C difficile risk
Oral Bioavailability


Standard Dose 500mg IV/PO q12h

Intra-Abdominal, Central Nervous System and Clostridium difficile Infections 500mg PO/IV q8h

Consider dose reduction with severe hepatic impairment (Child-Pugh C)

General Information

Suspected or confirmed anaerobic infections including:

  • Intra-abdominal

  • Biliary

  • Central nervous system

  • Clostridium difficile

  • Giardia

  • Pelvic infections

Also used in:

  • Crohns disease

  • Bacterial vaginosis

  • Hepatic encephalopathy

Assess for peripheral/optic neuropathy with prolonged therapy (>6wks) or if symptoms develop

GI symptoms common - Especially nausea/vomiting and metallic taste

Peripheral/optic neuropathy with extended therapy

Disulfiram-like reaction (severe vomiting)

Rare neurotoxicity including aseptic meningitis and encephalopathy

Ethanol - Disulfiram-like reaction

Increases levels of:

  • Cyclosporine

  • Lithium

  • Warfarin

  • Phenobarbital

  • Phenytoin

Bacterial, protozoal and ameobic DNA is fragmented by reactive nitroso-imidazole radicals

Antimicrobial class: Nitroimidazole

Pregnancy category: B

Average serum half life: 10 hours

Urine penetration: Poor

Lung penetration: Therapeutic

CSF penetration: Therapeutic

Biliary penetration: Therapeutic