Metronidazole: Difference between revisions
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==General==
==General==
*Type: Other Antibacterials
*Type: Other [[antibiotics]]
*Dosage Forms:  
*Dosage Forms:  
**IV
**IV
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===General===
===General===
*'''PO'''
*'''PO'''
**500 mg PO q6-8h x 7-10 days
**500mg PO q6-8h x 7-10 days
**First Dose: 500 mg PO x 1
**First Dose: 500mg PO x 1
*'''IV'''
*'''IV'''
**15mg/kg IV x1, then 7.5mg/kg IV q6h
**15mg/kg IV x1, then 7.5mg/kg IV q6h
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*Max: 1 gram/dose
*Max: 1 gram/dose


===Amebic Liver Abscess===
===[[Amebic liver abscess]]===
*500-750 mg PO q8h x 5-10 days
*500-750mg PO q8h x 5-10 days


===Colorectal Surgery Infection Prophylaxis===
===Colorectal Surgery Infection Prophylaxis===
*15 mg/kg IV x 1
*15mg/kg IV x 1
*Complete infusion 1h prior to surgery, then 7.5 mg/kg IV q6h x 2
*Complete infusion 1h prior to surgery, then 7.5mg/kg IV q6h x 2
*Max: 1 g/dose
*Max: 1 g/dose


===Intestinal Amebiasis===
===Intestinal [[Amebiasis]]===
*750mg PO q8h x 5-10 days
*750mg PO q8h x 5-10 days


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*See [[PID]] for full regimen
*See [[PID]] for full regimen


===Bacterial Vaginosis===
===[[Bacterial Vaginosis]]===
*Treatment
*500mg PO q12 x 7 days
**500mg PO q12 x 7 days
*Alt: May use 250mg PO q8h x 7 days in pregnant patients
**Alt: May use 250mg PO q8h x 7 days in pregnant patients
*Prophylaxis ([[Sexual Assault]])
*Prophylaxis ([[Sexual Assault]])
**2 g PO x 1
**2 g PO x 1


===Trichomoniasis===
===[[Trichomoniasis]]===
*Treatment
*Treatment
**Immunocompetent: 2 g PO x 1
**Immunocompetent: 2 g PO x 1
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**2 g PO x 1
**2 g PO x 1


===Giardiasis===
===[[Giardiasis]]===
*250mg PO q8h x 5-7 days
*250mg PO q8h x 5-7 days
*Alt: 2 g PO q 24h x 3 days
*Alt: 2 g PO q 24h x 3 days
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**500mg IV q8h (give with [[vancomycin]] PO)
**500mg IV q8h (give with [[vancomycin]] PO)


===H. pylori===
===[[H. pylori]]===
*250-375mg PO q6h x 10-14 days (in combination)
*250-375mg PO q6h x 10-14 days (in combination)


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*2 g PO x 1 (with azithromycin)
*2 g PO x 1 (with azithromycin)


===Tetanus==
===[[Tetanus (Acute)|Tetanus]]===
[[Metronidazole]] 500 mg  IV every 6 hours (see pediatric dosing below)
{{Tetanus Antibiotics Adults}}
;Pediatric
*Neonates (0-28 days): 7.5 mg/kg IV or orally every 12 hours
*Infants and children: 30 mg/kg/day IV divided every 6 hours, maximum 4 g/day


==Pediatric Dosing==
==Pediatric Dosing==
===General (<1200g)===
{{Metronidazole Weight Based}}
*7.5 mg/kg PO/IV q48h
*First Dose: 7.5 mg/kg PO/IV x 1


===General (>1200g AND <1 Month Old)===
===Bacterial Vaginosis===
*'''<7 days old'''
{{BV Metronidazole Weight Based}}
**7.5-15 mg/kg/day PO/IV q12-24h
**First Dose: 7.5-15 mg/kg PO/IV x 1
*'''>7 days old'''
**15-30 mg/kg/day PO/IV q12h
**First Dose: 7.5-15 mg/kg PO/IV x 1


===General (>1 Month Old)===
====Prophylaxis (sexual Assault)====
*30 mg/kg/day PO/IV q6h
{{BV Metronidazole Prophylaxis Weight Based}}
*First Dose: 7.5 mg/kg PO/IV x 1
*Max: 4 g/day


===Bacterial Vaginosis===
===[[Tetanus]]===
*Treatment
Same as [[Metronidazole#Pediatric_Dosing|Standard Pediatric Age/Weight Dosing]]
**<45kg
***15 mg/kg/day PO divided q12h x 7 days
***First Dose: 7 mg/kg PO x 1
***Max: 1 g/day
**>45kg
***500mg PO divided q8h x 7 days
***First Dose: 500mg PO x 1
***Max: 2 g/day
*Prophylaxis (sexual Assult)
**<45kg
***15 mg/kg/day PO divided q8h x 7 days
***First Dose: 7 mg/kg PO x 1
**>45kg
***2 g PO x 1


==Special Populations==
==Special Populations==
*Pregnancy: B
*Pregnancy: [[Drug Ratings in Pregnancy|B]]
*Lactation: Safety conditional
*Lactation: Safety conditional
*Renal Dosing
*Renal Dosing
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===Common===
===Common===
*[[Disulfiram_effect|Disulfiram effect]]
*[[Nausea and Vomiting]]
*[[Nausea and Vomiting]]
*Epigastric discomfort
*Epigastric discomfort
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*Excretion: Urine (70%); feces (15%)
*Excretion: Urine (70%); feces (15%)
*Mechanism of Action: Bactericidal
*Mechanism of Action: Bactericidal
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||R
|-
| ||[[Strep. Pneumoniae]]||R
|-
| ||[[Viridans strep]]||X1
|-
| ||Strep. anginosus gp||X1
|-
| ||[[Enterococcus faecalis]]||R
|-
| ||[[Enterococcus faecium]]||R
|-
| ||[[MSSA]]||R
|-
| ||[[MRSA]]||R
|-
| ||[[CA-MRSA]]||R
|-
| ||[[Staph. Epidermidis]]||R
|-
| ||[[C. jeikeium]]||R
|-
| ||[[L. monocytogenes]]||R
|-
| Gram Negatives||[[N. gonorrhoeae]]||R
|-
| ||[[N. meningitidis]]||R
|-
| ||[[Moraxella catarrhalis]]||R
|-
| ||[[H. influenzae]]||R
|-
| ||[[E. coli]]||R
|-
| ||[[Klebsiella]] sp||R
|-
| ||E. coli/Klebsiella ESBL+||R
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||R
|-
| ||[[Enterobacter]] sp, AmpC pos||R
|-
| ||[[Serratia]] sp||X1
|-
| ||Serratia marcescens||R
|-
| ||[[Salmonella]] sp||R
|-
| ||[[Shigella]] sp||R
|-
| ||[[Proteus mirabilis]]||X1
|-
| ||[[Proteus vulgaris]]||R
|-
| ||[[Providencia sp.]]||X1
|-
| ||[[Morganella sp.]]||X1
|-
| ||[[Citrobacter freundii]]||X1
|-
| ||[[Citrobacter diversus]]||X1
|-
| ||[[Citrobacter sp.]]||X1
|-
| ||[[Aeromonas sp]]||X1
|-
| ||[[Acinetobacter sp.]]||R
|-
| ||[[Pseudomonas aeruginosa]]||R
|-
| ||[[Burkholderia cepacia]]||R
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||R
|-
| ||[[Francisella tularensis]]||R
|-
| ||[[Brucella sp.]]||R
|-
| ||[[Legionella sp.]]||R
|-
| ||[[Pasteurella multocida]]||X1
|-
| ||[[Haemophilus ducreyi]]||R
|-
| ||[[Vibrio vulnificus]]||R
|-
| Misc||[[Chlamydophila sp]]||R
|-
| ||[[Mycoplasm pneumoniae]]||R
|-
| ||[[Rickettsia sp]]||R
|-
| ||[[Mycobacterium avium]]||R
|-
| Anaerobes||[[Actinomyces]]||R
|-
| ||[[Bacteroides fragilis]]||'''S'''
|-
| ||[[Prevotella melaninogenica]]||'''S'''
|-
| ||[[Clostridium difficile]]||'''S'''
|-
| ||[[Clostridium (not difficile)]]||''S+'''
|-
| ||[[Fusobacterium necrophorum]]||'''S'''
|-
| ||[[Peptostreptococcus sp.]]||I
|}
===Key===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
*Epocrates
<references/>


[[Category:Drugs]]
[[Category:Pharmacology]]
[[Category:ID]]

Revision as of 23:26, 22 September 2019

General

  • Type: Other antibiotics
  • Dosage Forms:
    • IV
    • PO: 250mg; 375mg; 500mg
  • Common Trade Names: Flagyl

Adult Dosing

General

  • PO
    • 500mg PO q6-8h x 7-10 days
    • First Dose: 500mg PO x 1
  • IV
    • 15mg/kg IV x1, then 7.5mg/kg IV q6h
    • First Dose: 15mg/kg IV x1
  • Max: 1 gram/dose

Amebic liver abscess

  • 500-750mg PO q8h x 5-10 days

Colorectal Surgery Infection Prophylaxis

  • 15mg/kg IV x 1
  • Complete infusion 1h prior to surgery, then 7.5mg/kg IV q6h x 2
  • Max: 1 g/dose

Intestinal Amebiasis

  • 750mg PO q8h x 5-10 days

PID

  • 500mg PO q12 x 14 days
  • See PID for full regimen

Bacterial Vaginosis

  • 500mg PO q12 x 7 days
  • Alt: May use 250mg PO q8h x 7 days in pregnant patients
  • Prophylaxis (Sexual Assault)
    • 2 g PO x 1

Trichomoniasis

  • Treatment
    • Immunocompetent: 2 g PO x 1
    • Immunocompromised: 500mg PO q12h x 7 days
  • Prophylaxis (Sexual Assault)
    • 2 g PO x 1

Giardiasis

  • 250mg PO q8h x 5-7 days
  • Alt: 2 g PO q 24h x 3 days

C. Difficile

  • Mild-mod
    • 500mg PO q8h x 10-14 days
  • Severe

H. pylori

  • 250-375mg PO q6h x 10-14 days (in combination)

Urethritis, recurrent/persistent (Non-Gonococcal)

  • 2 g PO x 1 (with azithromycin)

Tetanus

  • 500 mg IV every 6 hours

Pediatric Dosing

(<1200g)

  • 7.5 mg/kg PO/IV q48h
  • First Dose: 7.5 mg/kg PO/IV x 1

(>1200g AND <1 Month Old)

  • <7 days old
    • 7.5-15 mg/kg/day PO/IV q12-24h
    • First Dose: 7.5-15 mg/kg PO/IV x 1
  • >7 days old
    • 15-30 mg/kg/day PO/IV q12h
    • First Dose: 7.5-15 mg/kg PO/IV x 1

(>1 Month Old)

  • 30 mg/kg/day PO/IV q6h
  • First Dose: 7.5 mg/kg PO/IV x 1
  • Max: 4 g/day

Bacterial Vaginosis

<45kg
  • 15 mg/kg/day PO divided q12h x 7 days
  • First Dose: 7 mg/kg PO x 1
  • Max: 1 g/day
>45kg
  • 500mg PO divided q8h x 7 days
  • First Dose: 500mg PO x 1
  • Max: 2 g/day

Prophylaxis (sexual Assault)

<45kg'

  • 15 mg/kg/day PO divided q8h x 7 days
  • First Dose: 7 mg/kg PO x 1

>45kg

  • 2 g PO x 1

Tetanus

Same as Standard Pediatric Age/Weight Dosing

Special Populations

  • Pregnancy: B
  • Lactation: Safety conditional
  • Renal Dosing
    • Adult
      • No adjustment for renal insufficiency
      • Hemodialysis: Give dose after dialysis
      • Peritoneal Dialysis: No supplement
    • Pediatric
      • CrCl <10: Decrease dose 50%
      • Hemodialysis: Give dose after dialysis
      • Peritoneal Dialysis: No supplement
  • Hepatic Dosing (Adult & Pediatric)
    • Severe impairment: decrease dose, amount not defined

Contraindications

  • Black Box: carcinogenic in mice and rats; avoid unnecessary use; reserved for approved conditions
  • Allergy to class/drug
  • Pregnancy (single 2 dose retimen)
  • Alcohol use within 3 days
  • Disulfram use within 14 days

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 8h
  • Metabolism: Liver; CYP450: 2C9 inhibitor
  • Excretion: Urine (70%); feces (15%)
  • Mechanism of Action: Bactericidal

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G R
Strep. Pneumoniae R
Viridans strep X1
Strep. anginosus gp X1
Enterococcus faecalis R
Enterococcus faecium R
MSSA R
MRSA R
CA-MRSA R
Staph. Epidermidis R
C. jeikeium R
L. monocytogenes R
Gram Negatives N. gonorrhoeae R
N. meningitidis R
Moraxella catarrhalis R
H. influenzae R
E. coli R
Klebsiella sp R
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg R
Enterobacter sp, AmpC pos R
Serratia sp X1
Serratia marcescens R
Salmonella sp R
Shigella sp R
Proteus mirabilis X1
Proteus vulgaris R
Providencia sp. X1
Morganella sp. X1
Citrobacter freundii X1
Citrobacter diversus X1
Citrobacter sp. X1
Aeromonas sp X1
Acinetobacter sp. R
Pseudomonas aeruginosa R
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica R
Francisella tularensis R
Brucella sp. R
Legionella sp. R
Pasteurella multocida X1
Haemophilus ducreyi R
Vibrio vulnificus R
Misc Chlamydophila sp R
Mycoplasm pneumoniae R
Rickettsia sp R
Mycobacterium avium R
Anaerobes Actinomyces R
Bacteroides fragilis S
Prevotella melaninogenica S
Clostridium difficile S
Clostridium (not difficile) S+'
Fusobacterium necrophorum S
Peptostreptococcus sp. I

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. ↑ Sanford Guide to Antimicrobial Therapy 2014
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