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T. vaginalis is usually highly sensitive (minimal inhibitory concentration <1 μg/mL) to the 5-nitroimidazole compounds,[47] but not to most other antimicrobial agents. A study carried out in Basra, Iraq, for example, failed to demonstrate any therapeutic effect from doxycycline or praziquantel.[48] Recently, however, relative resistance to metronidazole in some strains has been demonstrated.[22,33,49,50]

In women, metronidazole is thus most widely used[19,22,30,31,51–53] with a recommended dose regimen of 2.0 g as a single dose; this cures 85% of cases, and, when the sexual partner is treated simultaneously, the success rate rises to 95%. Another regimen utilizes a single-day divided dose of 1.6 g. A regimen using 250 mg three times a day for 7 days probably gives a comparable result. In men, a 7-day course is of proven efficacy, while the single-dose regimen has not been adequately assessed. Metronidazole possesses significant side-effects ( Chapter 79), including the development of a