Metronidazole for thrush?

Why is there a question mark in the header? Because Metronidazole does not belong to antifungal agents (antimycotics), but to antibiotics and antiprotozoal drugs. And if someone recommended you to use Metronidazole for thrush or its synonyms - Metrovagin, Metroseptol, Flagil or Trichopolis for women with thrush, then this “someone” was wrong.

Does metronidazole help with thrush?

The nitroimidazole antibiotic Metronidazole has a detrimental effect on peptostreptokokki, clostridia, fuzobakterii, porphyromonads, a large group of bacteroids and, as it turned out, even on helicobacter. But, first of all, diseases caused by such protozoa or microbes as are introduced into the indications for use of this drug:

• Trichomonas vaginalis - the cause of  trichomoniasis, and in men -  trichomonas urethritis ; Gardnerella vaginalis, due to which bacterial vaginosis  (or gardnerellosis) develops ;
• the culprit Giardia Giardia intestinalis;
• Entamoeba histolytica is the causative agent of amebiasis.

According to the recommendations of the Infectious Diseases Society of America (IDSA), Metronidazole and another antibiotic, Clindamycin (belonging to the lincosamide group), are the drugs of choice for treating bacterial vulvovaginosis in women. Their method of administration and doses depend on whether a woman is pregnant or not, but in any of the options, treatment takes no more than five to seven days.

Metronidazole is also used for skin infections, rosacea, oral infections, inflammatory diseases of the pelvic organs, colitis associated with Clostridium difficile, and gastric ulcer with a positive test for Helicobacter pylori.

But the yeast-like  fungi Candida (Candida), which are the cause of thrush, that is,  candidal vaginitis, are not listed in the list of indications of Metronidazole, and all this can be found by reading the instructions for its use.

So, Metronidazole for thrush in women and men - any form of release of this drug (injection, tablets, gel, candles) - will not help. And his appointment can be justified only in cases when during laboratory research a smear from the vagina, and in men - from the urethra, was discovered not only a fungal infection, but also a bacterial infection.

Then it is advisable to use the combined drugs, for example, Klion D vaginal tablets, which are composed in equal proportions of metronidazole and the antifungal agent miconazole.

[1], [2], [3], [4]

Why Metronidazole does not help with thrush?

To make all of the above more convincing, it is necessary to explain in general terms how Metronidazole works, that is, what its pharmacodynamics is.

Essentially selective for anaerobic bacteria and protozoa, Metronidazole is a prodrug in the form of a non-ionized substance that becomes active upon contact with these microorganisms.

And only anaerobic microorganisms that have a special enzyme, ferredoxin oxidoreductase (POR), activate Metronidazole, which restores the nitro group of the drug (NO ₂ ) to form a reactive metabolite that interacts with microbes and protozoa DNA.

As a result of this interaction, the biosynthesis of amino acids in the cells of microorganisms is slowed down, and without proteins their reproduction becomes impossible.

However, Metronidazole does not affect the majority of aerobic bacteria, as well as fungal infections (including Candida albicans), because they lack the POR enzyme and cannot activate the active ingredient of this drug.

What helps with thrush?

All standard treatment regimens for uncomplicated vulvovaginal candidiasis work equally well, even if taken once (150 mg), and after three days Fluconazole is re-taken  from thrush  (other commercial names are Flucostat Diflucan, Difluzol, Mikomax, Fucis). Fluconazole capsules, a systemic antifungal agent for the azole group, are effective both in candidal vaginitis in women and in thrush in men. See also -  Antifungal drugs for thrush in men.

You can be treated for a week, using another azole antimycotic -  Clotrimazole from thrush, in the form of suppositories of the same name or using their analogues - Candibene vaginal tablets or Guine-Lotrimin.

The results of clinical studies and the positive feedback from practitioners have become the basis for the approval of Fluconazole and Clotrimazole by the US FDA and the European Medicines Agency (EMEA). More information in the material -  Effective treatment of candidiasis with the help of tablets

For local treatment it is common to use a variety of  candles from thrush, in particular:

• candles with polyene antifungal antibiotics - Levorin and  Nystatin from thrush ;
• globules with nystatin and nifuratel Makmiror;
• candles with polyene antibiotic natamycin  Pimafucin for thrush ;
• Livarol suppositories (with ketoconazole);
• candles with miconazole Ginezol;
• Ekalin and Gyno-Pevaril with econazole.

Most often, their use during pregnancy is allowed only from the second trimester and, according to the strict indications of the obstetrician-gynecologist. Read more -

Treatment of thrush during pregnancy

And the use for children is considered in the publication -  Candida infection (candidiasis, thrush) in children

Can metronidazole cause thrush?

As is known, all antibiotics contribute to the development of fungal infections, including bronchopulmonary and gastrointestinal Candida as a nosocomial infection, by the way, the most common acquired in the hospital.

As studies show, also after systemic antibacterial therapy, including with the use of metronidazole, increased colonization of the oropharyngeal tract and vagina is common with the development of vulvovaginal candidiasis, that is, thrush.

Why can antibacterial drugs, including metronidazole, cause thrush? The prevalence of candidiasis among people taking antibiotics, experts explain that antibiotics kill bacteria that usually live in the body, and against the background of the lack of "competition" Candida begins to multiply freely.

Some forms of candidiasis, for example, invasive candidiasis of the heart valves, spleen, kidneys, as well as candidemia (fungus entering the systemic circulation with the development of neutropenia) are very dangerous.

[5], [6], [7]