Ver el código de «Metronidazole»

==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 (Acute)|Tetanus]]===
{{Tetanus Antibiotics Adults}}

==Pediatric Dosing==
{{Metronidazole Weight Based}}

===Bacterial Vaginosis===
{{BV Metronidazole Weight Based}}

====Prophylaxis (sexual Assault)====
{{BV Metronidazole Prophylaxis Weight Based}}

===[[Tetanus]]===
Same as [[Metronidazole#Pediatric_Dosing|Standard Pediatric Age/Weight Dosing]]

==Special Populations==
*Pregnancy: [[Drug Ratings in 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
*Disulfiram 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|Disulfiram effect]] (should abstain from ETOH at least two days after last dose)
*[[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]]<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==
*[[Antibiotics (Main)]]

==References==
<references/>

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