|•||PO, IV: Treatment of the following anaerobic infections.
|•||IV: Perioperative prophylactic agent in colorectal surgery.|
|•||PO: Amebicide in the management of amebic dysentery, amebic liver abscess, and trichomoniasis.
|•||Topical: Treatment of acne rosacea.|
|•||Vag: Management of bacterial vaginosis.|
|•||Treatment of giardiasis.|
|•||. Treatment of anti-infective associated pseudomembranous colitis.|
|•||PO (Adults): Anaerobic infections — 7.5 mg/kg q 6 hr (not to exceed 4 g/day). Trichomoniasis — 250 mg q 8 hr for 7 days or single 2-g dose or 1 g bid for 1 day. Amebiasis — 500–750 mg q 8 hr for 5–10 days. H. pylori — 250 mg 4 times daily or 500 mg twice daily for 1–2 wk (with other agents). Bacterial vaginoses — 750 mg once daily as ER tablets for 7 days. Antibiotic associated pseudomembranous colitis — 250–500 mg 3–4 times/day for 10–14 days.|
|•||PO (Infants and Children): Anaerobic infections-30 mg/kg/day divided q 6 hr, maximum dose: 4 g/day Trichomoniasis — 15–30 mg/kg/day divided q 8 hr for 7–10 days. Amebiasis — 35–50 mg/kg/day divided q 8 hr for 5–10 days (not to exceed 750 mg/dose). Antibiotic associated pseudomembranous colitis — 30 mg/kg/day divided q 6 hr for 7–10 days. H. pylori — 15–20 mg/kg/day divided twice daily for 4 weeks.|
|•||IV, PO (Neonates 0–4 weeks, <1200 g): 7.5 mg/kg q 48 hr. Postnatal age <7 days, 1200–2000 g —7.5 mg/kg/day q 24 hr. Postnatal age <7 days, >2000 g — 15 mg/kg/day divided q 12 hr. Postnatal age >7 days, 1200–2000 g — 15 mg/kg/day divided q 12 hr. Postnatal age >7 days, >2000 g — 30 mg/kg/day divided q 12 hr.|
|•||IV (Adults): Anaerobic infections — Initial dose 15 mg/kg, then 7.5 mg/kg q 6–8 hr or 500 mg q 6–8 hr (not to exceed 4 g/day). Perioperative prophylaxis — Initial dose 15 mg/kg 1 hr before surgery, then 7.5 mg/kg 6 and 12 hr later. Amebiasis — 500–750 mg q 8 hr for 5–10 days.|
|•||IV (Children): Anaerobic infections — 30 mg/kg/day divided q 6 hr, maximum dose: 4 g/day.|
|•||Topical (Adults): Acne rosacea — apply thin film to affected area bid.|
|•||Vag (Adults): Bacterial vaginosis — One applicatorful (5 g) 2 times daily for 5 days.|
Enters bacterial or protozoal cell and impairs synthesis of DNA, resulting in cell death.
Hypersensitivity to nitroimidazole derivatives or any component of the products; first trimester of pregnancy in patients with trichomoniasis.
CNS: Headache (18%); dizziness (4%); seizures; optic and peripheral neuropathy; vertigo; incoordination; ataxia; confusion; depression; insomnia; syncope; irritability; weakness; encephalopathy; aseptic meningitis; dysarthria.
DERM: Pruritis (6%); generalized itching or rash, skin irritation, transient skin erythema, mild skin dryness and burning (2%); thrombophlebitis after IV use; urticaria; erythematous rash; flushing; local allergic reaction, contact dermatitis, worsening of rosacea, transient redness; Steven-Johnson syndrome.
EENT: Metallic taste (9%); rhinitis (4%); sinusitis, pharyngitis (3%); nasal congestion.
GI: Nausea (10%); GI discomfort (7%); abdominal pain (5%); diarrhea, vomiting (4%); unusual taste (2%); decreased appetite (1%). anorexia; constipation; epigastric distress; cramps; pseudomembranous colitis; furry tongue; glossitis; stomatitis; pancreatitis.
GU: Vaginitis (15%); vaginal discharge (12%); symptomatic Candida cervicitis/vaginitis (10%); vulva/vaginal irritative symptoms (9%); genital pruritus (5%); abnormal urine, dysmenorrhea, pelvic discomfort (3%); UTI (2%); breast pain, metrorrhagia (1%); darkening of urine; dysuria; cystitis; polyuria; incontinence; decreased libido; proctitis; dyspareunia.
HEMA: Mild leukopenia; reversible thrombocytopenia; reversible neutropenia.
OTHER: Fungal infection (12%); bacterial infection (7%); influenza-like symptoms (6%); upper respiratory tract infection (4%); moniliasis (3%); infection, unspecified cramping (1%); hypersensitivity reactions including dermatologic reactions, dry mouth or vagina, and fever; fleeting joint pain; flattening of T-wave.
Anticoagulants (eg, warfarin)
Anticoagulant effect may be increased.
Therapeutic failure of metronidazole may occur.
May prolong the half-life and decrease plasma Cl of metronidazole.
Concurrent use may result in acute psychosis or confusional state. Do not give metronidazole to patients who have taken disulfiram within last 2 wk.
Disulfiram-like reaction including flushing, palpitations, tachycardia, nausea, and vomiting may occur with concurrent use.
Plasma levels may be elevated by metronidazole, increasing the risk of lithium toxicity.
Do not use aluminum-containing equipment with metronidazole because solution will turn orange/rust color.
Therapeutic Classification: anti-infectives, antiprotozoals, antiulcer agents
Absorption: 80% absorbed after oral administration. Minimal absorption after topical or vaginal application.
Distribution: Widely distributed into most tissues and fluids, including CSF. Crosses the placenta and enters fetal circulation rapidly; enters breast milk in concentrations equal to plasma levels.
Metabolism/Excretion: Partially metabolized by the liver (30–60%), partially excreted unchanged in the urine, 6–15% eliminated in the feces.
Half-life: Neonates: 25–75 hr; Children and adults: 6–12 hr.
|ORAL||RAPID||1-3 HOUR||8 HOUR|
|ORAL-ER||RAPID||UNKNOWN||UPTO 24 HOUR|
|IV||RAPID||END OF INFUSION||6-8 HOUR|
|TOPICAL||3 WEEK||9 WEEK||12HOUR|
|VAGINAL||UNKNOWN||6-12 HOUR||12 HOUR|