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Metronidazole & Bacterial vaginosis

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The standard first-line therapy with metronidazole (MTZ) is successful in some cases of bacterial vaginosis (BV), but over 50% of patients experience a recurrence within a year.
Bradshaw et al. 2006 J Infect Dis 193: 1478-1486
Cohen et al. 2020 NEJM 382: 1906-1915
Schwebke et al. 2021 Clin Infect Dis 73: e672-e679

Possibly, the reason for frequent recurrence could be the shift of the FGT microbiome towards Lactobacillus iners dominance instead of a Lactobacillus crispatus dominance due to Metronidazole
Srinivasan et al. 2010 PLoS ONE 5: e10197
Mitche…