Nifuratel (CAS 4936-47-4) displays a strong antiprotozoarian and antibacterial activity and is provided with certain fungicidal effect, but it is not active against the physiologic flora. Its therapeutic effectiveness has been evaluated in more than 12,000 patients. The wide clinical experience with
nifuratel confirms that the
drug is safe and effective for the treatment of
trichomoniasis,
bacterial vaginosis, candidosis, and, particularly, in patients suffering from mixed vaginal
infection. A meta-analysis of clinical trials comparing
nifuratel and
metronidazole (CAS 443-48-1) in vulvovaginal
infections was performed. All parallel-group
metronidazole-controlled trials carried out in patients with vulvovaginal
infections have been included, complying with the following criteria: 1) cure assessed both as disappearance of symptoms and signs, and negative microbiological findings; 2) microbiological tests performed with valid methods still used in current practice. Seven clinical trials have been selected, including overall 1767 patients, 832 out of whom were treated with
nifuratel and 935 with
metronidazole. The results of the meta-analysis confirmed the equivalence between
nifuratel and
metronidazole: overall proportion of cured patients in the two groups were 88.5% and 90.0%, respectively, in the presence of homogeneity among studies (p = 0.342). In the fixed and random effect analyses, the confidence interval of Odds ratio included 1 and the p values for testing the hypothesis of no difference between treatments were 0.656-1.266, p = 0.582 (fixed effects) and 0.643-1.290, p = 0.599 (random effects), respectively, indicating equivalence. Furthermore, some controlled studies and the wide clinical experience showed that the cure rate of
nifuratel in patients with
mixed infections due to Trichomonas vaginalis + Candida or Trichomonas vaginalis + bacteria or with
bacterial vaginosis and mixed bacterial flora is higher than that of
metronidazole, due to the wide spectrum of action of
nifuratel.