C difficile risk
Oral Bioavailability
IV-$3/d PO-$1/d


There is a wide variety of dosage recommendations in the literature, see other references as needed.

15 mg/kg/DOSE.

PNA-days 0 - 7PNA-days 7+ 7.5 mg/kg/DOSE given q24-48h.15 mg/kg/DAY divided q12h.

PNA-days 0 - 7PNA-days 7+ 15 mg/kg/DAY divided q12h30 mg/kg/DAY divided q12h

Usual dose, Oral: 30-50 mg/kg/DAY divided into 3 daily doses; Max 2250 mg/DAYUsual dose, IV: 22.5-40 mg/kg/DAY divided q8h. Max 1500 mg/DAY.

Severe impairment: Dose adjustment may be required. Consult with a pharmacist if using in a patient with severe hepatic impairment.

Renally cleared, requires dosage adjustment with changes in renal function. Consult with a pharmacist for renal dosing.

General Information

Suspected or confirmed anaerobic infections including intra-abdominal, biliary, central nervous system, Clostridium difficile, Giardia and pelvic infections.

Also used in Crohns disease, bacterial vaginosis, and hepatic encephalopathy

CBC with differential at baseline and after prolonged or repeated courses of therapy. With prolonged therapy (>6wks) or if symptoms develop assess for peripheral/optic neuropathy

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

Disulfiram reaction wtih alcohol or alcohol-containing medications/products.

May enhance the QT prolongation of drugs which are known to prolong the QT interval

May increase the serum concentation of vitamin K antagonists (warfarin)

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

Antimicrobial class: Nitroimidazole

Average serum half life:

  • Neonates <7 days: (prolonged with lower GA) 24.8-75.3 hours.

  • Neonates ≥7 days: ~22.5 hours

  • Children and adolescents: 6-10 hours.

  • Adults: 8 hours

Route of Elimination:

  • urine (unchanged drug and metabolites: 60-80%; ~20% of total as unchanged drug)

  • feces (6-15%)

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