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Metronidazole

Metronidazole

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metronidazole
(me troeni' da zole)

Apo-Metronidazole (CAN), Flagyl, Flagyl 375, Flagyl ER, Flagyl IV, Flagyl IV
RTU, MetroCream (CAN), MetroGel, Metro I.V., Neo-Tric (CAN), NidaGel
(CAN), Noritate, Novonidazol (CAN), PMS-Metronidazole (CAN), Protostat,
Trikacide (CAN)

Pregnancy Category B
Drug classes

Antibiotic
Antibacterial
Amebicide
Antiprotozoal

Therapeutic actions

Bactericidal: Inhibits DNA synthesis in specific (obligate) anaerobes, causing cell death;
antiprotozoal-trichomonacidal, amebicidal: Biochemical mechanism of action is not
known.

Indications
\u2022
Acute infection with susceptible anaerobic bacteria
\u2022
Acute intestinal amebiasis
\u2022
Amebic liver abscess
\u2022
Trichomoniasis (acute and partners of patients with acute infection)
\u2022
Preoperative, intraoperative, postoperative prophylaxis for patients undergoing
colorectal surgery
\u2022
Topical application: Treatment of inflammatory papules, pustules, and erythema
of rosacea
\u2022

Unlabeled uses: Prophylaxis for patients undergoing gynecologic, abdominal
surgery; hepatic encephalopathy; Crohn's disease; antibiotic-associated
pseudomembranous colitis; treatment of Gardnerella vaginalis, giardiasis (use
recommended by the CDC)

Contraindications and cautions
\u2022
Contraindicated with hypersensitivity to metronidazole; pregnancy (do not use for
trichomoniasis in first trimester).
\u2022
Use cautiously with CNS diseases, hepatic disease, candidiasis (moniliasis), blood
dyscrasias, lactation.
Available forms
Tablets\u2014250, 500 mg; ER tablets\u2014750 mg; capsules\u2014375 mg; powder for injection\u2014
500 mg; injection\u2014500 mg/100 mL
Dosages
ADULTS
Oral
\u2022
Amebiasis: 750 mg/tid PO for 5\u201310 days. (In amebic dysentery, combine with
iodoquinol 650 mg PO tid for 20 days.)
\u2022
Antibiotic-associated pseudomembranous colitis: 1\u20132 g/day PO for 7\u201310 days.
\u2022
Gardnerella vaginalis: 500 mg bid PO for 7 days.
\u2022
Giardiasis: 250 mg tid PO for 7 days.
\u2022
Trichomoniasis: 2 g PO in 1 day (1-day treatment) or 250 mg tid PO for 7 days.
IV
\u2022
Anaerobic bacterial infection: 15 mg/kg IV infused over 1 hr; then 7.5 mg/kg
infused over 1 hr q 6 hr for 7\u201310 days, not to exceed 4 g/day.
\u2022
Prophylaxis: 15 mg/kg infused IV over 30\u201360 min and completed about 1 hr
before surgery. Then 7.5 mg/kg infused over 30\u201360 min at 6- to 12-hr intervals
after initial dose during the day of surgery only.
Topical (MetroGel)
\u2022
Treatment of inflammatory papules, pustules, and erythema of rosacea: Apply and

rub in a thin film twice daily, morning and evening, to entire affected areas after
washing; results should be seen within 3 wk; treatment through 9 wk has been
effective.

PEDIATRIC PATIENTS
\u2022
Anaerobic bacterial infection: Not recommended.
\u2022
Amebiasis: 35\u201350 mg/kg/day PO in 3 doses for 10 days.
Pharmacokinetics
Route
Onset
Peak
Oral
Varies
1\u20132 hr
IV
Rapid
1\u20132 hr
Topical
Generally no systemic absorption

Metabolism: Hepatic; T1/2: 6\u20138 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine and feces

IV facts
Preparation: Reconstitute by adding 4.4 mL of sterile water for injection, bacteriostatic

water for injection, 0.9% sodium chloride injection, bacteriostatic 0.9% sodium chloride
injection to the vial and mix thoroughly. Resultant volume is 5 mL with a concentration
of 100 mg/mL. Solution should be clear to pale yellow to yellow-green; do not use if
cloudy or if containing precipitates; use within 24 hr; protect from light. Add
reconstituted solution to glass or plastic container containing 0.9% sodium chloride
injection, 5% dextrose injection or lactated Ringer's; discontinue other solutions while
running metronidazole.

Infusion: Prior to administration, add 5 mEq sodium bicarbonate injection for each
500 mg used (if not using premixed bags); mix thoroughly. Do not refrigerate neutralized
solution. Do not administer solution that has not been neutralized. Infuse over 1 hr.
Adverse effects
\u2022
CNS: Headache, dizziness, ataxia, vertigo, incoordination, insomnia, seizures,
peripheral neuropathy, fatigue
\u2022
GI: Unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset,
cramps
\u2022
GU: Dysuria, incontinence, darkening of the urine
\u2022
Local: Thrombophlebitis (IV); redness, burning, dryness, and skin irritation
(topical)
\u2022
Other: Severe, disulfiram-like interaction with alcohol, candidiasis
(superinfection)
Interactions
Drug-drug
\u2022
Decreased effectiveness with barbiturates
\u2022
Disulfiram-like reaction (flushing, tachycardia, nausea, vomiting) with alcohol
\u2022
Psychosis if taken with disulfiram
\u2022
Increased bleeding tendencies with oral anticoagulants
Drug-lab test
\u2022
Falsely low (or zero) values in AST, ALT, LDH, triglycerides, hexokinase glucose
tests
Nursing considerations
Assessment
\u2022
History: CNS or hepatic disease; candidiasis (moniliasis); blood dyscrasias;
pregnancy; lactation
\u2022
Physical: Reflexes, affect; skin lesions, color (with topical application);
abdominal exam, liver palpation; urinalysis, CBC, liver function tests
Interventions
\u2022
Avoid use unless necessary. Metronidazole is carcinogenic in some rodents.
\u2022
Administer oral doses with food.
\u2022
Apply topically (MetroGel, MetroCream) after cleansing the area. Advise patient
that cosmetics may be used over the area after application.
\u2022
Reduce dosage in hepatic disease.
Teaching points
\u2022
Take full course of drug therapy; take the drug with food if GI upset occurs.
\u2022
Do not drink alcohol (beverages or preparations containing alcohol, cough
syrups); severe reactions may occur.
\u2022
Your urine may appear dark; this is expected.
\u2022
Refrain from sexual intercourse unless partner wears a condom during treatment
for trichomoniasis.
\u2022

Apply the topical preparation by cleansing the area and then rubbing a thin film into the affected area. Avoid contact with the eyes. Cosmetics may be applied to the area after application.

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