Diferencia entre revisiones de «Metronidazole»
(Remove disease-specific entries now covered by AntibioticDose (6 sections))
 
(No se muestran 16 ediciones intermedias de 8 usuarios)
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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===
*500-750 mg PO q8h x 5-10 days


===Colorectal Surgery Infection Prophylaxis===
*15 mg/kg IV x 1
*Complete infusion 1h prior to surgery, then 7.5 mg/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===
===Indications by Disease===
*Treatment
{{#ask: [[Has DrugName::Metronidazole]] [[Has Population::Adult]]
**500mg PO q12 x 7 days
|?Treats disease=Disease
**Alt: May use 250mg PO q8h x 7 days in pregnant patients
|?Has Dose=Dose
*Prophylaxis ([[Sexual Assault]])
|?Has Context=Context
**2 g PO x 1
|format=table
 
|limit=50
===Trichomoniasis===
|mainlabel=-
*Treatment
|headers=show
**Immunocompetent: 2 g PO x 1
|sort=Treats disease
**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==
==Pediatric Dosing==
{{Metronidazole Weight Based}}
{{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]]
===Indications by Disease===
{{#ask: [[Has DrugName::Metronidazole]] [[Has Population::Pediatric]]
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
}}


==Special Populations==
==Special Populations==
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*Pregnancy (single 2 dose retimen)
*Pregnancy (single 2 dose retimen)
*Alcohol use within 3 days
*Alcohol use within 3 days
*Disulfram use within 14 days
*Disulfiram use within 14 days


==Adverse Reactions==
==Adverse Reactions==
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===Common===
===Common===
*[[Disulfiram_effect|Disulfiram effect]] (should abstain from ETOH at least two days after last dose)
*[[Nausea and Vomiting]]
*[[Nausea and Vomiting]]
*Epigastric discomfort
*Epigastric discomfort
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*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


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


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

Revisión actual - 11:07 20 mar 2026

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



Indications by Disease

DiseaseDoseContext
Acute diarrhea250mg PO q8hrs for 7-10daysGiardia
Acute diarrhea750mg PO three times daily for 5-10 daysEntamoeba
Acute necrotizing ulcerative gingivitis500mg PO three times daily x 7 daysUncomplicated
Acute tetanus500mg IV (7.5mg/kg) q6hrsActive tetanus
Amebiasis750mg PO q8h x 5-10 daysIntestinal colitis
Ascending cholangitis500mg IV q8hrsCombined with ciprofloxacin
Bacterial vaginosis500mg PO Twice a day x 7 daysSexual Assault Prophylaxis
Bacterial vaginosis500mg PO Twice a day x 7 daysPregnant
Bacterial vaginosis500 mg PO Twice Daily for 7 daysFirst Line
Brain abscess500mg IV q6hrOtogenic
Clostridium difficile500mg PO or IV three times daily for 10 daysNon-Severe (third line)
Diabetic foot infection500mg IV q8hrsInpatient DFI
Diverticulitis500mg PO Q8h x 5 daysUncomplicated, PCN allergy
Diverticulitis500mg PO Q8hrsUncomplicated, Alternative
Epidural abscess (spinal)500mg (7.5mg/kg) q6 hrsEmpiric
Giardia lamblia250mg PO q8h x 5-7 days; Alt: 2 g PO q 24h x 3 daysGiardiasis
Helicobacter pylori250-375mg PO q6h x 10-14 days (in combination)H. pylori
Ludwig's angina500 mg IV q6 hrsImmunocompetent
Ludwig's angina500 mg IV q6 hrsImmunocompromised
Mammalian bites500mg IV q8hrsSevere mammalian bite infection with Ceftriaxone
Pelvic inflammatory disease500mg IV or PO q12hrInpatient
Pelvic inflammatory disease500mg PO BID x 14 daysOutpatient; recommended empirically by CDC and European guidelines
Peritonitis500mg IV q8hrsPrimary
Peritonitis500mg IV q8hrsAllergy/Prior exposure
Peritonsillar abscess500mg QIDOutpatient
Peritonsillar abscess500mg IV three times dailyInpatient
Postpartum endometritis500mg IV or PO q8hrs>48hrs postpartum; combined with Doxycycline
Trichomonas vaginalis500mg PO BID for 7 daysPregnant
Trichomonas vaginalis500mg PO BID for 7 daysNon-Pregnant
Urethritis in men2 g PO in a single doseRecurrent/Persistent, Trichomonas

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



Indications by Disease

DiseaseDoseContext
Acute tetanus7.5mg/kg IV q6hrs (max 500mg/dose) x 7-10 daysPediatric Active tetanus
Brain abscess7.5mg/kg IV q6hrs (max 500mg)Pediatric Empiric
Clostridium difficile7.5mg/kg PO/IV TID x 10 days (max 500mg/dose)Pediatric Non-Severe (third line)
Epidural abscess (spinal)7.5mg/kg IV q6hrs (max 500mg)Pediatric Empiric
Infectious tenosynovitis7.5mg/kg IV four times dailyPediatrics
Ludwig's angina7.5mg/kg IV q6hrs (max 500mg)Pediatric Immunocompetent
Ludwig's angina7.5mg/kg IV q6hrs (max 500mg)Pediatric Immunocompromised
Mammalian bites7.5mg/kg IV q8hrs (max 500mg)Pediatric Severe with Ceftriaxone
Peritonitis7.5mg/kg IV q8hrs (max 500mg)Pediatric
Peritonsillar abscess7.5mg/kg IV q8hrs (max 500mg/dose)Pediatric Inpatient
TetanusSame as Standard Pediatric Age/Weight DosingTetanus

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
  • Disulfiram 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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