >0.05).

 Conclusion

Metronidazole combined with oral probiotics was more effective than metronidazole alone, with comparable safety in both groups. These findings support considering combination therapy as a preferred option for managing BV in sexually active women of reproductive age.

 Keywords Bacterial Vaginosis Gynecology Metronidazole Probiotics Ethics Statement

Ethics committee: Ethics Committee, Fatima Jinnah Medical University, Lahore, Pakistan. Approval number: MS/2020-FJMU-0916, dated September 05, 2023.

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