Metronidazole works by entering bacterial and protozoal cells and interfering with their genetic material (DNA). It damages the DNA and also prevents the bacteria and protozoa from forming new DNA. This ultimately results in metronidazole killing the micro-organisms, which clears up the infection.
Metronidazole is also used to prevent infection following surgery, particularly gynaecological surgery and surgery on the gut, where many anaerobic bacteria may be found. In high doses, metronidazole penetrates the brain and can be used to treat abscesses in the brain.
Metronidazole is also used to treat infections with protozoa. These micro-organisms are also anaerobic and include Trichomonas vaginalis (which causes trichomonas infection of the vagina) and other protozoa, such as Entamoeba histolytica (which causes amoebic dysentry) and Gardia lambila (which causes giardiasis).
Indiction for Used Metronidazole
Metronidazole is also used to prevent infection following surgery, particularly gynaecological surgery and surgery on the gut, where many anaerobic bacteria may be found. In high doses, metronidazole penetrates the brain and can be used to treat abscesses in the brain.
Metronidazole is also used to treat infections with protozoa. These micro-organisms are also anaerobic and include Trichomonas vaginalis (which causes trichomonas infection of the vagina) and other protozoa, such as Entamoeba histolytica (which causes amoebic dysentry) and Gardia lambila (which causes giardiasis).
Indiction for Used Metronidazole
- Preventing and treating infections with anaerobic bacteria following surgery, particularly surgery on the gut or gynaecological surgery
- Bacterial infection of the blood (septicaemia or blood poisoning)
- Bacterial infection of the blood following childbirth (puerperal fever/sepsis)
- A serious form of pneumonia (necrotising pneumonia)
- Bacterial infections of bone (osteomyelitis)
- Bacterial infections in the abdomen (peritonitis)
- Abscess in the pelvic cavity, usually a result of an abdominal infection
- Inflammation of the connective tissue and muscle around the uterus due to bacterial infection (pelvic cellulitis)
- Brain abscesses
- Bacterial dental infections, eg dental abscesses
- Painful inflammation and ulcers of the gums (ulcerative gingivitis)
- Bacteria infected leg ulcers
- Bacteria infected pressure sores
- Bacterial infection of the vagina (bacterial vaginosis)
- Protozoal infection of the urinary organs or genitals (urogenital trichomoniasis)
- Protozoal infection of the intestine (amoebiasis or amoebic dysentry)
- Parasitic gut infection caused by the protozoa Giardia lamblia (giardiasis)
Pregnancy and Breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
The safety of this medicine during pregnancy has not been fully established. It should only be used during pregnancy if considered essential by your doctor because no safer antibiotics are suitable or available. High dosage regimens should be avoided. Seek medical advice from your doctor.
This medicine passes into breast milk. It should be used with caution in breastfeeding mothers and only if the expected benefit to the mother is greater than any possible risk to the nursing infant. High dosage regimens should be avoided unless the mother stops breastfeeding during the course. Seek medical advice from your doctor.
Side Effect of Metronidazole
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
The safety of this medicine during pregnancy has not been fully established. It should only be used during pregnancy if considered essential by your doctor because no safer antibiotics are suitable or available. High dosage regimens should be avoided. Seek medical advice from your doctor.
This medicine passes into breast milk. It should be used with caution in breastfeeding mothers and only if the expected benefit to the mother is greater than any possible risk to the nursing infant. High dosage regimens should be avoided unless the mother stops breastfeeding during the course. Seek medical advice from your doctor.
Side Effect of Metronidazole
- Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
- Unpleasant taste
- Sensation of a furry tongue
- Inflamed and sore mouth
- Loss of appetite
- Itchy rash (urticaria)
- Severe swelling of lips, face or tongue (angioedema)
- Drowsiness
- Dizziness
- Headache
- Shaky movements and unsteady walk (ataxia)
- Skin rashes
- Pain in the muscles or joints
- Darkening of the urine
- Visual disturbances
- Confusion
- Liver disorders
- Disorder of the peripheral nerves called peripheral neuropathy, that causes weakness and numbness (on prolonged or intensive therapy)
- Decrease in the number of white blood cells in the blood (leucopenia)
- Seizures
Usual Adult Dose for Amebiasis
500 to 750 mg orally 3 times a day for 5 to 10 days
Usual Adult Dose for Pseudomembranous Colitis
250 to 500 mg orally 3 to 4 times a day for 10 to 14 days
Usual Adult Dose for Surgical Prophylaxis
Postoperative infection prophylaxis in contaminated or potentially contaminated colorectal surgery:
Preoperative: 15 mg/kg IV infused over 30 to 60 minutes and completed approximately one hour before surgery
Postoperative: 7.5 mg/kg IV infused over 30 to 60 minutes at 6 and 12 hours after the initial dose
Usual Adult Dose for Trichomoniasis
2 g orally one time or 500 mg twice a day for 7 days or 375 mg twice a day for 7 days
The patient's sexual partner(s) should also be evaluated/treated.
Usual Adult Dose for Crohn's Disease - Acute
250 mg orally every 6 hours
Treatment should initially be continued for about four to eight weeks. If no response occurs, the drug should be discontinued. If there is a response, the drug can be continued for about three months, at which time tapering can be attempted. Because of potential dose-related side effects, long-term therapy (greater than 3 to 6 months) is not recommended.
Usual Adult Dose for Crohn's Disease - Maintenance
250 mg orally every 6 hours
Treatment should initially be continued for about four to eight weeks. If no response occurs, the drug should be discontinued. If there is a response, the drug can be continued for about three months, at which time tapering can be attempted. Because of potential dose-related side effects, long-term therapy (greater than 3 to 6 months) is not recommended.
Usual Adult Dose for Dracunculiasis
250 mg orally every 8 hours
Treatment should be continued for about 10 days, depending on the nature and severity of the infection.
Usual Adult Dose for Giardiasis
250 mg orally every 8 hours
Treatment should be continued for about 7 days, depending on the nature and severity of the infection.
Usual Adult Dose for Helicobacter pylori Infection
250 mg orally every 6 hours
Therapy should be continued for approximately 14 days.
Usual Adult Dose for Pelvic Inflammatory Disease
500 mg orally every 12 hours
Oral metronidazole is part of a regimen recommended by the Centers for Disease Control and Prevention (CDC) for the treatment of pelvic inflammatory disease (PID) in the outpatient setting. This outpatient regimen also includes therapy with doxycycline. Both drugs should be given for 14 days. If this patient is acutely ill, parenteral antimicrobial therapy is generally recommended. Many experts recommend that all patients with PID be hospitalized so that supervised treatment with parenteral antimicrobials be initiated. The CDC currently recommend that acutely ill patients with PID be treated with parenteral cefoxitin (or cefotetan) and doxycycline, or parenteral clindamycin and gentamicin. (Metronidazole is not part of the CDC's current recommendations for the treatment of PID in the inpatient setting.)
The patient's sexual partner(s) should also be evaluated/treated.
Usual Adult Dose for Deep Neck Infection
500 mg IV every 6 hours
Therapy should be continued for about 2 to 3 weeks, depending on the nature and severity of the infection.
Usual Adult Dose for Bacterial Vaginosis
500 mg orally every 12 hours for 7 days
Alternatively, 250 mg every 8 hours or extended release tablets 750 mg once daily for 7 days may also be given. Two grams given as a single dose is also effective; however, any treatment failures from this regimen should receive metronidazole for 7 days.
The patient's sexual partner(s) should also be evaluated/treated.
Usual Adult Dose for Aspiration Pneumonia
7.5 mg/kg IV every 6 hours
Intravenous therapy should be continued until the clinical condition stabilizes and fever subsides. Oral therapy may then be substituted. Oral doses are generally equal to intravenous doses. Therapy of documented anaerobic pleuropulmonary infections should be continued until the infiltrate is cleared or a residual scar forms, sometimes for as long as 2 to 4 months.
Usual Adult Dose for Bacteremia
7.5 mg/kg IV every 6 hours
Therapy should be continued for about 14 days, depending on the nature and severity of the infection.
Usual Adult Dose for Meningitis
7.5 mg/kg IV every 6 hours
Therapy should be continued for about 14 days, depending on the nature and severity of the infection.
Usual Adult Dose for Diverticulitis
7.5 mg/kg IV every 6 hours
Therapy should be continued for about 10 to 14 days, depending on the nature and severity of the infection.
Usual Adult Dose for Intraabdominal Infection
7.5 mg/kg IV every 6 hours
Therapy should be continued for about 10 to 14 days, depending on the nature and severity of the infection.
Usual Adult Dose for Peritonitis
7.5 mg/kg IV every 6 hours
Therapy should be continued for about 10 to 14 days, depending on the nature and severity of the infection.
Usual Adult Dose for Endocarditis
7.5 mg/kg IV every 6 hours
Therapy should be continued for about 4 to 6 weeks, depending on the nature and severity of the infection.
Usual Adult Dose for Joint Infection
7.5 mg/kg IV every 6 hours
Therapy should be continued for approximately 3 to 4 weeks, depending on the nature and severity of the infection. Longer therapy, 6 weeks or more, may be required for prosthetic joint infections.
Usual Adult Dose for Osteomyelitis
7.5 mg/kg IV every 6 hours
Therapy should be continued for about 4 to 6 weeks, depending on the nature and severity of the infection. Chronic osteomyelitis may require an additional 1 to 2 months of antibiotic therapy.
Usual Adult Dose for Pneumonia
7.5 mg/kg IV every 6 hours
Therapy should be continued for about 10 to 21 days, depending on the nature and severity of the infection.
Usual Adult Dose for Skin or Soft Tissue Infection
7.5 mg/kg IV every 6 hours
Therapy should be continued for about 7 days or 3 days after resolution of acute inflammation, depending on the nature and severity of the infection. For more severe infections, such as diabetic soft tissue infections, 14 to 21 days of therapy may be required.
Usual Pediatric Dose for Bacterial Infection
Anaerobic infections:
0 to 4 weeks, 1199 g or less: 7.5 mg/kg orally or IV every 24 to 48 hours
7 days or less, 1200 to 2000 g: 7.5 mg/kg orally or IV every 24 hours
7 days or less, 2001 g or more: 7.5 mg/kg orally or IV every 12 hours
8 days to 4 weeks, 1200 to 2000 g: 7.5 mg/kg orally or IV every 12 hours
8 days to 4 weeks, 2001 g or more: 15 mg/kg orally or IV every 12 hours
Infants and children: 7.5 mg/kg orally or IV every 6 hours; maximum dose 4 g/day
Usual Pediatric Dose for Amebiasis
Infants and children: 35 to 50 mg/kg/day orally in 3 divided doses for 10 days
Usual Pediatric Dose for Pseudomembranous Colitis
Infants and children: 20 mg/kg/day orally in 4 divided doses every 6 hours; maximum dose 2 g/day
Usual Pediatric Dose for Trichomoniasis
Infants and children: 15 to 30 mg/kg/day orally in 3 divided doses every 8 hours for 7 days
Adolescents: Adult dosage
The patient's sexual partner(s) should also be evaluated/treated.
Usual Pediatric Dose for Dracunculiasis
Children: 25 mg/kg/day orally in 3 divided doses for 10 days; maximum dose 750 mg/day
Usual Pediatric Dose for Giardiasis
Children: 15 mg/kg/day orally in 3 divided doses
Therapy should be continued for 5 to 10 days, depending on the nature and severity of the infection
Usual Pediatric Dose for Bacterial Vaginosis
Children 44 kg or less: 15 mg/kg/day orally in 2 divided doses for 7 days; maximum dose 1 g/day
Adolescents: Adult dosage
The patient's sexual partner(s) should also be evaluated/treated.
Renal Dose Adjustments
CrCl 9 mL/min or less: The usual dose may be given every 12 hours or half the dose may be given at the usual interval.
Liver Dose Adjustments
Patients with severe hepatic disease metabolize metronidazole slowly, with resultant accumulation of metronidazole and its metabolites in the plasma. Accordingly, for such patients, doses below those usually recommended should be administered cautiously. Close monitoring of plasma metronidazole levels and toxicity is recommended.
Dose Adjustments
In elderly patients, the pharmacokinetics of metronidazole may be altered, and, therefore, monitoring of serum levels may be necessary to adjust the metronidazole dosage accordingly.
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Unknown - Tuesday, 5 April 2011
