Spectrum: Local Antimicrobial Stewardship, for Saskatchewan Health Authority - Saskatoon Area

Metronidazole

C. diff Risk

Low

Oral Bioavailability

Excellent

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

Renal

No adjustment required

Hepatic

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

Adult

Standard Dose
500mg IV/PO q12h

Central nervous system and mild/moderate Clostridium difficile infections
500mg PO/IV q8h

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

Biliary penetration: Therapeutic

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor