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

Authors

Abstract

Objective: 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

Published

2026/06/03

Issue

Vol. Volume 7-issue 2

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