Metronidazol

Metronidazole (Flagyl, MetroGel, MetroGel Vaginal)

Category:

Antibiotic

Description:

Antiprotozoal

Indications:

Anaerobic infections
Trichomoniasis
Amebia
Colorectal surgery prophylaxis
Acne rosacea
Bacterial vaginosis

Contraindications:

Trichomoniasis infections in the first trimester of pregnancy

Precautions:

Pregnancy category B
Use with caution in patients with organic CNS disease or severe hepatic dysfunction
Use condoms during therapy to avoid re-infection if trichomoniasis
Counsel patient to finish all medication
Avoid using alcohol during therapy and 1-2 days post-therapy to avoid “disulfiram-type” reaction
Will cause a metallic taste in the mouth
Take with food to avoid GI side effects
Will darken the color of urine

Adverse Reactions (Side Effects):

Seizures and peripheral neuropathy
Gastrointestinal: anorexia, nausea, diarrhea, cramping, metallic taste
Headache
Rash
Dysuria and darkened urine

Dosage:

Administered orally, topically and IV injection
Acute intestinal amebiasis:
- 750mg tid for 5-10 days
Amebic liver abscess amebiasis:
- Adult: 500-750mg tid for 5-10 days
- Children: 35-50mg/kg/day in three divided doses for 10 days
Trichomoniasis (treat sexual partner(s) also):
- One day therapy: 2 grams in one or two doses
- Seven day therapy: 250mg tid for 7 days
Anaerobic bacterial infections:
- Initial: 15mg/kg infused over one hour
- Maintenance: Six hours post loading dose, 75mg/kg (max 4 grams per day) oral or IV (infused over 1 hour) q6h for 7-10 days
Colorectal surgery prophylaxis:
- 15mg/kg infused IV (over 1 hour) and completed one hour prior to surgery, then 7.5mg/kg at 6 and 12 hour intervals after initial dose.
Acne rosacea:
- Apply a thin film twice a day for 3-9 weeks
Bacterial vaginosis:
- Insert 1 applicatorful (5 grams or 37.5mg metronidazole) once or twice a day for 5 days
- For once daily dosing, dose at bedtime

Source: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300