Pale Yellow bullet shaped Pessary.
Clotrimazole is a synthetic imidazole derivative with a broad spectrum of antimycotic activity.
Metronidazole is a 5-nitroimidazole derivative with activity against anaerobic protozoa and anaerobic bacteria. Metronidazole has excellent activity against anaerobes but poor activity against lactobacilli. Its cure rate is excellent and it also covers trichomonas vaginitis and bacterial vaginosis.
Lactobacillus Sporogenes is used to maintain normal bacterial flora in vaginal fluid.
Clotrimazole is a broad spectrum antifungal agent available for topical or intravaginal use. It is active against yeast and dermatophytes and also some action against Gram +ve bacteria, especially Staphylococci and against Trichomonas. Clotrimazole acts by altering the permeability of fungal cell walls by interfering with cell wall lipids.
Metronidazole is active against several protozoa including Trichomonas vaginalis. It is bactericidal. Metronidazole is used in the treatment of susceptible protozoal infections and in the treatment and prophylaxis of anaerobic infections. Specific bacterial infections treated with Metronidazole include bacterial vaginosis (nonspecific vaginitis).
The vagina is a dynamic ecosystem that normally contains approximately 1 of bacterial colony forming units per gram of vaginal fluid. The normal bacterial flora is dominated by Lactobacilli. Lactic acids and other organic acids are metabolized from glycogen by the lactobacilli, maintaining the vaginal pH between 3.8 and 4.2.
The acidic environment inhibits the overgrowth of bacteria and other organisms with pathogenic potential. Because of vaginal infections like bacterial vaginosis, trichomoniasis and vulvovaginal candidiasis, the Lactobacilli flora goes down and vaginal pH increases to more than 4.5. Because of anaerobic bacteria, musty or fishy odour starts. Lactobacillus is in spore form. It is used to recolonize the vaginal flora and to maintain the vaginal pH between 3.8 to 4.2.
When applied topically Clotrimazole penetrates the epidermis but there is little if any systemic absorption has been reported following vaginal administration. Absorption of Metronidazole from vaginal Pessaries has been reported to be poor. Lactobacillus Sporogenes recolonize the vaginal flora.