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Meta-Analysis
. 2025 Feb;311(2):333-340.
doi: 10.1007/s00404-024-07899-z. Epub 2025 Feb 19.

Tinidazole vs metronidazole for the treatment of bacterial vaginosis: a systematic review and meta-analysis

Milene Vitória Sampaio Sobral  1 , Victor Gonçalves Soares  2 , João Lucas de Magalhães Leal Moreira  3 , Livia Kneipp Rodrigues  4 , Hilária Saugo Faria  5 , Clara de Andrade Pontual Peres  6 , Lubna Al-Sharif  7 , Maria Julia Gonzaga Pascoalin  1 , Fernando Augusto Barreiros  8 , Marina Ayabe Gomes de Moraes  9
Affiliations
Meta-Analysis

Tinidazole vs metronidazole for the treatment of bacterial vaginosis: a systematic review and meta-analysis

Milene Vitória Sampaio Sobral et al. Arch Gynecol Obstet. 2025 Feb.

Abstract

Introduction: Tinidazole shows potential as a first-line treatment for bacterial vaginosis (BV). However, its superiority to metronidazole remains uncertain. Therefore, this meta-analysis compares tinidazole versus metronidazole in patients with BV.

Methods: We systematically searched PubMed, Embase and Cochrane for studies comparing tinidazole and metronidazole in patients with BV. Statistical analyses were performed using R Studio 4.3.2. Heterogeneity was examined with the Cochran Q test and I2 statistics. Risk ratios (RR) with 95% confidence intervals (CI) were pooled across trials. Outcomes of interest were BV cure at the first and the second follow-up appointment, and adverse events such as nausea and bad or metallic taste.

Results: Five randomized controlled trials and 1 prospective observational study, reporting data on 1,036 patients were included in this meta-analysis. Among them, 511 (49%) received tinidazole and 525 (51%) received metronidazole. Follow-up ranged from 1 to 6 weeks. There was no significant difference between groups for BV cure at the first follow-up appointment (RR 1.03; 95% CI 0.92 to 1.14; I2 = 76%), cure at the second follow-up appointment (RR 1.05; 95% CI 0.80-1.38; I2 = 88%), nausea (RR 0.89; 95% CI 0.39-2.04; I2 = 83%), and bad or metallic taste (RR 0.74; 95% CI 0.12-4.45; I2 = 89%).

Conclusion: In patients with BV, tinidazole and metronidazole exhibit similar efficacy and safety, with equivalent cure rates and incidence of adverse events.

Keywords: Bacterial vaginosis; Meta-analysis; Metronidazole; Tinidazole.

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Conflict of interest statement

Declarations. Conflict of interest statement: The authors Milene Vitória Sampaio Sobral, Victor Gonçalves Soares, João Lucas de Magalhães Leal Moreira, Livia Kneipp Rodrigues, Hilária Saugo Faria, Clara de Andrade Pontual Peres, Lubna Al-Sharif, Maria Julia Gonzaga Pascoalin,1 Fernando Augusto Barreiros and Marina Ayabe Gomes de Moraes have no relevant financial or non-financial interests to disclose. All authors report no relationships that could be construed as a conflict of interest. The authors have no competing interests to declare that are relevant to the content of this article. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study screening and selection
Fig. 2
Fig. 2
There was no statistically significant difference in terms of cure between groups at the first and second appointments. MH Mantel–Haenszel method, CI Confidence Interval
Fig. 3
Fig. 3
There was no statistically significant difference in terms of nausea between groups. MH Mantel–Haenszel method, CI Confidence Interval
Fig. 4
Fig. 4
There was no statistically significant difference in terms of bad or metallic taste between groups. MH Mantel–Haenszel method, CI Confidence Interval
Fig. 5
Fig. 5
There was no statistically significant difference in terms of diarrhea between groups. MH Mantel–Haenszel method, CI Confidence Interval
Fig. 6
Fig. 6
There was no statistically significant difference in terms of headache between groups. MH Mantel–Haenszel method, CI Confidence Interval
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