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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
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)
Available forms
Tablets—250, 500 mg; ER tablets—750 mg; capsules—375 mg; powder for injection—
500 mg; injection—500 mg/100 mL
Dosages
ADULTS
Oral
Amebiasis: 750 mg/tid PO for 5–10 days. (In amebic dysentery, combine with
iodoquinol 650 mg PO tid for 20 days.)
Antibiotic-associated pseudomembranous colitis: 1–2 g/day PO for 7–10 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.
IV
Anaerobic bacterial infection: 15 mg/kg IV infused over 1 hr; then 7.5 mg/kg
infused over 1 hr q 6 hr for 7–10 days, not to exceed 4 g/day.
Prophylaxis: 15 mg/kg infused IV over 30–60 min and completed about 1 hr
before surgery. Then 7.5 mg/kg infused over 30–60 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 effective.
PEDIATRIC PATIENTS
Anaerobic bacterial infection: Not recommended.
Amebiasis: 35–50 mg/kg/day PO in 3 doses for 10 days.
Pharmacokinetics
Route Onset Peak
Oral Varies 1–2 hr
IV Rapid 1–2 hr
Topical Generally no systemic absorption
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,
cramps
GU: Dysuria, incontinence, darkening of the urine
Local: Thrombophlebitis (IV); redness, burning, dryness, and skin irritation
(topical)
Other: Severe, disulfiram-like interaction with alcohol, candidiasis
(superinfection)
Interactions
Drug-drug
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 tests
Nursing considerations
Assessment
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
Interventions
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.
These side effects may occur: Dry mouth with strange metallic taste (use frequent
mouth care, suck sugarless candy); nausea, vomiting, diarrhea (eat frequent small
meals).
Report severe GI upset, dizziness, unusual fatigue or weakness, fever, chills.
Adverse effects in Italic are most common; those in Bold are life-threatening.