Spectrum: Local Antimicrobial Stewardship, for Lake of the Woods District Hospital

Metronidazole (Flagyl)

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

PO ~ $0.40 /day
IV ~ $5.40 / day

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

General Spectrum of Activity

Antibiogram Data

Dosing

Hepatic

Consider dose reduction by 50% with severe hepatic impairment (Child-Pugh C).

Adult

Renal

No renal adjustment necessary

General Information

Common Usage

Common Usage

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

Drug Monitoring

Drug Monitoring

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

Adverse Effects

Adverse Effects

  • 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.

Major Interactions

Major Interactions

Ethanol - Disulfiram-like reaction.

Increases levels of:

  •  Cyclosporine

  •  Lithium

  •  Warfarin

  •  Phenobarbital

  •  Phenytoin

Additional Information

Additional Information

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

Pharmacology

Pharmacology

Antimicrobial class: Nitroimidazole

Pregnancy category: B

Average serum half life: 10 hours

Urine penetration: Poor

Lung penetration: Therapeutic

CSF penetration: Therapeutic

Biliary penetration: Therapeutic