C difficile risk
Oral Bioavailability


No adjustment required

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

Standard Dose
500mg IV/PO q12h

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

General Information

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

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.

Antimicrobial class: Nitroimidazole

Pregnancy category: B

Average serum half life: 10 hours

Biliary penetration: Therapeutic

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor