Treatment of inflammatory lesions (papules and pustules) associated with rosacea (acne rosacea); topical gel designated an orphan drug by FDA for use in this condition.
Optimal treatment not determined; inflammatory lesions may respond to long-term treatment with topical anti-infectives (e.g., metronidazole) or oral anti-infectives (e.g., doxycycline, tetracycline, erythromycin, ampicillin, metronidazole). Topical metronidazole may be preferred to oral metronidazole; has been effective in patients with inadequate response or relapse with other therapies (e.g., oral tetracycline).
Effects appear palliative; manifestations recur commonly following discontinuance of therapy.
Adjunctive measures recommended to decrease exposure to factors that exacerbate rosacea (e.g., excessive sunlight, wind, hot liquids, spicy food, alcohol, extremes of heat and cold).
Bacterial Vaginosis
Treatment of bacterial vaginosis (formerly called Haemophilusvaginitis, Gardnerella vaginitis, nonspecific vaginitis, Corynebacterium vaginitis, anaerobic vaginosis) in nonpregnant women.
CDC recommends treatment of bacterial vaginosis in all symptomatic women (including pregnant women). In addition, asymptomatic pregnant women at high risk for complications of pregnancy should be screened (preferably at the first prenatal visit) and treatment initiated if needed.
Treatment recommendations for bacterial vaginosis in HIV-infected women are the same as those for women without HIV infection.
Regimens of choice in nonpregnant women are a 7-day regimen of oral metronidazole, a 5-day regimen of intravaginal metronidazole gel, or a 7-day regimen of intravaginal clindamycin cream; alternative regimens are a 7-day regimen of oral clindamycin or 3-day regimen of intravaginal clindamycin suppositories. The preferred regimens for pregnant women are a 7-day regimen of oral metronidazole or a 7-day regimen of oral clindamycin.
Regardless of regimen used, relapse or recurrence is common; an alternative regimen (e.g., oral therapy when topical was used initially) may be used in such situations.
Routine treatment of asymptomatic male sexual contacts of women who have relapsing or recurrent bacterial vaginosis not recommended.
Decubitus and Other Ulcers
Treatment of infected decubitus ulcers†; topical metronidazole designated an orphan drug by FDA for use in treatment of grade III or IV, anaerobically infected, decubitus ulcers.
Perioral Dermatitis
Treatment of perioral dermatitis†; topical gel designated an orphan drug by FDA for treatment of this condition.
Trichomoniasis
Has been used intravaginally as an adjunct to oral metronidazole for treatment of trichomoniasis caused by Trichomonas vaginalis† in selected cases (e.g., refractory infections), but not included in CDC recommendations for treatment of trichomoniasis. Intravaginal metronidazole not effective used alone.
Drug of choice for treatment of trichomoniasis is oral metronidazole or oral tinidazole.
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