Spectrum: Local Antimicrobial Stewardship, for Bakersfield Memorial Hospital

Metronidazole

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

Adult

Standard Dose
500 mg IV/PO every 12 hr

Intra-abdominal, central nervous system and Clostridium difficile infections
500 mg PO/IV every 8 hr

Hepatic

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

General Information

Common Usage

Common Usage

Suspected or confirmed anaerobic infections including:

  •  Intra-abdominal

  •  Biliary

  •  Central nervous system

  •  Clostridium difficile

  •  Giardia

  •  Pelvic infections

  •  Bacterial vaginosis

Drug Monitoring

Drug Monitoring

Lab

  • Consider baseline LFTs

*Clinical

  • GI effects

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

  • Avoid alcohol

Adverse Effects

Adverse Effects

GI symptoms common - Especially nausea/vomiting and metallic taste

Peripheral/optic neuropathy with extended therapy

Disulfiram-like reaction (severe vomiting): Avoid Alcohol

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