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Topical metronidazole is an effective and well tolerated alternative to systemic antibacterials for the management of rosacea. Although having no effect on telangiectasia, metronidazole monotherapy appears to be as effective as oral tetracyclines in the treatment of mild to severe rosacea (e.g. reductions in inflammatory lesions and erythema). Efficacy is independent of the formulation (cream, gel or lotion) used.Ocular rosacea must be treated with systemic antibacterials, but topical metronidazole may provide additional benefit. Combination therapy may also be advantageous when oral antibacterials or topical metronidazole alone provide an inadequate response.Remission is maintained effectively during long term topical administration but, as with all management options, metronidazole is not curative. Relapse on stopping therapy with topical metronidazole is common, but it is no worse than after oral alternatives.