Metronidazole

C difficile risk
Low
Oral Bioavailability
Excellent

Spectrum Of Activity

Dosing

500mg PO Q8-12h, or 500mg IV Q6-8h

500mg PO/IV Q8-12h (doses given on HD days should be given after HD)

500mg PO Q8-12h, or 500mg IV Q6-12h

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

Standard Dose 500mg IV/PO q12h

Intra-abdominal, central nervous system and 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