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Published by api-3797941

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Published by: api-3797941 on Oct 17, 2008
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(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


Therapeutic actions

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

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

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
Contraindicated with hypersensitivity to metronidazole; pregnancy (do not use for
trichomoniasis in first trimester).
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
Amebiasis: 750 mg/tid PO for 5\u201310 days. (In amebic dysentery, combine with
iodoquinol 650 mg PO tid for 20 days.)
Antibiotic-associated pseudomembranous colitis: 1\u20132 g/day PO for 7\u201310 days.
Gardnerella vaginalis: 500 mg bid PO for 7 days.
Giardiasis: 250 mg tid PO for 7 days.
Trichomoniasis: 2 g PO in 1 day (1-day treatment) or 250 mg tid PO for 7 days.
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.
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)
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

Anaerobic bacterial infection: Not recommended.
Amebiasis: 35\u201350 mg/kg/day PO in 3 doses for 10 days.
1\u20132 hr
1\u20132 hr
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
CNS: Headache, dizziness, ataxia, vertigo, incoordination, insomnia, seizures,
peripheral neuropathy, fatigue
GI: Unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset,
GU: Dysuria, incontinence, darkening of the urine
Local: Thrombophlebitis (IV); redness, burning, dryness, and skin irritation
Other: Severe, disulfiram-like interaction with alcohol, candidiasis
Decreased effectiveness with barbiturates
Disulfiram-like reaction (flushing, tachycardia, nausea, vomiting) with alcohol
Psychosis if taken with disulfiram
Increased bleeding tendencies with oral anticoagulants
Drug-lab test
Falsely low (or zero) values in AST, ALT, LDH, triglycerides, hexokinase glucose
Nursing considerations
History: CNS or hepatic disease; candidiasis (moniliasis); blood dyscrasias;
pregnancy; lactation
Physical: Reflexes, affect; skin lesions, color (with topical application);
abdominal exam, liver palpation; urinalysis, CBC, liver function tests
Avoid use unless necessary. Metronidazole is carcinogenic in some rodents.
Administer oral doses with food.
Apply topically (MetroGel, MetroCream) after cleansing the area. Advise patient
that cosmetics may be used over the area after application.
Reduce dosage in hepatic disease.
Teaching points
Take full course of drug therapy; take the drug with food if GI upset occurs.
Do not drink alcohol (beverages or preparations containing alcohol, cough
syrups); severe reactions may occur.
Your urine may appear dark; this is expected.
Refrain from sexual intercourse unless partner wears a condom during treatment
for trichomoniasis.

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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