Original Research

Efficacy of Probiotics with Metronidazole Versus Metronidazole Alone for the Treatment of Bacterial Vaginosis

Seher Anwar1
Fatima Jinnah Medical University/ Sir Ganga Ram Hospital, Lahore, Pakistan
Mahham Janjua1
Fatima Jinnah Medical University/ Sir Ganga Ram Hospital, Lahore, Pakistan
Quratulain Shahzad2
Akhtar Saeed Medical and Dental College, Lahore, Pakistan
Sumera Kanwal3
King Edward Medical University/ Lady Willingdon Hospital Lahore, Pakistan
Muniba Tahir2
Akhtar Saeed Medical and Dental College, Lahore, Pakistan
Noreen Akmal1
Fatima Jinnah Medical University/ Sir Ganga Ram Hospital, Lahore, Pakistan

✉ Correspondence: Quratulain Shahzad Email: anieeshahzed@gmail.com

DOI https://doi.org/10.70302/jpsim.v7i2.2626
Volume: 7, Issue 2 Pages: 131–135 Published: 03 Jun 2026
Received: 15 Nov 2025 Revised: 15 Apr 2026 Accepted: 04 May 2026 Published Online: 03 Jun 2026

Abstract

Objectives

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

Methods

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

How to Cite This Article

Anwar S, Janjua M, Shahzad Q, Kanwal S, Tahir M, Akmal N. Efficacy of Probiotics with Metronidazole Versus Metronidazole Alone for the Treatment of Bacterial Vaginosis. J Pak Soc Intern Med. 2026;7(2):131–135. doi:10.70302/jpsim.v7i2.2626

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Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

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CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2026 Journal of Pakistan Society of Internal Medicine.
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