A comparison of single-dose and multi-dose metronidazole prophylaxis for hysterectomy.

A multi-centre double-blind, placebo-controlled clinical trial was performed to determine the minimum number of doses of metronidazole required for effective prophylaxis of vaginal cuff abscess following hysterectomy. Four hundred and seventy-five patients received zero, one, two, three, six or twenty-one 500 mg doses of metronidazole. Data from 440 patients were analysed and showed that one dose of metronidazole markedly reduced the risk of vaginal cuff abscess in patients undergoing vaginal hysterectomy. The effect on vaginal cuff cellulitis was not evident. It is concluded that one preoperative dose of 500 mg metronidazole is an effective, convenient and cheap prophylaxis for patients undergoing vaginal hysterectomy.