? All forms of amoebiasis (intestinal & extra-intestinal disease including liver abscess & that of symptomless cyst passers) ? Trichomoniasis ? Giardiasis ? Bacterial vaginosis ? Acute ulcerative gingivitis ? Anaerobic infections including septicaemia, bacteremia, peritonitis, brain abscess, necrotising pneumonia, osteomyelitis, puerperal sepsis, pelvic abscess, pelvic cellulitis etc. ? Anaerobically-infected leg ulcers & pressure sores ? Acute dental infections (e.g. acute pericoronitis & acute apical infections) ? Surgical prophylaxis (prevention of postoperative infections due to anaerobic bacteria, particularly species of bacteroides & anaerobic streptococci ? Chronic symptomatic peptic ulcer disease (as an agent of triple therapy to eradicate H. pylori-the most important aetiological factor of peptic ulcer)
5-Nitroimidazole; Antiprotozoal/Antibacterial
Metronidazole is a member of the imidazole class of antibacterial drug and is classified therapeutically as an antiprotozoal agent. The 5-nitro group of Metronidazole is reduced by anaerobes metabolically. Studies have demonstrated that the reduced form of this drug interacts with DNA and gives bactericidal action of Metronidazole.
ORAL Amoebiasis; Balantidlasis; Blastocystis hominis infection: Adult: 400-800 mg tid for 5-10 days or 1.5-2.5 g as a single daily dose for 2-3 days. Alternatively, 1.5-2.5 g as a single dose for 2-3 days. Child: 1-3 yr:1/4 adult dose; 3-7 yr:1/3adult dose; 7-10 yr: 1 /2adult dose. Alternatively, 35-50 mg/kg daily in divided doses. Elderly: Use lower end of adult dose recommendations. Do not admin as a single dose. Trichomoniasis: Adult: 2 g as a single dose, or 800 mg in the morning & 1.2 g in the evening for 2 days, or 0.6-1 g daily in 2-3 divided doses for 7 days. There should be an interval of 4-6 wk if treatment needs to be repeated. Child: 1-3 yr: 50 mg tid; 3-7 yr: 100 mg bid; 7-10 yr: 100 mg tid. All doses to be taken for 7 days. Alternatively, 15 mg/kg daily in divided doses for 7 days. Elderly: Use lower end of adult dose recommendations. Do not admin as a single dose. Giardiasis: Adult: 2 g once daily for 3 consecutive days, or 400 mg tid for 5 days, or 500 mg bid for 7-10 days. Child: 1-3 yr: - adult dose; 3-7 yr:1/3 adult dose; 7-10 yr: 1/2 adult dose. Alternatively, 15 mg/ kg daily in divided doses. Elderly: Use lower end of adult dose recommendations. Do not admin as a single dose.
Disulfiram: Psychotic reactions have been reported in patients who were using metronidazole and disulfiram concurrently.
Alcohol: Alcoholic beverages and drugs containing alcohol should not be consumed during therapy and for at least one day afterwards because of the possibility of a disulfiram-like (antabuse effect) reaction (flushing, vomiting, tachycardia). Oral anticoagulant therapy (warfarin type): Potentiation of the anticoagulant effect and increased hemorrhagic risk caused by decreased hepatic catabolism. In case of co-administration, prothrombin time should be more frequently monitored and anticoagulant therapy adjusted during treatment with metronidazole.
Lithium: Plasma levels of lithium may be increased by metronidazole.
Cyclosporin: Serum cyclosporin and serum creatinine should be closely monitored when co-administration is necessary.
Phenytoin or phenobarbital: increased elimination of metronidazole resulting in reduced plasma levels.
5-Fluorouracil: Reduced clearance of 5-fluorouracil resulting in increased toxicity of 5-fluorouracil.
Busulfan: Plasma levels of busulfan may be increased by metronidazole, which may lead to severe busulfan toxicity.
History of hypersensitivity to metronidazole or other nitroimidazole derivatives. Pregnancy (1st trimester) & lactation. Patients w/ CNS diseases; discontinue IV therapy if abnormal neurologic symptoms occur. History of seizure disorder. Evidence or a history of blood dyscrasias; perform total & differential leukocyte counts before & after treatment. Severe hepatic impairment: monitor plasma levels. Predisposition to oedema (inj contains sodium). Prolonged use may result in fungal or bacterial superinfection.
Metalic taste, furred tongue, nausea, vomiting, diarrhoea, drowsiness, rashes & mild reversible leucopenia may be observed during treatment.
Not recommended during first & later trimesters. Breast feeding should be delayed until 48 hours after discontinuing metronidazole in the mother.
Single oral doses of metronidazole, up to 12 g have been reported in suicide attempts and accidental overdoses. Symptoms were limited to vomiting, ataxia and slight disorientation. There is no specific antidote for metronidazole overdosages. In case of suspected massive overdosages, a symptomatic and supportive treatment should be instituted.
Store below 30°C. Keep protected from light. Keep medicines out of the reach of children. Do not use later than the date of expiry.
.png&w=384&q=75)