Antimicrobials
Metronidazole

Metronidazole

Low
Excellent
IV: $$ PO: $

General Information

  • Perforated appendicitis: Ceftriaxone + Metronidazole
  • Necrotizing enterocolitis or perforated bowel: Neonate (Ampicillin + Tobramycin ± Metronidazole)

    • Add metronidazole for perforation, peritonitis and rapidly advancing sepsis
  • C. difficile associated diarrhea: Metronidazole PO or IV, if not able to tolerate PO

  • Brain Abscess: Ceftriaxone + Cloxacillin + Metronidazole

  • Other immunocompromised patients (eg, solid organ transplant, autoimmune disorders): (Cefotaxime + Vancomycin ± Metronidazole*)

    • *Add metronidazole to cefotaxime/vancomycin if suspect intra-abdominal focus in a post-transplant patient
  • Orbital Cellulitis:

    • IV: Cloxacillin + Ceftriaxone + Metronidazole

ODB Funded (tablet, capsule, vag cream, gel)

>10%:

  • Central nervous system: Headache (18%)
  • Gastrointestinal: Nausea (10% to 12%)
  • Genitourinary: Vaginitis (15%)

1% to 10%:

  • Central nervous system: Metallic taste (9%), dizziness (4%)
  • Dermatologic: Genital pruritus (5%)
  • Gastrointestinal: Abdominal pain (4%), diarrhea (4%), xerostomia (2%)
  • Genitourinary: Dysmenorrhea (3%), urine abnormality (3%), urinary tract infection (2%)
  • Infection: Bacterial infection (7%), candidiasis (3%)
  • Respiratory: Flu-like symptoms (6%), upper respiratory tract infection (4%), pharyngitis (3%), sinusitis (3%)
  • Monitor CBC with differential at baseline, during, and after prolonged or repeated courses of therapy
  • Closely monitor patients with severe hepatic impairment or ESRD for adverse reactions
  • Observe patients carefully if neurologic symptoms occur and consider discontinuation of therapy
  • Give PO with food or milk
  • Avoid alcohol
  • May enhance the QT prolongation of drugs which are known to prolong the QT interval
  • Check for drug interactions prior to use
  • Suspension is chocolate-cherry flavoured, but very bitter tasting
  • Trichomonas vaginalis: Partner must also be treated