How should metronidazole tablets be taken with food. What is the proper way to use metronidazole liquid. How often should metronidazole suppositories be used. What is the correct application method for metronidazole cream or gel. How long should a course of metronidazole treatment typically last.

Understanding Metronidazole: Forms and Applications

Metronidazole is a versatile antibiotic used to treat various infections. It comes in several forms, including tablets, liquid, suppositories, cream, and gel. Each form has specific usage instructions to ensure maximum effectiveness and minimal side effects.

What is Metronidazole Used For?

Metronidazole is prescribed for a wide range of infections, including:

• Bacterial vaginosis
• Trichomoniasis
• Giardiasis
• Amoebiasis
• Dental infections
• Rosacea (topical form)
• Skin infections
• Infected ulcers and wounds

Proper Usage of Metronidazole Tablets

Metronidazole tablets are a common form of the medication. To ensure optimal absorption and reduce the risk of stomach upset, it’s important to take them correctly.

Should Metronidazole Tablets Be Taken with Food?

Yes, metronidazole tablets should be taken with food. Swallow the tablets whole with a full glass of water after eating. This helps to minimize potential gastrointestinal side effects and improve absorption.

How Often Should Metronidazole Tablets Be Taken?

The frequency of metronidazole tablet administration depends on the specific infection being treated. Some infections may require a single dose, while others might need a course lasting up to two weeks. Always follow your doctor’s or pharmacist’s instructions regarding dosage and duration.

Administering Metronidazole Liquid

Metronidazole liquid offers an alternative for those who have difficulty swallowing tablets. Its administration differs slightly from the tablet form.

Does Metronidazole Liquid Need to Be Taken with Food?

Unlike the tablets, metronidazole liquid does not need to be taken after food. However, taking it with or after a meal may help reduce stomach upset in some individuals.

How to Measure Metronidazole Liquid Accurately?

To ensure accurate dosing of metronidazole liquid:

1. Use the provided plastic syringe or spoon to measure the prescribed dose
2. If you don’t have a measuring device, ask your pharmacist for one
3. Avoid using kitchen teaspoons as they do not provide accurate measurements

Using Metronidazole Suppositories

Metronidazole suppositories are an option for those who have difficulty swallowing or when other forms of the medication are not suitable.

How Often Are Metronidazole Suppositories Typically Used?

Metronidazole suppositories are usually prescribed to be used three times a day. However, always follow the specific instructions provided by your healthcare provider or the packaging information.

What’s the Proper Way to Use Metronidazole Suppositories?

To use metronidazole suppositories correctly:

1. Wash your hands thoroughly before and after insertion
2. Remove the suppository from its packaging
3. Lie on your side with your lower leg straightened and your upper leg bent
4. Gently insert the suppository into the rectum, pointed end first
5. Stay in this position for a few minutes to allow the suppository to dissolve

Applying Metronidazole Cream or Gel

Metronidazole cream and gel are topical forms of the medication, primarily used for skin conditions like rosacea or certain skin infections.

How Often Should Metronidazole Cream or Gel Be Applied?

For rosacea, metronidazole cream or gel is typically applied twice daily for about two months. For skin infections or infected wounds, application may be once or twice daily. Always follow your healthcare provider’s specific instructions.

What’s the Correct Method for Applying Metronidazole Cream or Gel?

To apply metronidazole cream or gel correctly:

1. Wash your hands before and after application
2. Clean and dry the affected area
3. Apply a thin layer of the cream or gel to the affected area
4. Gently rub it in until absorbed
5. Avoid getting the medication in your eyes
6. If it does get in your eyes, rinse immediately with cold water

Duration of Metronidazole Treatment

The duration of metronidazole treatment varies depending on the type and severity of the infection being treated.

How Long Does a Typical Course of Metronidazole Last?

A course of metronidazole can range from a single dose to a two-week regimen. Some conditions may require longer treatment. It’s crucial to complete the entire prescribed course, even if symptoms improve before the medication is finished.

Why Is It Important to Complete the Full Course of Metronidazole?

Completing the full course of metronidazole is essential because:

• It ensures all harmful bacteria are eliminated
• It reduces the risk of the infection returning
• It helps prevent antibiotic resistance
• It maximizes the treatment’s effectiveness

Managing Missed Doses of Metronidazole

Occasionally, you might forget to take a dose of metronidazole. Knowing how to handle missed doses is important for maintaining the effectiveness of your treatment.

What Should You Do If You Miss a Dose of Metronidazole?

If you miss a dose of metronidazole:

1. Take it as soon as you remember, unless it’s almost time for your next dose
2. If it’s nearly time for your next dose, skip the missed dose and continue with your regular schedule
3. Never take a double dose to make up for a missed one
4. If you frequently forget doses, consider setting reminders or asking your pharmacist for advice on remembering your medication

Potential Side Effects and Precautions

While metronidazole is generally well-tolerated, it’s important to be aware of potential side effects and necessary precautions.

What Are Common Side Effects of Metronidazole?

Common side effects of metronidazole may include:

• Nausea and vomiting
• Loss of appetite
• Metallic taste in the mouth
• Diarrhea
• Headache
• Dizziness
• Skin rash or itching (for topical forms)

Are There Any Precautions to Take While Using Metronidazole?

When using metronidazole, consider these precautions:

• Avoid alcohol during treatment and for at least 48 hours after the last dose
• Inform your doctor of any other medications you’re taking to avoid potential interactions
• If you’re pregnant or breastfeeding, consult your doctor before using metronidazole
• For topical forms, avoid exposure to strong sunlight or UV rays, as metronidazole can increase skin sensitivity

Storing Metronidazole Properly

Proper storage of metronidazole ensures its effectiveness and safety throughout the course of treatment.

How Should Metronidazole Be Stored?

To store metronidazole correctly:

• Keep it at room temperature, away from direct sunlight and moisture
• Store tablets and liquid forms in their original packaging
• Keep creams and gels tightly closed when not in use
• Store all forms of metronidazole out of reach of children
• Do not use metronidazole after its expiration date

By following these guidelines for the proper use, administration, and storage of metronidazole, you can maximize the effectiveness of your treatment while minimizing potential side effects. Always consult your healthcare provider or pharmacist if you have any questions or concerns about using metronidazole.

How and when to take or use metronidazole

Tablets, liquid or suppositories

Metronidazole tablets, liquid and suppositories are prescribed for a number of types of infections.

Dosage for tablets, liquid or suppositories

The type of metronidazole your doctor prescribes, the dose and how long you need to take it for depends on the type of infection and how serious it is.

Some infections can be treated with a single dose, while others may need a 2-week course. Children’s doses are lower and depend on the age or weight of your child.

Follow the instructions from your doctor or pharmacist.

How to take metronidazole tablets

Swallow the tablets whole with a drink of water, after you’ve eaten some food.

How to take metronidazole liquid

Metronidazole liquid does not need to be taken after food.

This medicine comes with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

How to use metronidazole suppositories

Your doctor may prescribe metronidazole suppositories if you have difficulty swallowing medicines. You’ll usually use them 3 times a day. Follow the instructions that come in the packaging with your medicine.

When to take tablets, liquid or suppositories

If you need to take several doses of metronidazole a day, try to space them evenly. For example, if you take your medicine 3 times a day, this could be first thing in the morning, mid-afternoon, and at bedtime.

How long to take metronidazole tablets, liquid or suppositories for

It’s very important to keep taking metronidazole for as long as your doctor has prescribed it.

Important:
Finishing your course of tablets, liquid or suppositories

Carry on taking metronidazole tablets, liquid or suppositories until you have finished the course, even if you feel better. If you stop your treatment early, the infection could come back.

If you forget to take metronidazole tablets, liquid or suppositories

If you forget to take a dose of metronidazole tablets, liquid or suppositories, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just leave out the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicines.

If you take too much metronidazole tablets, liquid or suppositories

Taking an extra dose of metronidazole tablets, liquid or suppositories is unlikely to harm you or your child.

Speak to your pharmacist or doctor if you’re worried or you take more than 1 extra dose.

Cream or gel for skin infections

If you’re prescribed metronidazole cream or gel for rosacea, you’ll normally use it twice a day for about 2 months. Treatment can sometimes last longer. Follow the instructions from your doctor or pharmacist.

If you’re using the cream or gel for a skin infection, or infected ulcers or wounds, you’ll usually put it on once or twice a day. Follow your doctor or pharmacist’s instructions, and continue treatment until your infection has healed.

How to put on metronidazole cream or gel

Put a thin layer of cream or gel onto the area you’re treating and rub it in very gently.

Try to avoid getting it into your eyes, as it can sting. If you do get some in your eye, wash it out immediately with cold water.

Remember to wash your hands before and after using it.

How long to use metronidazole cream or gel for

It’s very important to keep using metronidazole cream or gel for as long as your doctor has prescribed it.

Important:
Finishing your course of cream or gel

Carry on using metronidazole cream or gel until you have finished the course, even if you feel better. If you stop your treatment early, the infection could come back.

If you forget to use metronidazole cream or gel

If you forget to use metronidazole cream or gel, put it on as soon as you remember, unless it’s nearly time for your next dose. In this case, just leave out the missed dose and use your next dose at the usual time.

Do not use it more than twice a day unless your doctor tells you to.

If you use too much metronidazole cream or gel

If you put on too much cream or gel, or if you get some in your mouth, it’s unlikely to harm you.

Talk to your pharmacist or doctor if you’re worried, or if you or your child swallows a lot of it.

Vaginal gel

For treating bacterial vaginosis, you’ll use an applicator to put the metronidazole gel into your vagina.

Dosage for metronidazole vaginal gel

The usual dose for treating bacterial vaginosis is 1 applicator full, every night for 5 nights.

How to use metronidazole vaginal gel

Follow the instructions that come in the packaging along with your medicine. These will tell you how to fill the applicator with gel and put it into your vagina.

Do not have sex while using the vaginal gel.

It’s recommended that you do not use the gel while having your period.

How long to use metronidazole vaginal gel for

It’s very important to keep using metronidazole vaginal gel for as long as your doctor has prescribed it.

Important:
Finishing your course of vaginal gel

Carry on using metronidazole vaginal gel until you have finished the course, even if you feel better. If you stop your treatment early, the infection could come back.

If you forget to use metronidazole vaginal gel

If you forget to use metronidazole vaginal gel, use it as soon as you remember, unless it’s nearly time for your usual dose. In this case, skip the missed dose and use your next dose at the usual time.

Do not use it more than once a night.

If you use too much metronidazole vaginal gel

If you use too much vaginal gel it’s unlikely to harm you.

Talk to your pharmacist or doctor if you’re worried.

Metronidazole | VCA Animal Hospital

What is metronidazole?

Metronidazole (brand name Flagyl®) is an antibacterial and antiprotozoal agent used in the treatment of certain anaerobic bacterial and protozoal infections, such as those caused by Giardia and Trichomonas. It is often used to treat diarrhea and other intestinal problems.

The use of metronidazole to treat Giardia infections and most other infections in dogs, cats, small mammals, birds, reptiles, and other animals is off-label. Many drugs are commonly prescribed for off-label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully.

How is metronidazole given?

Metronidazole is available as a capsule, tablet, and liquid suspension. It may also be compounded into a formulation (called metronidazole benzoate) that tastes less bitter and is easier to administer to cats. An injectable form is also available that your veterinarian will administer at your veterinary hospital.

“Metronidazole should be given by mouth with food.”

Metronidazole should be given by mouth with food. Liquid forms must be shaken well before use. Metronidazole is very bitter, so take care not to crush these tablets as it will be difficult to administer to your pet. Follow the dosing instructions provided by your veterinarian. If you have difficulty administering the medication, contact your veterinary clinic for advice.

This medication should take effect within one to two hours, and while effects may not be visibly noticed immediately, gradual improvements are usually noticeable after a few days.

Exposure to this medication may lead to adverse effects in pregnant humans, so care must be taken to avoid accidental exposure. Gloves should be worn when handling the medication. DO NOT crush pills, as this creates powders that can become airborne, and inhaling the drug can lead to exposure. If your pet vomits after giving this drug, wear gloves while cleaning up.

What if I miss giving my pet the medication?

If you miss a dose, give it when you remember, but if it is close to the time for the next dose, skip the dose you missed and give the medication at the next scheduled time and continue with the regular dosing schedule. Never give your pet two doses at once or give extra doses.

It is very important to give the medication for the length of time your veterinarian has recommended.

Are there any potential side effects?

Side effects of metronidazole may include nausea, vomiting, diarrhea, regurgitation, decreased appetite, tiredness, and drooling.

Metronidazole can cause neurological effects including lack of muscle control or coordination, tremors, seizures, vomiting, eye twitching, and weakness. These effects usually occur if metronidazole is given at high doses or for extended periods of time, but they can occur with lower doses as well. Contact your veterinarian immediately if you notice any of these signs with your pet.

Liver toxicity can occasionally occur. Signs of liver toxicity may include inappetence or yellowing of the skin, eyes, or gums. Contact your veterinarian if you notice these signs.

“Liver toxicity can occasionally occur.”

Very rarely, metronidazole may cause a skin disorder called cutaneous vasculitis, in which blood vessels become inflamed in the skin. Signs of this skin disorder include scaling, hair loss, bruising, swelling, and bumps on the skin. Contact your veterinarian if you notice any of these signs.

This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

Do not use metronidazole in pets that:

• have a known hypersensitivity or allergy to it or drugs related to it
• are pregnant or nursing
• are in a weakened condition or debilitated

Metronidazole should be used with caution in pets that:

• have certain liver disorders
• are puppies or kittens
• are on blood thinners

Are there any drug interactions I should be aware of?

Certain drugs may interact with metronidazole, including certain chemotherapy drugs, and gastro protectants (cimetidine), cyclosporine, phenobarbital, phenytoin, and warfarin. Your veterinarian will weigh the potential risks of metronidazole if your pet is taking these medications. It is important to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking.

“It is important to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking. ”

Is there any monitoring that needs to be done with this medication?

Monitor to ensure that the medication is working and monitor for adverse effects.

How do I store metronidazole?

Metronidazole tablets, capsules, and oral solution should be stored in a tightly sealed container, protected from light, and at temperatures below 30°C (86°F). Some special liquid formulations should be stored in the refrigerator. If your veterinarian has made a special formulation, follow the storage instructions provided with the product.

What should I do in case of an emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.

Analogues, what helps, side effects

THERE ARE CONTRAINDICATIONS. POSSIBLE SIDE EFFECTS. A SPECIALIST’S CONSULTATION IS REQUIRED.Antibiotics in capsulesAntibiotics in tabletsAntibiotic ointments

Author of the article

Anisimova Kristina Vasilievna,

Pharmacist

All authors

Contents of the article 90 011

• Is metronidazole an antibiotic or not
• What does Metronidazole help with
• How to take Metronidazole
• Side effects of Metronidazole
• Metronidazole during pregnancy
• Metronidazole and alcohol
• Ask an expert on the topic of the article

In Europe alone, 25,000 cases per year do not work with antibiotics. People are dying. This is due to the development of resistance of microorganisms to commonly prescribed drugs. But while there is metronidazole, an antiprotozoal agent with an antibacterial effect, which causes resistance less often than other drugs.

Let’s tell you what it helps with, what side effects and contraindications it has, and also compare it with analogues.

All products Metronidazole 21 review

Metronidazole is an antibiotic or not

The drug has an antimicrobial effect, so experts are often asked the question: “Metronidazole – is it an antibiotic or not?”. Yes, Metronidazole is an antibiotic. However, it is primarily used as an antiprotozoal agent. It is 99% effective against Trichomonas, Amoebas and Giardia.

Metronidazole contains the active ingredient of the same name. Its mechanism of action is to block the DNA of microorganisms, because of which they die. The resistance of bacteria and protozoa to it develops much less frequently than to other antibiotics. For example, bacteria have C. difficile resistance to metronidazole is 1%, and to ciprofloxacin – 95%.

You may be interested in: Broad Spectrum Antibiotics for Children and Adults

What Metronidazole Helps with

Here is a list of extensive indications for the use of Metronidazole:

• infections caused by protozoa (protozoal infections): Trichomonas vaginitis, Trichomonas urethritis, amoebiasis
• bone and joint infections, CNS infections (including meningitis, brain abscess), bacterial endocarditis, pneumonia
• abdominal infections (peritonitis, liver abscess), pelvic infections (endometritis, endomyometritis, fallopian tube and ovarian abscess, vaginal fornix infections after surgery), skin and soft tissue infections
• sepsis
• gastritis or duodenal ulcer associated with Helicobacter pylori colitis
• alcoholism
• prevention of postoperative complications
• radiation therapy of patients with tumors

Metronidazole is often prescribed:

• for inflammation of the uterine appendages
• for cystitis in women (as a consequence of trichomoniasis)
• for moderately severe giardiasis without complications
• for diarrhea caused by susceptible bacteria
• men with Trichomonas urethritis

How to take Metronidazole

Metronidazole is available in the following dosage forms and dosages:

• tablets 0. 25 g, 0.5 g
• solution for infusion 0.5%
• vaginal suppositories 0.5 g
• gel for external use 1%

Metronidazole tablets are taken before or after meals with plenty of water.

Dosing regimens for tablets and other forms depend on the diagnosis and severity of the disease, the dosage and duration of treatment are selected by the doctor.

Side effects of Metronidazole

When prescribing Metronidazole, the doctor should warn the patient about possible side effects and take into account contraindications.

The most common side effects are:

• diarrhea, anorexia, nausea, vomiting, intestinal colic, constipation, metallic taste in the mouth, dry mouth
• dizziness, incoordination
• allergic reactions: urticaria, skin rash, skin flushing, nasal congestion
• candidiasis, red-brown urine.

Metronidazole during pregnancy

The drug passes through the placental barrier and into breast milk. There are no data on the effect on the development of the fetus and child. In this regard, it is forbidden to use Metronidazole during pregnancy and during breastfeeding.

Metronidazole and alcohol

Metronidazole is incompatible with alcoholic beverages – if taken simultaneously, acute intoxication of the body develops. Possible consequences after a “cocktail” of alcohol and Metronidazole: redness of the face and body, increased blood pressure, trembling, vomiting. In some cases, death is possible.

All products Trichopolum 20 reviews

All products Ornidazole 19 reviews

All products Tinidazole 20 reviews

Consider analogues of the drug Metronidazole.

• Trichopolum. It contains the same active ingredient – Metronidazole. It is produced in Poland in the form of tablets of 0.25 g for internal use and in the form of vaginal tablets of 0.5 g. The indications and contraindications of the drugs are identical. Differences are only in the forms of release and manufacturers of substances. Both drugs are generics of the original metronidazole – Flagyl.
• Choosing what is better Metronidazole or Trichopolum is necessary taking into account the disease and the treatment regimen prescribed by the doctor. The effectiveness of the drugs is the same.
• Tinidazole is an antiprotozoal drug, like metronidazole. It has a similar mechanism of action. Tinidazole is taken 1 time per day for up to three days. Metronidazole – 2-3 times a day for up to 7 days, depending on the indications.
• Difference between Tinidazole and Metronidazole: The former is used mainly for the treatment of infections caused by protozoa and is not used for bacterial infections. Metronidazole is the drug of choice for bacterial vaginosis.
• Ornidazole. The active substance is ornidazole, also an antiprotozoal agent. The difference with Metronidazole lies in the greater effectiveness of Ornidazole in trichomoniasis, in the convenience of using it in a short course and in the frequency of administration – 2 times a day for 3-5 days. Ornidazole has a higher safety profile. It is used in patients with renal and hepatic insufficiency, in the second and third trimester of pregnancy under medical supervision. Unlike Metronidazole, it is compatible with alcohol.

Having examined Metronidazole, we learned that this drug belongs to antiprotozoal agents with antibacterial activity. This group of drugs helps to get rid of trichomoniasis, giardiasis, amoebiasis, bacterial vaginosis, and is used to prevent infections during operations. Do not drink alcohol during treatment with Metronidazole. Including taking alcohol-containing medicines with caution.

Metronidazole is a prescription drug. Compared with analogues, it has a wider range of indications and a variety of dosage forms. Inferior to them in ease of use and safety, as it can cause more “side effects”.

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Metronidazole: instruction, price, analogues | Compendium – drug guide

Metronidazole , which has been widely used for many years to treat trichomoniasis, amebiasis and jardiasis, has recently shown activity against anaerobic bacteria. Serum, cerebrospinal fluid and tissue concentrations are bactericidal, the required concentration is reached after the usual doses administered orally or intravenously, or higher doses administered rectally (suppository). Prospective studies (dividing study participants into groups who will or will not receive the test substance) have shown that the addition of metronidazole to preoperative bowel preparation regimens reduces the incidence of postoperative infection and eliminates anaerobic infection. Similarly, anaerobic infection after acute appendectomy or hysterectomy was virtually eliminated with metronidazole given before and for 1 week after surgery. Metronidazole has been successfully used to treat anaerobic infections of the chest, head, gastrointestinal tract and genitourinary system, as well as anaerobic septicemia and bacteremia.

Metronidazole is the most active drug available against obligate anaerobes and is likely to be of great value in the treatment of serious infections caused by these organisms. Although the lack of formal comparative studies in many areas of its use makes it difficult to clearly determine the relative therapeutic efficacy of metronidazole compared with other drugs such as clindamycin, chloramphenicol or penicillin, it is nevertheless a very effective tool for the treatment and prevention of anaerobic infections.

Antimicrobial activity: metronidazole, like other nitroimidazoles such as tinidazole, is active in vitro against obligate anaerobes, but does not show clinically significant activity against facultative anaerobes, obligate aerobes or microaerophilic bacteria, except Campylobacter 9016 3 fetus . At concentrations that are easily achieved in serum after oral, rectal or intravenous administration, metronidazole is active against Bacteroides fragilis and B. melaninogenicus , Fusobacterium spp. , Clostridium perfringens and other species Clostridium . However, it is generally less active against non-spore-forming Gram-positive bacteria such as Actinomyces spp. , Propionibacterium spp. , Bifidobacterium spp. and Eubacterium sp. ; it is also somewhat less active against Gram-positive cocci ( Peptostreptococcus and Peptococcus spp. ), but less sensitive strains are usually not obligate anaerobes. Against susceptible organisms, metronidazole is usually bactericidal at concentrations equal to or slightly above the minimum inhibitory concentration.

Mechanism of action

. Exact mechanism of action Metronidazole is unclear, but it appears that once it enters the cell, it is somehow reduced and bound to deoxyribonucleic acid.

Toxicological studies

. Long-term toxicity of metronidazole has been considered in strains of mice and various animal species, however, neurological disorders appear in dogs not observed in other animal species. High oral doses caused weight loss and testicular atrophy in one strain of mice and in rats, while intravenous metronidazole did not affect the rate of weight gain in rats and did not cause any significant changes in blood pressure or hematological or biochemical parameters. Histological changes in the liver without associated changes in the level of enzymes in the blood serum were detected in monkeys receiving high doses. Doses up to 1 g/kg body weight per day for 5 weeks did not cause a dominant lethal effect in mice. An increased incidence of lung tumors and malignant lymphomas has been reported in Swiss mice studied in one laboratory, but not in species 9 rats. 0162 Sprague-Dawley or hamsters studied by other investigators. Further studies have not been able to demonstrate that Metronidazole induces DNA synthesis or is mutagenic in male mice as a result of an inherited translocation procedure.

A recent retrospective study by the Mayo Clinic showed that the course of oncopathology in women treated with metronidazole for the treatment of infections T. vaginalis did not differ significantly from that in other women in this group without the use of metronidazole, based on the observed number of cases in a larger population.

Pharmacokinetics

. Metronidazole appears to be readily absorbed after oral administration. Peak serum concentrations are reached 1-3 hours after a single dose, but serum levels vary depending on the assay method used. Microbiological analysis is advantageous as it indicates therapeutic activity but does not distinguish between the parent substance and some of its metabolites. After a single dose of 250 mg, the peak serum concentration is about 5 μg / ml, determined using gas-liquid chromatography. The bioavailability of metronidazole does not appear to be significantly reduced by concomitant food intake.

Distribution studies in healthy individuals and patients show that Metronidazole easily penetrates the cerebrospinal fluid and reaches therapeutic concentrations. Metronidazole has a high volume of distribution and is only slightly bound to serum proteins.

Metronidazole is excreted from the human body primarily by metabolism resulting from side chain oxidation, hydroxylation or conjugation of the parent compound. Within 24 hours after oral administration of metronidazole, the recovery of the total amount of nitro derivatives in the urine is 35–65% of the dose when determined by chemical analysis and 15–20% when using bioassay. In the biliary tract, metronidazole is found in hepatic bile at concentrations similar to those found in serum and at therapeutic concentrations in the gallbladder (no abnormalities). The reported half-life ranged from 6.2 to 11.5 hours in healthy subjects. The area under the serum concentration-time curve did not differ significantly in patients with normal or impaired renal function.

Metronidazole for anaerobic infections

. Anaerobes are responsible for various types of infections and are often found in clinical specimens of abdominal abscess, peritonitis, chest empyema, and female genital tract infections. Although the distinction between isolates that are commensals or contaminants and isolates that are true pathogens is sometimes difficult to distinguish from routine specimens, anaerobes have been shown to play a major role in postoperative infections associated with the abdominal cavity. Species Bacteroides is frequently isolated from abdominal abscesses and wounds and in mixed culture from infections associated with loss of intestinal mucosal integrity and operations on the female genital tract.

Metronidazole administered orally, rectally or intravenously has been successfully used to treat a wide range of intra-abdominal anaerobic infections, anaerobic infections resulting from operations and injuries of the female genital tract, anaerobic infections of the chest, anaerobic infections of the head (brain abscess), periodontal infections, otitis media, bone and joint infections, as well as anaerobic bacteremia and endocarditis (several cases). Sometimes the effectiveness of metronidazole was difficult to determine, since it was used in combination with antibacterial drugs active against aerobic and anaerobic bacteria. However, metronidazole was effective in the treatment of sepsis caused by anaerobic bacteria resistant to chloramphenicol and clindamycin and bacteremias that do not respond to clindamycin,

Metronidazole has been shown to be effective in anaerobic infections of the chest and anaerobic infections of the soft tissues of the pelvis in obstetrics and gynecology, but has not been compared in formal therapeutic studies with currently used antimicrobials. Of the several drugs available for the treatment of anaerobic pleuropulmonary infections, penicillin is the drug of choice for the treatment of B. fragilis infection. Although some clinicians consider (large documentation) that clindamycin is the alternative of choice in penicillin-sensitive patients, others would prefer to use metronidazole.

For complex anaerobic pelvic infections, clinicians in some parts of the world will consider Metronidazole the drug of choice over chloramphenicol and clindamycin, the current drugs of choice in other countries.

Because metronidazole readily penetrates into the cerebrospinal fluid, some clinicians consider it to be superior to chloramphenicol in the treatment of anaerobic meningitis. Based on available data, it appears to be relatively non-toxic.

In endocarditis ( B. fragilis ) Metronidazole may become the drug of choice due to its rapid bactericidal action and should probably be included in the antimicrobial therapy regimen.

Prospective studies in patients undergoing elective colon surgery have shown that the administration of metronidazole before and within 7 days after surgery, in combination with other antimicrobials, significantly reduces the incidence of postoperative infection and eliminates anaerobic infection that does not cause sporulation. Wound infections caused by facultative organisms have occurred in some patients treated with metronidazole, but generally less frequently than in untreated patients.

Administration of metronidazole 1–2 g at admission and 200 mg 3 times daily for up to 7 days postoperatively reduced the incidence of infections and virtually eliminated anaerobic infection after emergency appendectomy or elective hysterectomy.

The indications for the use of prophylactic antibiotics in elective bowel surgery are still being debated, but studies using metronidazole in addition to kanamycin, neomycin, or phthalylsulfathiazole strongly suggest that anaerobic bacteria (especially Bacteroides spp. ) are the main factors of intra-abdominal and wound infection after colon surgery.

Side effects

. Rarely observed in patients treated with metronidazole for anaerobic infections. The use of doses exceeding the usual, led to rare cases of parasthesia of the feet and hands, peripheral neuropathy and epileptiform seizures. Further studies are needed to determine the frequency and nature of side effects that may occur with higher doses and longer duration of metronidazole treatment, sometimes necessary for the treatment of severe anaerobic infections.

Dosing regimen

. In the treatment of anaerobic infections, the usual adult oral dose is 400 mg 3 times a day for 7 days or longer according to clinical response. The oral dose for infants and children is 7.5 mg/kg body weight 3 times a day. When using rectal suppositories, adults should receive 1 g 3 times a day for 3 days, and then inject every 12 hours for 4 days, the corresponding pediatric (age 5-12 years) dose is 0.5 g (half the adult dose). Children aged 1 to 5 years should receive the 250 mg pediatric dose; for children under the age of 1 year, the dose is 125 mg.

By intravenous infusion, the usual adult dose is 500 mg in 100 ml of solution every 8 hours, administered at a rate of 5 ml per minute. For children under 12 years of age, the intravenous dose is 7.5 mg/kg body weight.

In the prevention of anaerobic infection in gynecological surgery, 1 g orally as a single dose before surgery, and immediately after surgery, 200 mg orally 3 times a day for up to 7 days is recommended. During planned surgical intervention on the colon Metronidazole has been successfully used in the following schedule: 1 g as a single dose before surgery, after surgery 200 mg every 8 hours (if oral medications are possible, and if not, then 1 g rectally every 8 hours for periods when oral preparations are not possible, only 7 days of treatment) and when administered simultaneously with kanamycin or phthalylsulfathiazole (Brogden R.