Metronidazole: Difference between revisions
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==General== | ==General== | ||
*Type: Other | *Type: Other [[antibiotics]] | ||
*Dosage Forms: | *Dosage Forms: | ||
**IV | **IV | ||
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===General=== | ===General=== | ||
*'''PO''' | *'''PO''' | ||
** | **500mg PO q6-8h x 7-10 days | ||
**First Dose: | **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 | ||
Line 16: | Line 16: | ||
*Max: 1 gram/dose | *Max: 1 gram/dose | ||
===Amebic | ===[[Amebic liver abscess]]=== | ||
*500- | *500-750mg PO q8h x 5-10 days | ||
===Colorectal Surgery Infection Prophylaxis=== | ===Colorectal Surgery Infection Prophylaxis=== | ||
* | *15mg/kg IV x 1 | ||
*Complete infusion 1h prior to surgery, then 7. | *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]]=== | ||
*500mg PO q12 x 7 days | |||
*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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*[[Antibiotics (Main)]] | *[[Antibiotics (Main)]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[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
- 500mg IV q8h (give with vancomycin PO)
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
- Adult
- 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
- Seizures
- Aseptic meningitis
- Perifpheral neuropathy
- Optic neuropathy
- Encephalopathy
- Hypersensitivity Reaction
- Stevens-Johnson Syndrome
- Toxic Epidermal Necrolysis
- Leukopenia
- Carcinogenicity (in animals)
Common
- Disulfiram effect
- Nausea and Vomiting
- Epigastric discomfort
- Diarrhea
- Metallic taste
- Rash
- Headache
- Dizziness
- Dark reddish-brown urine
- Candidiasis
- Thrombophlebitis (IV use)
Pharmacology
- Half-life: 8h
- Metabolism: Liver; CYP450: 2C9 inhibitor
- Excretion: Urine (70%); feces (15%)
- Mechanism of Action: Bactericidal
Antibiotic Sensitivities[1]
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
- ↑ Sanford Guide to Antimicrobial Therapy 2014