Metronidazole

C difficile risk
Low
Oral Bioavailability
Excellent
Cost
PO: <$1/day IV: $2-3/day

Dosing

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

500mg PO/IV q8h

30-40 mg/kg/day divided q8h

General Information

Suspected or confirmed anaerobic infections including:

  •  Intra-abdominal

  •  Biliary

  •  Central nervous system

  •  Clostridium difficile - severe infection IV metronidazole + oral vancomycin.

  •  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.

Per IDSA guidelines, no longer recommended as first line treatment for C. difficile associated diarrhea. Oral vancomycin preferred.

Antimicrobial class: Nitroimidazole

Average serum half life: 8-10 hours

Biliary penetration: Therapeutic

CSF penetration: Therapeutic

Lung penetration: Therapeutic

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