Metronidazole use in obstetrics and gynecology: A review

Since metronidazole's introduction in 1960 as an effective antitrichomonal agent, its use has extended to the treatment of amebiasis, giardiasis, nonspecific vaginitis, and anaerobic infections, including upper genital tract infections. It is also being explored as a prophylactic agent in numerous surgical procedures. Recent introduction of an intravenous form has further facilitated its expanded use. This review examines the mode of action and pharmacokinetics of metronidazole and discusses evidence concerning the question of mutagenicity and carcinogenicity. Current uses of metronidazole are discussed, with the potential problem of bacterial inactivation/resistance explored. Finally, recommendations are made for the use of metronidazole in obstetrics and gynecology, with an emphasis on caution with respect to potential problems, which remain unanswered.