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Key takeaways
Metronidazole is an antibiotic used for various bacterial and parasitic infections but may not be suitable for everyone due to potential side effects, resistance, or pregnancy.
Alternatives to metronidazole include tinidazole, Solosec, Cleocin, Vancocin, and Alinia, which vary in uses, side effect profiles, and dosages.
Natural remedies like probiotics and prebiotics can support gut health during antibiotic treatment but should not replace prescribed antibiotics without professional guidance.
Switching from metronidazole to an alternative should be done under medical advice to ensure safety and effectiveness, and completing the prescribed course is crucial to avoid resistance.
Metronidazole (brand name Flagyl) is an antibiotic that is used to treat a variety of bacterial and parasitic infections. Metronidazole belongs to a group of antibiotics called nitroimidazoles that works to disrupt the DNA of bacterial and parasitic cells. This medication is primarily used to treat infectious diseases caused by anaerobic bacteria (bacteria that survive without oxygen) and single-cell parasites such as amoebas and trichomonas. Depending on the type and severity of infection, metronidazole is taken by mouth as a tablet or capsule, administered as an injection, or applied topically as a cream, gel, or lotion. Metronidazole is used for a wide range of conditions. Common infections that it can treat include bacterial vaginosis, pelvic inflammatory disease (PID), trichomoniasis, Clostridioides difficile (C. diff), amebiasis (amebic dysentery and liver abscess), giardiasis, Crohn’s disease, and Helicobacter pylori (H. pylori).
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While an effective treatment option for some people, metronidazole may not be the best and safest option for all people treating bacterial or parasitic infections. Metronidazole should not be used in pregnant women during the first trimester of pregnancy. Alcohol should be avoided while using metronidazole as this can lead to a serious drug interaction. Some people may need to switch to a different antibiotic after laboratory results identify a growth of a bacteria or parasite that metronidazole may not effectively treat. Additionally, an alternative may need to be used due to antimicrobial resistance. According to the Centers for Disease Control and Prevention (CDC), antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow. Resistant infections can be difficult, and sometimes impossible, to treat. As the incidence of this resistance increases, alternative therapies may need to be utilized.
RELATED: Metronidazole side effects and how to avoid them
What can I take in place of metronidazole?
There are other options available to treat bacterial or parasitic infections that do not improve with metronidazole. These alternative oral prescription medications include other nitroimidazoles and other antibiotics. It’s important that the alternative antibiotic has antimicrobial activity against the specific infection being treated as the alternative options vary in their range of activity. These options may be more suitable for certain individuals due to their different uses, side effect profiles, and dosages.
Compare metronidazole alternatives |
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|---|---|---|---|
| Drug name | Uses | Dosage | Savings options |
| Flagyl (metronidazole) |
|
Take 500 to 750 mg by mouth every 6 to 12 hours for 5 to 14 days depending on the type of infection | Flagyl coupons |
| Alinia (nitazoxanide) |
|
Take 500 mg by mouth every 12 hours for 3 days | Alinia coupons |
| Augmentin (amoxicillin–
clavulanate) |
|
Take 500 mg/125 mg to 875 mg/125 mg by mouth every 12 hours for 3 to 10 days depending on type of infection | Augmentin coupons |
| Cleocin (clindamycin) |
|
Take 150 to 450 mg by mouth every 6 to 12 hours depending on type of infection | Cleocin coupons |
| Dificid (fidaxomicin) |
|
Take 200 mg by mouth twice daily for 10 days | Dificid coupons |
| Humatin (paromomycin) |
|
Take 25 to 35 mg per kg by mouth daily divided in three doses for 5 to 10 days depending on type of infection | Humatin coupons |
| Solosec (secnidazole) |
|
Take 2 grams by mouth once daily for one dose | Solosec coupons |
| Tinidazole |
|
Take 2 grams by mouth once daily for 1 to 5 days depending on type of infection | Tinidazole coupons |
| Vancocin (vancomycin) |
|
Take 125 to 500 mg by mouth four times daily for 10 to 14 days depending on type of infection | Vancocin coupons |
| Xifaxan |
|
Take 200 to 550 mg by mouth two to three times daily for 3 to 20 days depending on condition | Xifaxan coupons |
Top 5 metronidazole alternatives
The following are some of the most common alternatives to metronidazole.
1. Tinidazole
Tinidazole is a generic medication that belongs to the same group of antibiotics, nitroimidazoles, as metronidazole. Tinidazole can be used for a variety of infections including amebiasis, bacterial vaginosis, giardiasis, and trichomoniasis. This medication is available as an oral tablet that should be taken with food as this helps to prevent an upset stomach. Tinidazole has a convenient dosing schedule as it is often given as one single dose, but may be given once daily up to five days depending on the condition being treated. This may be a suitable alternative for people who are unable to tolerate metronidazole as it has fewer reported side effects. The most common side effects include metallic/bitter taste, nausea, and weakness or fatigue.
2. Solosec
Solosec (secnidazole) is currently only available as a brand name medication and belongs to the same group of antibiotics, nitroimidazoles, as metronidazole. Solosec is used to treat sexually transmitted infections (STIs), formerly called sexually transmitted diseases (STDs), such as bacterial vaginosis and trichomonas vaginalis. This medication is available as a packet of oral granules that can be sprinkled onto applesauce, yogurt, or pudding. Solosec has a convenient dosing schedule as only one dose is needed. The most common side effects include vaginal yeast infection, headache, nausea, diarrhea, and abdominal pain.
3. Cleocin (clindamycin)
Cleocin is the brand name of the generic medication clindamycin and belongs to a group of antibiotics called lincosamides. Like metronidazole, clindamycin is effective at treating anaerobic bacteria infections. Clindamycin is used to treat a wide variety of infections including skin and soft tissue infections, lower respiratory tract infections, bone and joint infections, and bacterial vaginosis. This medication is available as an oral capsule and an oral solution. Clindamycin has a potential risk of causing a of Clostridioides difficile (C. diff)-associated diarrhea.
RELATED: 8 antibiotics that cause C.Diff
4. Vancocin (vancomycin)
Vancocin is the brand name of the generic medication vancomycin and belongs to a group of antibiotics called glycopeptides. When used as the oral formulation, vancomycin is typically used to treat Clostridioides difficile (C.diff) infections (previously referred to as Clostridium difficile) and enterocolitis. Vancomycin oral formulations include a capsule and solution. Common side effects include stomach pain, nausea, diarrhea, flatulence, and vomiting.
5. Alinia (nitazoxanide)
Alinia is the brand name of the generic medication nitazoxanide and is an antiprotozoal. This type of medication fights infections caused by protozoa that feed on organic tissues and other microorganisms. Alinia can be used to treat giardiasis and Clostridioides difficile (C.diff). These infections can cause diarrhea and inflammation of the colon (colitis). This medication is available as an oral tablet and oral solution, and should be taken with food. Common side effects include nausea, abdominal pain, urine discoloration, and headache.
Natural alternatives to metronidazole
It is not recommended to replace metronidazole and other antibiotics with natural therapies. It’s important for people taking prescription therapies to know that certain supplements or herbal treatments may lead to an increased risk of drug interactions or adverse effects if used without the guidance of a healthcare provider.
Natural remedies to take alongside prescription antibiotics include probiotics and prebiotics. Probiotics replenish the natural gastrointestinal (GI) flora with nonpathogenic organisms. When taking antibiotics, there is a disruption of the GI flora that normally acts as a barrier to infection and aids in the digestion of carbohydrates, which can cause antibiotic-associated diarrhea (AAD). Clinical trials have shown taking probiotics for the entire course of antibiotic treatment can help prevent diarrhea.
Prebiotics are a type of dietary fiber the bacteria in the gut feed on to promote gut health. Foods that are rich in prebiotics include asparagus, sugar beet, garlic, onion, wheat, honey, banana, barley, tomato, rye, soybean, peas, and beans.
RELATED: Why you should take probiotics with antibiotics
How to switch to a metronidazole alternative
1. Discuss all health conditions with a healthcare provider
Before switching from metronidazole to an alternative, it’s important the prescribing doctor has reviewed all health conditions. Alternatives may have serious side effects or precautions that need to be avoided. It’s best to seek medical advice prior to changing medication therapy. If the reason for seeking an alternative to metronidazole is cost, SingleCare can help. Using a SingleCare discount card can create a prescription savings of up to 80%.
2. Do not suddenly stop taking metronidazole
Before stopping metronidazole, make a care plan with the healthcare team to avoid further progression of the infection. Once a plan has been made, metronidazole can be safely discontinued and replaced with the new antimicrobial treatment if appropriate.
3. Complete the course of antibiotic treatment
It’s important to follow the directions on the prescription for antibiotics as the number of days of therapy has been chosen based on the type of infection determined through treatment guidelines. Even if a person is feeling better after a few days, that doesn’t mean all of the infection is actually gone. If treatment stops too soon, and the infection comes back, the remaining bacteria may become resistant to the antibiotic that was previously taken.
RELATED: What happens if you don’t finish antibiotics?
Misuse and overuse of antibiotics have contributed to a phenomenon known as antibiotic resistance. This resistance develops when potentially harmful bacteria change in a way that reduces or eliminates the effectiveness of antibiotics. As the prevalence of infectious diseases like sexually transmitted infections (STIs) increases, drug resistance is a major threat to treatment options.