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metronidazole

Pronunciation

Generic Name: metronidazole (me troe NI da zole)
Brand Name: Flagyl, Flagyl 375, Flagyl ER, Flagyl I.V. RTU, Metro I.V., Protostat, Flagyl I.V., Metryl

What is metronidazole?

Metronidazole is an antibiotic. It fights bacteria in your body.

Metronidazole is used to treat bacterial infections of the vagina, stomach, skin, joints, and respiratory tract. This medication will not treat a vaginal yeast infection.

Metronidazole may also be used for purposes not listed in this medication guide.

What is the most important information I should know about metronidazole?

Take this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Metronidazole will not treat a viral infection such as the common cold or flu.

Slideshow: Is it Safe to Give Human Medicine to Pets?

Always get your pet's drug and dose recommendation from the veterinarian.

Do not drink alcohol while you are taking metronidazole and for at least 3 days after you stop taking it. You may have unpleasant side effects such as fast heartbeats, warmth or redness under your skin, tingly feeling, nausea, and vomiting.

What should I discuss with my healthcare provider before taking metronidazole?

You should not use this medication if you are allergic to metronidazole, or if you are in the first trimester of pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Before taking metronidazole, tell your doctor if you are allergic to any drugs, or if you have:

  • liver disease;

  • a stomach or intestinal disease such as Crohn's disease;

  • a blood cell disorder such as anemia (lack of red blood cells) or leukopenia (lack of white blood cells);

  • epilepsy or other seizure disorder; or

  • nerve disorders.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication.

Metronidazole can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take metronidazole?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Take the extended-release metronidazole tablet (Flagyl ER) on an empty stomach, at least 1 hour before or 2 hours after eating a meal.

Do not crush, chew, or break an extended-release tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time.

Take this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Metronidazole will not treat a viral infection such as the common cold or flu.

To be sure this medication is not causing harmful effects, your blood may need to be tested often. Your liver function may also need to be tested. Visit your doctor regularly.

This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using metronidazole.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, vomiting, dizziness, loss of balance or coordination, numbness and tingling, or seizures (convulsions).

What should I avoid while taking metronidazole?

Do not drink alcohol while you are taking metronidazole and for at least 3 days after you stop taking it. You may have unpleasant side effects such as fast heartbeats, warmth or redness under your skin, tingly feeling, nausea, and vomiting.

Check the labels of any medicines or food products you use to make sure they do not contain alcohol.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking metronidazole and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Metronidazole side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

  • numbness or tingling in your hands or feet;

  • white patches or sores inside your mouth or on your lips;

  • pain or burning when you urinate;

  • diarrhea that is watery or bloody;

  • vision problems, pain behind your eyes;

  • trouble concentrating, slurred speech, mood or behavior changes, tremors, muscle twitching, seizure (convulsions);

  • fever, chills, muscle pain, confusion, headache, sore throat, neck stiffness, increased sensitivity to light, drowsiness, nausea and vomiting; or

  • severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Less serious side effects may include:

  • stomach pain, diarrhea;

  • dizziness, loss of balance;

  • vaginal itching or discharge;

  • dry mouth or unpleasant metallic taste;

  • cough, sneezing, runny or stuffy nose; or

  • swollen or sore tongue.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Metronidazole dosing information

Usual Adult Dose for Bacterial Infection:

Serious anaerobic infections:
IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-Infections of the bone and joint, lower respiratory tract, and endocardium may require longer treatment.

Approved indications: For the treatment of serious infections due to susceptible anaerobic bacteria; such infections include intraabdominal infections (including peritonitis, intraabdominal abscess, liver abscess), skin and skin structure infections, gynecologic infections (including endometritis, endomyometritis, tuboovarian abscess, postsurgical vaginal cuff infection), bacterial septicemia, bone and joint infections (as adjunctive therapy), CNS infections (including meningitis, brain abscess), lower respiratory tract infections (including pneumonia, empyema, lung abscess), and endocarditis

Usual Adult Dose for Amebiasis:

Acute intestinal amebiasis (acute amebic dysentery): 750 mg orally 3 times a day for 5 to 10 days
Amebic liver abscess: 500 to 750 mg orally 3 times a day for 5 to 10 days

Comments:
-Aspiration or drainage of pus is still needed for amebic liver abscess.

Some experts recommend:
Mild to moderate intestinal disease: 500 to 750 mg orally 3 times a day for 7 to 10 days
Severe intestinal and extraintestinal disease: 750 mg orally 3 times a day for 7 to 10 days

Usual Adult Dose for Pseudomembranous Colitis:

(Not approved by FDA)

Mild to moderate Clostridium difficile infection (CDI): 500 mg orally 3 times a day
Severe, complicated CDI: 500 mg IV every 8 hours
Duration of therapy: 10 days

Comments:
-Metronidazole is the drug of choice for initial episode of mild to moderate CDI.
-Vancomycin (oral or rectal) with or without IV metronidazole is the regimen of choice for initial episode of severe, complicated CDI.
-Metronidazole should not be used beyond the first recurrence of CDI or for long-term chronic therapy due to possible neurotoxicity.

Usual Adult Dose for Surgical Prophylaxis:

Initial preoperative dose: 15 mg/kg IV infused over 30 to 60 minutes and completed about 1 hour before surgery
Intraoperative/postoperative dose: 7.5 mg/kg IV infused over 30 to 60 minutes at 6 and 12 hours after the initial dose

Comments:
-Should be administered, if needed, at 6-hour intervals to maintain effective drug levels
-Prophylactic use of metronidazole should be stopped within 12 hours after surgery.

Approved indication: For surgical prophylactic use, to prevent postoperative infection in contaminated or potentially contaminated colorectal surgery

Usual Adult Dose for Trichomoniasis:

1-day regimen: 2 g orally as a single dose (or as 1 g twice on the same day)

7-day regimen:
Tablets: 250 mg orally 3 times a day for 7 consecutive days
Capsules: 375 mg orally twice a day for 7 consecutive days

Comments:
-The dose regimen should be individualized in females and males; some patients may tolerate 1 regimen more than the other.
-The patient's sexual partner(s) should also be evaluated/treated.
-Some studies indicate the 7-day regimen may have higher cure rates (according to vaginal smears, signs/symptoms) than the 1-day regimen.
-Single-dose therapy can assure compliance (especially if supervised) if cannot rely on patient to complete the 7-day regimen.
-A 7-day regimen may minimize reinfection by protecting patient long enough for sexual partner(s) to get appropriate treatment.
-Pregnant patients should not be treated during the first trimester; if alternative therapy was not adequate in a pregnant patient, the 1-day regimen is not recommended (results in higher serum levels which can reach fetal circulation).
-When repeat courses are needed, an interval of 4 to 6 weeks between courses and reconfirmation of Trichomonas vaginalis by appropriate laboratory testing are recommended; total and differential leukocyte counts recommended before and after retreatment.
-T vaginalis can interfere with abnormal cytological smear assessment; additional smears recommended after parasite eradication.
-Individual decision whether to treat asymptomatic male partners with negative/no cultures; a woman may become reinfected if her sexual partner is not treated; since isolating T vaginalis from asymptomatic male carriers can be considerably difficult, negative smears and cultures cannot be relied upon.
-Sexual partner(s) should be treated with metronidazole in cases of reinfection.

Approved indications:
-Symptomatic trichomoniasis: For the treatment of Trichomonas vaginalis infection in females and males when confirmed by appropriate laboratory procedures (wet smears and/or cultures)
-Asymptomatic trichomoniasis: For the treatment of asymptomatic T vaginalis infection in females when associated with endocervicitis, cervicitis, or cervical erosion
-Treatment of asymptomatic sexual partners: For the simultaneous treatment of asymptomatic sexual partners of treated patients if T vaginalis is present to prevent reinfection of the partner

CDC recommendations:
Recommended regimen: 2 g orally as a single dose
Alternative regimen: 500 mg orally twice a day for 7 days

Comments:
-If treatment failure occurs with single-dose therapy and reinfection is excluded, 500 mg orally twice a day for 7 days is recommended; for patients failing this regimen, 2 g orally for 5 days should be considered.
-Sexual partner(s) should be treated simultaneously with the same dose; appropriate treatment of sexual partner(s) may increase reported cure rates.
-Male partners of women who fail nitroimidazole therapy should be evaluated and treated with 500 mg orally twice a day for 7 days.
-Women can be treated with 2 g orally as a single dose at any stage of pregnancy.
-In women coinfected with trichomoniasis and HIV, single-dose therapy was not as effective as 500 mg orally twice a day for 7 days; this 7-day regimen should be considered for HIV-infected women.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Helicobacter pylori Infection:

Some experts recommend:
Bismuth quadruple therapy: 250 mg orally 4 times a day
Clarithromycin-based triple therapy: 500 mg orally twice a day
Duration of therapy: 10 to 14 days

Comments:
-Bismuth quadruple therapy is one recommended primary therapy; includes (a proton pump inhibitor [PPI] or histamine-2 receptor antagonist), bismuth, metronidazole, and tetracycline.
-Clarithromycin-based triple therapy is another recommended primary therapy; includes a PPI, clarithromycin, and (amoxicillin or metronidazole).

Usual Adult Dose for Pelvic Inflammatory Disease:

IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-The patient's sexual partner(s) should also be evaluated/treated.

Approved indications: For the treatment of serious gynecologic infections (including endometritis, tuboovarian abscess) due to susceptible anaerobic bacteria

CDC recommendations:
Mild to moderately severe acute pelvic inflammatory disease (PID): 500 mg orally twice a day for 14 days

Comments:
-Recommended regimens for outpatient, oral therapy include ceftriaxone plus doxycycline with or without metronidazole, cefoxitin/probenecid plus doxycycline with or without metronidazole, or other parenteral third-generation cephalosporin plus doxycycline with or without metronidazole.
-Since anaerobic organisms are suspected in the etiology of PID, the addition of metronidazole should be considered; also, metronidazole effectively treats bacterial vaginosis, which is often associated with PID.
-When tuboovarian abscess is present, metronidazole with doxycycline is recommended for continued therapy; provides more effective anaerobic coverage than doxycycline alone.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Bacterial Vaginosis:

Extended-release tablets: 750 mg orally once a day for 7 consecutive days

Comments:
-The patient's sexual partner(s) should also be evaluated/treated.
-Extended-release tablets should be taken at least 1 hour before or 2 hours after meals (under fasting conditions).
-Extended-release tablets should not be split, chewed, or crushed.

Approved indication: For the treatment of bacterial vaginosis in nonpregnant women

CDC recommendations:
Nonpregnant women:
Immediate-release tablets (recommended regimen): 500 mg orally every 12 hours for 7 days
Extended-release tablets (alternative regimen): 750 mg orally once a day for 7 days

Pregnant women:
Immediate-release tablets: 500 mg orally twice a day for 7 days or 250 mg orally 3 times a day for 7 days

Comments:
-Treatment is recommended for all women with symptoms.

Usual Adult Dose for Aspiration Pneumonia:

IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-Infections of the lower respiratory tract may require longer treatment.
-IV therapy should be continued until the clinical condition stabilizes and fever subsides then oral therapy may be substituted.
-Therapy of documented anaerobic pleuropulmonary infections should be continued until the infiltrate is cleared or a residual scar forms, sometimes for as long as 2 to 4 months.

Approved indications: For the treatment of serious lower respiratory tract infections due to susceptible anaerobic bacteria

Usual Adult Dose for Bacteremia:

IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.

Approved indications: For the treatment of serious infections due to susceptible anaerobic bacteria; such infections include bacterial septicemia and CNS infections (including meningitis)

Usual Adult Dose for Meningitis:

IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.

Approved indications: For the treatment of serious infections due to susceptible anaerobic bacteria; such infections include bacterial septicemia and CNS infections (including meningitis)

Usual Adult Dose for Diverticulitis:

IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.

Approved indications: For the treatment of serious intraabdominal infections (including peritonitis, intraabdominal abscess, liver abscess) due to susceptible anaerobic bacteria

Usual Adult Dose for Intraabdominal Infection:

IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.

Approved indications: For the treatment of serious intraabdominal infections (including peritonitis, intraabdominal abscess, liver abscess) due to susceptible anaerobic bacteria

Usual Adult Dose for Peritonitis:

IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.

Approved indications: For the treatment of serious intraabdominal infections (including peritonitis, intraabdominal abscess, liver abscess) due to susceptible anaerobic bacteria

Usual Adult Dose for Endocarditis:

IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-Infections of the endocardium may require longer treatment; about 4 to 6 weeks has been recommended.

Approved indications: For the treatment of serious infections (such as endocarditis) due to susceptible anaerobic bacteria

Usual Adult Dose for Joint Infection:

IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-Infections of the joint may require longer treatment; approximately 3 to 4 weeks or longer therapy (6 weeks or more; for prosthetic joint infections) has been recommended.

Approved indications: For the treatment of serious joint infections (as adjunctive therapy) due to susceptible anaerobic bacteria

Usual Adult Dose for Osteomyelitis:

IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-Infections of the joint may require longer treatment; about 4 to 6 weeks has been recommended; chronic osteomyelitis may require an additional 1 to 2 months of antibiotic therapy.

Approved indications: For the treatment of serious bone infections (as adjunctive therapy) due to susceptible anaerobic bacteria

Usual Adult Dose for Pneumonia:

IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-Infections of the lower respiratory tract may require longer treatment; up to 21 days has been recommended.

Approved indications: For the treatment of serious lower respiratory tract infections (including pneumonia) due to susceptible anaerobic bacteria

Usual Adult Dose for Skin or Soft Tissue Infection:

IV:
Loading dose: 15 mg/kg IV
Maintenance dose: 7.5 mg/kg IV every 6 hours

Oral: 7.5 mg/kg orally every 6 hours

Maximum dose: 4 g per day
Usual duration of therapy: 7 to 10 days

Comments:
-IV metronidazole should be infused over 1 hour.
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-Some experts recommend continuing therapy for 3 days after resolution of acute inflammation; for more severe infections (such as diabetic soft tissue infections) 14 to 21 days of therapy may be required.

Approved indications: For the treatment of serious skin and skin structure infections due to susceptible anaerobic bacteria

Usual Adult Dose for Giardiasis:

(Not approved by FDA)

Some experts recommend: 250 mg orally 3 times a day for 5 to 7 days

Usual Adult Dose for STD Prophylaxis:

(Not approved by FDA)

CDC recommendations:
Prophylaxis after sexual assault: 2 g orally as a single dose

Comments:
-Metronidazole plus (ceftriaxone or cefixime) plus (azithromycin or doxycycline) is the recommended empiric antimicrobial regimen for chlamydia, gonorrhea, and trichomonas.

Usual Adult Dose for Nongonococcal Urethritis:

(Not approved by FDA)

CDC recommendations:
Recurrent or persistent urethritis: 2 g orally as a single dose

Comments:
-If the patient was compliant with the initial regimen and reexposure can be excluded, metronidazole plus azithromycin (if not used for initial episode) is recommended while waiting for results of diagnostic tests.

Usual Adult Dose for Balantidium coli:

(Not approved by FDA)

Some experts recommend: 500 to 750 mg orally 3 times a day for 5 days

Comments:
-Recommended as an alternative agent.

Usual Adult Dose for Dientamoeba fragilis:

(Not approved by FDA)

Some experts recommend: 500 to 750 mg orally 3 times a day for 10 days

Usual Pediatric Dose for Bacterial Infection:

(Not approved by FDA)

American Academy of Pediatrics (AAP) General Dosing Recommendations for Susceptible Infections:
Neonates:
7 days or less, 2000 g or less: 7.5 mg/kg IV every 24 to 48 hours
7 days or less, greater than 2000 g: 15 mg/kg IV every 24 hours
8 to 28 days, 2000 g or less: 15 mg/kg IV every 24 hours
8 to 28 days, greater than 2000 g: 15 mg/kg IV every 12 hours

1 month or older:
IV: 22.5 to 40 mg/kg/day IV in 3 divided doses
Maximum dose: 1.5 g/day

Oral: 30 to 50 mg/kg/day orally in 3 divided doses
Maximum dose: 2.25 g/day

Comments:
-Therapy may start with a 15 mg/kg loading dose and the longer dosing interval may be used in extremely low birth weight (less than 1 kg) neonates.

Usual Pediatric Dose for Amebiasis:

35 to 50 mg/kg/day orally in 3 divided doses for 10 days
Maximum dose: 750 mg/dose

Comments:
-Aspiration or drainage of pus is still needed for amebic liver abscess.
-Some experts (includes AAP) recommend this dose for mild to severe intestinal and extraintestinal disease; duration of therapy recommended is 7 to 10 days.

Approved indications: For the treatment of acute intestinal amebiasis (amebic dysentery) and amebic liver abscess

Usual Pediatric Dose for Pseudomembranous Colitis:

(Not approved by FDA)

AAP recommendations:
Children and adolescents: 30 mg/kg/day orally in 4 divided doses
Maximum dose: 2 g/day
Duration of therapy: At least 10 days

Comments:
-Antimicrobial therapy for C difficile infection is recommended for symptomatic patients.
-Metronidazole is the drug of choice for initial treatment of mild to moderate diarrhea and for first relapse.
-Vancomycin enema plus IV metronidazole is recommended as initial therapy for patients with severe disease and for patients who do not respond to oral metronidazole.
-Metronidazole should not be used beyond the first recurrence or for chronic therapy due to possible neurotoxicity.

Usual Pediatric Dose for Trichomoniasis:

(Not approved by FDA)

Some experts (includes AAP) recommend:
Children less than 45 kg with prepubertal vaginitis (sexually transmitted infection [STI]-related): 15 mg/kg/day orally in 3 divided doses for 7 days
Maximum dose: 2 g/day

Adolescent vulvovaginitis: 2 g orally as a single dose

Comments:
-If treatment failure occurs in adolescents and reinfection is excluded, 500 mg orally twice a day for 7 days is recommended.
-The patient's sexual partner(s) should be treated simultaneously with the same dose.

Usual Pediatric Dose for Bacterial Vaginosis:

(Not approved by FDA)

Children less than 45 kg with prepubertal vaginitis (STI-related): 15 mg/kg/day orally in 2 divided doses for 7 days
Maximum dose: 1 g/day

Adolescent vulvovaginitis: 500 mg orally twice a day for 7 days

Comments:
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Giardiasis:

(Not approved by FDA)

Some experts (includes AAP) recommend: 15 mg/kg/day orally in 3 divided doses for 5 to 7 days
Maximum dose: 250 mg/dose

Usual Pediatric Dose for STD Prophylaxis:

(Not approved by FDA)

Prophylaxis after Sexual Assault:
AAP recommendations for preadolescent children:
Less than 45 kg: 15 mg/kg/day orally in 3 divided doses for 7 days
Maximum dose: 2 g/day

45 kg or more: 2 g orally as a single dose

Comments:
-Metronidazole plus ceftriaxone plus (azithromycin or erythromycin) is the recommended empiric antimicrobial regimen for patients less than 45 kg.
-Metronidazole plus (ceftriaxone or cefixime) plus (azithromycin or doxycycline [if at least 8 years of age]) is the recommended empiric antimicrobial regimen for patients at least 45 kg.

CDC recommendations for adolescents: 2 g orally as a single dose

Comments:
-Metronidazole plus (ceftriaxone or cefixime) plus (azithromycin or doxycycline) is the recommended empiric antimicrobial regimen for chlamydia, gonorrhea, and trichomonas.

Usual Pediatric Dose for Balantidium coli:

(Not approved by FDA)

Some experts (includes AAP) recommend: 35 to 50 mg/kg/day orally in 3 divided doses for 5 days
Maximum dose: 750 mg/dose

Comments:
-Recommended as an alternative agent.

Usual Pediatric Dose for Dientamoeba fragilis:

(Not approved by FDA)

Some experts (includes AAP) recommend: 35 to 50 mg/kg/day orally in 3 divided doses for 10 days
Maximum dose: 750 mg/dose

What other drugs will affect metronidazole?

Tell your doctor about all other medicines you use, especially:

  • cimetidine (Tagamet);

  • seizure medication such as phenytoin (Dilantin) or phenobarbital (Luminal, Solfoton);

  • a blood thinner such as warfarin (Coumadin, Jantoven);

  • lithium (Lithobid, Eskalith, others); or

  • disulfiram (Antabuse).

This list is not complete and other drugs may interact with metronidazole. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about metronidazole.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 10.01. Revision Date: 2011-02-14, 3:28:42 PM.

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