Metronidazole

Armstrong E, et al. demonstrated that metronidazole treatment for bacterial vaginosis (BV) rapidly reduces genital inflammation; however, this immune benefit is not due to an absolute increase in protective Lactobacillus species. While treatment shifted the vaginal microbiota to Lactobacillus dominance proportionally, this change was driven by a substantial reduction in the absolute abundance of BV-associated bacteria. There was no significant increase in key lactobacilli like L. crispatus, and minor increases in other species were not independently linked to reduced inflammation. The study concludes that the post-treatment decrease in genital inflammation and associated HIV risk is primarily attributable to the elimination of dysbiotic, pro-inflammatory bacteria rather than a gain in lactobacilli.

Fig. 1 Impact of metronidazole treatment on the relative abundance of BV-associated bacteria and vaginal Lactobacillus species. (Armstrong E, et al., 2022)

Priya GL, et al. compared the efficacy of two empirical oral antibiotic regimens, ciprofloxacin plus metronidazole versus cefixime plus metronidazole, for treating uncomplicated liver abscess, combined with prompt percutaneous drainage when indicated. Among 140 participants, both regimens demonstrated high efficacy, with an overall clinical cure rate of 89.3% and no significant difference in mean therapy duration (approximately 2–3 weeks). The study concludes that both oral regimens are efficacious for uncomplicated liver abscess, but cefixime plus metronidazole may offer an advantage in reducing the need for extended treatment due to unresolved collections—a finding that warrants further investigation in larger trials.

Fig. 2 Study design, screening and enrollment. (Priya GL et al, 2024)