Alternatives to Metronidazole

Abstract

To the Editor.— The recent warning in The Medical Letter1 regarding the mutagenicity and possible carcinogenicity of metronidazole (Flagyl) raises the question of whether there is an alternative treatment of equal efficacy that is not equally suspect.The pharmacologic treatment options seem to include orally administered nitroimidazole drugs other than metronidazole, or topical agents available in vaginal-tablet or suppository form, such as furazolidone and nifuroxime (components of Tricofuron). None of the other nitroimidazoles are currently available in the United States, although tinidazole (Fasigyn) will apparently soon be released. Tinidazole2 and nimorazole are reported to have a better than 90% cure rate. However, the mutagenicity of nimorazole was demonstrated in the same study that implicated metronidazole,3 and subsequent research by the same group has apparently also demonstrated the mutagenic potential of tinidazole (C. E. Voogd, unpublished data).The efficacy of topically applied furazolidone, alone or in combination with