Antimicrobials
Metronidazole

Metronidazole

Low
Excellent
PO: <$1/day IV: $2-3/day

Spectrum of Activity

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