Nitroimidazole

Definition:

 A bactericidal and DNA synthesis inhibiting drug used especially to treat vaginal

trichomoniasis, amebiasis, and infections by anaerobic bacteria
 Used to treat anaerobic bacterial infections, parasitic infections, and protozoal infections and
prevent postoperative infections.
 It is available in capsule form, tablet form, and topical form, and suppository preparations for
the treatment of various infections.
 Names of nitroimidazoles include: Flagyl, Flagyl ER, Flagyl IV RTU, Metronidazole,
Secnidazole, Solosec, Tindamax, Tinidazole


Indication:

 For the treatment of confirmed trichomoniasis caused by Trichomonas vaginalis (except for in the
first trimester of pregnancy) and the patient's sexual partners, bacterial vaginosis certain types of
amebiasis, and various anaerobic infections.
 Anaerobic infections may occur on: the skin and skin structures, the abdomen, the heart,
reproductive organs, central nervous system, and the respiratory system.
 Infection may also be present in the bloodstream in cases of septicemia.
 Common infections treated by metronidazole are Bacteroides species infections, Clostridium
infections, and Fusobacterium infections, as well as Peptococcus and Peptostreptococcus
infections.
 Off label uses: used in the treatment of Chron’s disease and rosacea, as phrophylactic agent after
surgery; treatment of Helicobacter pylori infection, and has also been studied in the prevention of
preterm births and to treat periodontal disease.

Side Effects:

The common side effects include:

 Nausea
 Vomiting
 Loss of appetite
 Bitter taste in the mouth
 Stomach pain
 Headache
 Dry mouth
  Constipation
 Dark color of urine

Other rare side effects include:

 Lethargy/tiredness
 Ataxia (lack of muscle control or coordination of voluntary movements)
 Seizures (sudden uncontrolled electrical disturbance in the brain)
 Vertigo (sensation of feeling off-balance)
 Dizziness/unsteadiness
 Mood changes
 Numbness/tingling of hands or feet
 Painful urination
 Oral thrush
 Rash on face/tongue
 Trouble breathing

Contraindications:

 Nitroimidazoles should be used with caution in patients with a medical history of central
nervous system disorders (seizures) and with blood dyscrasias (a disorder that affects blood
and its components).

Nursing Implementation:

Assessment

 History: CNS or hepatic disease; candidiasis (moniliasis); blood dyscrasias; pregnancy;

lactation
 Physical: Reflexes, affect; skin lesions, color (with topical application); abdominal
examination, liver palpation; urinalysis, CBC, LFTs

Interventions

 Avoid use unless necessary. Metronidazole may be carcinogenic.

 Administer oral doses with food.
 Apply topically (MetroGel) after cleansing the area. Advise patient that cosmetics may be
used over the area after application.
 Reduce dosage in hepatic disease.
Health Teaching

 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 be a darker color than usual; this is expected.
 Refrain from sexual intercourse during treatment for trichomoniasis, unless partner wears a
condom.
 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.
 You may experience these side effects: Dry mouth with strange metallic taste (frequent mouth
care, sucking sugarless candies may help); nausea, vomiting, diarrhea (eat frequent small meals).
 Report severe GI upset, dizziness, unusual fatigue or weakness, fever, chills.