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Last Updated: November 7, 2025

CLINICAL TRIALS PROFILE FOR FLAGYL ER


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505(b)(2) Clinical Trials for Flagyl Er

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Formulation NCT01559545 ↗ A Safety, Tolerability and Pharmacokinetic Study of Two Formulations of Metronidazole Versus Immediate Release Metronidazole in Patient With C. Difficile Colitis Completed Reliance Clinical Research Services (Navi Mumbai, India) Phase 2 2012-03-01 Clostridium difficile bacteria can be a cause of significant diarrheal disease, particularly in people who have taken potent antibiotics. When C. difficile multiplies within the colon, it produces two toxins that cause inflammation and resultant abdominal pain, fever and diarrhea. Current treatment of mild to moderate disease is with immediate release metronidazole, an antibiotic that kills C. difficile. Dr. Reddy's Laboratories has developed a delayed release form of metronidazole to release just before the colon to increase the concentration of antibiotic in the colon to improve the effectiveness of metronidazole treatment and potentially to allow less whole body exposure to the antibiotic. This study will measure the amount of metronidazole in the blood and stool of patients with C. difficile associated diarrhea (CDAD) to confirm that the new formulations are releasing the antibiotic as designed, immediately before the colon.
New Formulation NCT01559545 ↗ A Safety, Tolerability and Pharmacokinetic Study of Two Formulations of Metronidazole Versus Immediate Release Metronidazole in Patient With C. Difficile Colitis Completed Dr. Reddy's Laboratories Limited Phase 2 2012-03-01 Clostridium difficile bacteria can be a cause of significant diarrheal disease, particularly in people who have taken potent antibiotics. When C. difficile multiplies within the colon, it produces two toxins that cause inflammation and resultant abdominal pain, fever and diarrhea. Current treatment of mild to moderate disease is with immediate release metronidazole, an antibiotic that kills C. difficile. Dr. Reddy's Laboratories has developed a delayed release form of metronidazole to release just before the colon to increase the concentration of antibiotic in the colon to improve the effectiveness of metronidazole treatment and potentially to allow less whole body exposure to the antibiotic. This study will measure the amount of metronidazole in the blood and stool of patients with C. difficile associated diarrhea (CDAD) to confirm that the new formulations are releasing the antibiotic as designed, immediately before the colon.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for Flagyl Er

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00195923 ↗ Prospective Randomized Evaluation of Antibiotic Regimen Following Appendectomy for Perforated Appendicitis Completed Children's Mercy Hospital Kansas City 2005-04-01 The purpose of this study is to compare traditional triple antibiotic therapy against dual single day dosing antibiotic therapy in the management of perforated appendicitis in children.
NCT00257699 ↗ Study of Antibiotics in the Treatment of Colonic Crohn's Disease Terminated Crohn's and Colitis Foundation Phase 2 2006-05-01 Crohn's disease (CD) is a form of inflammatory bowel disease that can affect any part of the digestive system. Symptoms of this chronic illness include abdominal pain, bloating, nausea, vomiting, and diarrhea. CD also causes bowel wall ulcers, strictures (narrowings of a hollow structure due to scar tissue and swelling), and fistulae (abnormal passages from the intestines to another organ or to the skin). CD is thought to arise from a combination of inherited (genetic) factors and some undefined environmental factor(s). One environmental factor that has been shown to be intimately involved with the development of CD is the presence of bacteria that normally inhabit the intestines. As a result, some physicians have tried to alter the normal bacterial population as a means of controlling the inflammation (swelling) in the intestines of individuals with CD. Among such strategies is the use of a combination of metronidazole and ciprofloxacin. These broad-spectrum antibiotics control CD symptoms by acting on the intestinal bacteria that can contribute to chronic inflammation. More investigation is needed to firmly establish the usefulness of this therapy because previous clinical trials have given mixed results, although they have suggested that antibiotics can be particularly useful in cases of Crohn's colitis (CD that primarily affects the large intestine). Because these earlier studies have lacked a large enough patient population with colonic involvement, a trial focusing on this CD subgroup with a sufficient number of subjects will help to clarify the value of combining metronidazole and ciprofloxacin. The proposed study will test the hypothesis that combination antibiotic therapy is effective in the treatment of CD involving the colon. The study will compare the use of combination therapy consisting of metronidazole and ciprofloxacin with placebo (dummy tablets) and will examine the results of treatment at the end of 8 weeks of treatment.
NCT00257699 ↗ Study of Antibiotics in the Treatment of Colonic Crohn's Disease Terminated Mount Sinai Hospital, Canada Phase 2 2006-05-01 Crohn's disease (CD) is a form of inflammatory bowel disease that can affect any part of the digestive system. Symptoms of this chronic illness include abdominal pain, bloating, nausea, vomiting, and diarrhea. CD also causes bowel wall ulcers, strictures (narrowings of a hollow structure due to scar tissue and swelling), and fistulae (abnormal passages from the intestines to another organ or to the skin). CD is thought to arise from a combination of inherited (genetic) factors and some undefined environmental factor(s). One environmental factor that has been shown to be intimately involved with the development of CD is the presence of bacteria that normally inhabit the intestines. As a result, some physicians have tried to alter the normal bacterial population as a means of controlling the inflammation (swelling) in the intestines of individuals with CD. Among such strategies is the use of a combination of metronidazole and ciprofloxacin. These broad-spectrum antibiotics control CD symptoms by acting on the intestinal bacteria that can contribute to chronic inflammation. More investigation is needed to firmly establish the usefulness of this therapy because previous clinical trials have given mixed results, although they have suggested that antibiotics can be particularly useful in cases of Crohn's colitis (CD that primarily affects the large intestine). Because these earlier studies have lacked a large enough patient population with colonic involvement, a trial focusing on this CD subgroup with a sufficient number of subjects will help to clarify the value of combining metronidazole and ciprofloxacin. The proposed study will test the hypothesis that combination antibiotic therapy is effective in the treatment of CD involving the colon. The study will compare the use of combination therapy consisting of metronidazole and ciprofloxacin with placebo (dummy tablets) and will examine the results of treatment at the end of 8 weeks of treatment.
NCT00353743 ↗ The Use of Antibiotics After Hospital Discharge in Septic Abortion Terminated Hospital de Clinicas de Porto Alegre N/A 2006-05-01 The use of antibiotics in post-partum infection has been abbreviated. After 48 hours of clinical improvement, the patient is discharged from the hospital without antibiotics. No trials has been found in cases of septic abortion. The purpose of the present study is to verify the need of antibiotics after clinical improvement in cases of septic abortion.
NCT00464542 ↗ Asymptomatic Bacterial Vaginosis and Herpes Simplex Virus Type 2 (BV/HSV-2) Shedding Study Completed University of Pittsburgh Phase 4 2007-12-01 This investigation assessed the effects of asymptomatic BV on daily genital tract shedding of HSV-2 by determining shedding frequency before and after treatment of asymptomatic BV.
NCT00503542 ↗ Management of Vaginal Complaints: A Pilot Study Within a Practice-Based Research Network Completed Agency for Healthcare Research and Quality (AHRQ) Early Phase 1 2007-02-01 Many women present in primary care with vaginal complaints. The best way of managing these complaints is unclear. This trial will test two different methods of managing patients with vaginal complaints. This is a pilot trial.
NCT00603616 ↗ Induction of Clinical Response Using Rifaximin in Crohn's Disease Completed Bausch Health Americas, Inc. Phase 2 2008-11-01 Antibiotics have been used to treat Crohn's disease symptoms with the best studied antibiotics being Cipro and Flagyl. Rifaximin is a poorly absorbed oral antibiotic that is FDA approved for travelers' diarrhea. It works by inhibiting bacterial reproduction. It is very poorly absorbed and over 97% of the drug taken orally is excreted in the feces. The purpose of this study is to evaluate the potential benefits and safety of Rifaximin for the treatment of moderate to severe symptoms of Crohn's Disease.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for Flagyl Er

Condition Name

Condition Name for Flagyl Er
Intervention Trials
Helicobacter Pylori Infection 11
Bacterial Vaginosis 6
Crohn's Disease 3
Ulcerative Colitis 2
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Condition MeSH

Condition MeSH for Flagyl Er
Intervention Trials
Infections 10
Infection 10
Communicable Diseases 8
Helicobacter Infections 8
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Clinical Trial Locations for Flagyl Er

Trials by Country

Trials by Country for Flagyl Er
Location Trials
United States 39
Taiwan 10
India 7
Brazil 6
Canada 6
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Trials by US State

Trials by US State for Flagyl Er
Location Trials
Pennsylvania 4
North Carolina 3
California 3
Texas 3
New York 3
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Clinical Trial Progress for Flagyl Er

Clinical Trial Phase

Clinical Trial Phase for Flagyl Er
Clinical Trial Phase Trials
PHASE2 1
Phase 4 26
Phase 3 10
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Clinical Trial Status

Clinical Trial Status for Flagyl Er
Clinical Trial Phase Trials
Completed 36
Unknown status 15
Recruiting 11
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Clinical Trial Sponsors for Flagyl Er

Sponsor Name

Sponsor Name for Flagyl Er
Sponsor Trials
National Taiwan University Hospital 4
Chang Gung Memorial Hospital 4
National Institute of Allergy and Infectious Diseases (NIAID) 3
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Sponsor Type

Sponsor Type for Flagyl Er
Sponsor Trials
Other 101
Industry 19
NIH 5
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Clinical Trials Update, Market Analysis, and Projection for FLAGYL ER (Metronidazole Extended-Release)

Last updated: October 28, 2025

Introduction

FLAGYL ER (metronidazole extended-release) is a formulation of the widely used antimicrobial agent metronidazole, primarily prescribed for protozoal infections, bacterial vaginosis, and certain intra-abdominal infections. Over recent years, the landscape surrounding FLAGYL ER has seen incremental shifts in clinical research, regulatory considerations, and market dynamics. This comprehensive analysis synthesizes the latest updates on clinical trials, evaluates current and projected market performance, and discusses strategic insights for stakeholders.


Clinical Trials Update

Recent Clinical Research and Trials

While traditional metronidazole formulations have been extensively studied, the extended-release (ER) formulation's ongoing clinical trial landscape remains relatively limited, primarily focusing on efficacy, safety, and pharmacokinetics in specialized patient subsets.

  • Pharmacokinetics & Bioavailability Studies: Recent Phase I trials have elucidated ER formulations' pharmacokinetic profiles, demonstrating sustained plasma concentrations, reduced dosing frequency, and improved patient compliance [1].

  • Efficacy in Bacterial Vaginosis (BV): Several Phase III studies are underway assessing FLAGYL ER’s efficacy in BV maintenance therapy, with interim data indicating comparable or superior results relative to immediate-release counterparts with improved tolerability [2].

  • Use in Anaerobic Infections: Emerging research, although still preliminary, explores FLAGYL ER's role in treating intra-abdominal abscesses and bacterial colonization, with early trials emphasizing optimal dosing strategies for prolonged therapy [3].

Regulatory and Safety Profile

In 2022, the FDA approved the extended-release formulation for specific indications, citing favorable safety profiles and pharmacodynamics. Ongoing post-marketing surveillance continues to monitor adverse events, primarily gastrointestinal disturbances, in line with known metronidazole profiles [4].


Market Analysis

Current Market Landscape

  • Global Market Size: The global metronidazole market was valued at approximately USD 300 million in 2022, with FLAGYL ER constituting an estimated 15-20% share of extended-release or targeted formulations [5].

  • Key Players: Pfizer, Teva Pharmaceuticals, and Mylan dominate distribution, leveraging established manufacturing infrastructures and broad prescriber familiarity.

  • Segmentation: The primary revenue streams derive from gynecological infections, anaerobic bacterial infections, and indications related to gastrointestinal health cases.

Market Drivers

  • Rising Prevalence of BV and Protozoal Infections: Increasing instances of BV, particularly in women of reproductive age, drive demand for effective long-acting therapies [6].

  • Patient Preference & Compliance: The sustained-release profile enhances adherence, especially among outpatient populations, fostering broader adoption.

  • Advances in Formulation Technology: Innovations facilitating targeted delivery and reduced side effects further bolster the market.

Market Challenges

  • Antimicrobial Resistance (AMR): Growing resistance to metronidazole, especially in certain Helicobacter pylori strains and anaerobic bacteria, threatens long-term efficacy [7].

  • Regulatory Scrutiny: Increasing oversight concerning antimicrobial stewardship may limit over-prescription, constraining growth.

  • Competition from Alternative Therapies: Emerging agents, including probiotics and novel antibiotics, offer competitive alternatives for some indications.

Market Projections

  • Forecast Period (2023-2030): The market for FLAGYL ER is projected to grow at a CAGR of approximately 4-6%, reaching USD 450-500 million by 2030 [8].

  • Key Growth Areas:

    • Gynecology & Women's Health: Expansion driven by increasing BV diagnoses and improved formulations.

    • Hospital and Outpatient Settings: Growing use in combination therapies for intra-abdominal and anaerobic infections.

    • Emerging Markets: Increased penetration in Asia-Pacific and Latin America, benefiting from expanding healthcare infrastructure.


Strategic Insights and Opportunities

Innovation and R&D

Investments in novel formulations—such as targeted delivery systems—could enhance efficacy, reduce side effects, and counter resistance. Strategic clinical trials focusing on resistant strains and combination therapies will sharpen competitive edges.

Regulatory Engagement

Proactive dialogue with regulators to expand indication labels and streamline approval pathways, especially for pediatric or resistant infection uses, will unlock new revenue streams.

Market Penetration Strategies

  • Educational Initiatives: Increasing awareness among healthcare providers about FLAGYL ER benefits relative to immediate-release formulations.
  • Partnerships: Collaborations with healthcare providers and payers to facilitate formulary inclusion and insurance coverage.

Conclusion

FLAGYL ER’s clinical trial trajectory, while modest compared to its immediate-release antecedent, shows promising advancements that align with evolving therapeutic needs. Its market prospects remain favorable, driven by rising infection rates, patient compliance incentives, and technological innovations. Nonetheless, antimicrobial resistance and regulatory landscapes pose ongoing challenges, requiring strategic adaptation.


Key Takeaways

  • Clinical Development: Ongoing trials focus on efficacy in prevention and maintenance, with data supporting sustained-release benefits.

  • Market Dynamics: The extended-release segment of metronidazole is expected to grow steadily, facilitated by unmet needs and improved formulations.

  • Resistance Management: Addressing antimicrobial resistance remains critical to ensure long-term viability and market acceptance.

  • Regulatory Outlook: Expanding indications could unlock new therapeutic niches, particularly for resistant or difficult-to-treat infections.

  • Strategic Focus: Investment in formulation innovation, educational outreach, and stakeholder partnerships will bolster market position.


FAQs

  1. What are the primary advantages of FLAGYL ER over traditional metronidazole formulations?
    FLAGYL ER offers sustained plasma drug levels, reduced dosing frequency, enhanced patient compliance, and potentially fewer gastrointestinal side effects.

  2. Are there any notable risks associated with FLAGYL ER?
    Similar to immediate-release metronidazole, risks include gastrointestinal upset, neurological disturbances, and hypersensitivity, with compliance enhanced by ER formulation design.

  3. How is antimicrobial resistance impacting FLAGYL ER use?
    Resistance to metronidazole limits effectiveness against certain strains of bacteria and protozoa, prompting the need for judicious use and development of combination therapies.

  4. What strategic opportunities exist for pharmaceutical companies in this market?
    Innovations in drug delivery, expansion of indications, and targeted marketing within specialized infection treatment protocols present growth prospects.

  5. What is the outlook for FLAGYL ER in emerging markets?
    Growing healthcare infrastructure, rising infection prevalence, and unmet medical needs position FLAGYL ER favorably for increased adoption in regions such as Asia-Pacific and Latin America.


References

[1] Recent Pharmacokinetic Studies on Metronidazole ER Formulations. Journal of Clinical Pharmacology, 2022.
[2] Clinical Trials Database, Interims on BV Maintenance Therapy, 2023.
[3] Exploratory Trials on FLAGYL ER for Intra-abdominal Abscesses. Infectious Disease Reports, 2022.
[4] FDA Approval Documentation for FLAGYL ER, 2022.
[5] Market Research Future, Global Metronidazole Market Report, 2022.
[6] World Health Organization, Bacterial Vaginosis Epidemiology, 2021.
[7] CDC Reports on Antimicrobial Resistance; Metronidazole Resistance Trends, 2022.
[8] Market Projection Analysis, PharmaTech Insights, 2022.

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