Metronidazole

Metronidazole - High activity against anaerobic bacteria and protozoa. It is also effective in the treatment of Clostridium difficile-associated disease preferably given by the oral route. IV metronidazole may be used in patients with impaired gastric emptying and/or ileus.

Uses
Clostridium difficile-associated diarrhoea
Anaerobic infections
Protozoal infections (Trichomonas vaginalis, Giardia intestinalis and amoebic dysentery)
Bacterial vaginosis
Eradication of Helicobacter pylori

Administration
• Clostridium difficile-associated diarrhoea
  Orally: 400 mg 8 hourly
  IV: 500 mg 8 hourly
• Anaerobic infections
  IV: 500 mg 8 hourly
  PR: 1 g 8 hourly
• Eradication of Helicobacter pylori

Metronidazole 400 mg PO/NG 12 hourly and proton pump inhibitor standard dose (e.g. lansoprazole 30 mg/omeprazole 20 mg)
PO/NG 12 hourly and amoxicillin 1 g PO/NG 12 hourly or clarithromycin 500 mg PO/NG 12 hourly; all for 7 days. IV eradication
therapy has less evidence of success than oral; therefore preferably wait until PO/NG route is available.

Adverse effects
Nausea and vomiting
Unpleasant taste
Rashes, urticaria and angioedema
Darkening of urine
Peripheral neuropathy (prolonged treatment)

Cautions
Hepatic impairment
Disulfiram-like reaction with alcohol