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Metronidazole + azithromycin is an investigational antibiotic combination regimen studied for the treatment of symptomatic bacterial vaginosis (BV). Metronidazole is a nitroimidazole antibiotic that targets anaerobic bacteria by disrupting DNA synthesis through the formation of reactive intermediates. Azithromycin is a macrolide antibiotic that inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit. This specific combination was evaluated in a Phase 4 clinical trial (NCT00353483) led by the University of Alabama at Birmingham to determine if the addition of azithromycin to standard metronidazole therapy, or extending the duration of metronidazole treatment, would improve clinical cure rates. The study found that while extending metronidazole treatment to 14 days improved outcomes, the addition of azithromycin provided no additional therapeutic benefit for BV.
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