C. diff Risk


Oral Bioavailability


Spectrum Of Activity


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

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

General Information

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

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

Suspected or confirmed anaerobic infections including:

  •  Intra-abdominal

  •  Biliary

  •  Central nervous system

  •  Clostridium difficile

  •  Giardia

  •  Pelvic infections

  •  Bacterial vaginosis


  • Consider baseline LFTs


  • GI effects

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

  • Avoid alcohol

Ethanol - Disulfiram-like reaction

Increases levels of:

  •  Cyclosporine

  •  Lithium

  •  Warfarin

  •  Phenobarbital

  •  Phenytoin

Antimicrobial class: Nitroimidazole

Pregnancy category: B

Average serum half life: 10 hours

Biliary penetration: Therapeutic

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor