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Metronidazole Dosage

Applies to the following strength(s): 500 mg ; 250 mg ; 375 mg ; 750 mg ; 500 mg/100 mL ; benzoate ; 50 mg/mL ; 100 mg/mL

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for Bacterial Infection

IV:
-Loading dose: 15 mg/kg IV once infused over 1 hour
-Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

ORAL:
Immediate-release Capsules and Tablets: 7.5 mg/kg orally every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

Comments:
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-IV therapy may be changed to oral when conditions warrant, based upon severity of disease and response of the patient.
-Infections of the bone and joint, lower respiratory tract, and endocardium may require longer treatment.

Uses: For the treatment of serious infections due to susceptible anaerobic bacteria including:
-Gynecologic infections, including endometritis, endomyometritis, tubo-ovarian abscess, and postsurgical vaginal cuff infection, caused by Bacteroides species including the B fragilis group, Clostridium species, Peptococcus species, Peptostreptococcus species, and Fusobacterium species
-Bacterial septicemia caused by Bacteroides species including the B fragilis group and Clostridium species
-Central nervous system (CNS) infections, including meningitis and brain abscess, caused by Bacteroides species including the B fragilis group
-Lower respiratory tract infections, including pneumonia, empyema, and lung abscess, caused by Bacteroides species including the B fragilis group
-Endocarditis caused by Bacteroides species including the B fragilis group

The Infectious Diseases Society of America (IDSA) recommends:
Surgical Site Infections:
-IV: 500 mg IV every 8 hours in combination with ceftriaxone, ciprofloxacin, or levofloxacin

Uses: For the treatment of infections following operations on the axilla, gastrointestinal tract, perineum, or female genital tract

Usual Adult Dose for Amebiasis

Acute Intestinal Amebiasis (Acute Amebic Dysentery):
-Immediate-release capsules and tablets: 750 mg orally 3 times a day for 5 to 10 days

Amebic Liver Abscess:
-Immediate-release capsules and tablets: 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.

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

Usual Adult Dose for Pseudomembranous Colitis

The manufacturer gives no specific dosing instructions.

The IDSA and The Society for Healthcare Epidemiology of America (SHEA) recommend:
Mild to moderate Clostridium difficile infection (CDI) initial episode:
ORAL:
-Immediate release tablets: 500 mg orally 3 times a day for 10 to 14 days

Severe, complicated CDI:
-IV: 500 mg IV every 8 hours with oral vancomycin

Comments:
-Metronidazole is the drug of choice for initial episode of mild to moderate CDI.
-Vancomycin orally (or rectally if ileus is present) 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
Following initial 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 should be limited to the day of surgery, following the above guidelines.

Use: For surgical prophylaxis to prevent postoperative infection in contaminated or potentially contaminated colorectal surgery

The IDSA, SHEA, The American Society of Health-System Pharmacists (ASHP), and The Surgical Infection Society (SIS) recommend:
-IV: 500 mg IV 1 hour before surgery; duration of prophylaxis for all procedures should be less than 24 hours

Colorectal Surgery Prophylaxis:
-Oral: 1 g orally in 3 divided doses over about 10 hours beginning after the mechanical bowl preparation the afternoon or evening before the procedure

Comments:
-May be used in combination with other antibiotics.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Trichomoniasis

Immediate-release Capsules: 375 mg orally twice a day for 7 consecutive days

Immediate-release Tablets:
-One-day regimen: 2 g orally as a single dose or 1 g twice given in the same day
-Seven-day regimen: 250 mg orally 3 times a day for 7 consecutive days

Comments:
-Single-dose regimens can assure compliance, however, a 7-day course may minimize reinfection by protecting the patient long enough for the sexual contact to be treated.
-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.
-If repeat courses are required, an interval of 4 to 6 weeks should elapse between courses and the presence of the trichomonad be reconfirmed by appropriate laboratory testing.
-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).

Uses:
-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

The Center for Disease Control and Prevention (CDC) recommends:
Immediate-release Tablets:
-Recommended regimen: 2 g orally as a single dose
-Alternative regimen: 500 mg orally twice a day for 7 days

Trichomoniasis in HIV-infected women:
-Immediate-release tablets: 500 mg orally twice a day for 7 days

Treatment failure with single-dose therapy and reinfection is excluded:
-Immediate-release tablets: 500 mg orally twice a day for 7 days; for patients failing this regimen, 2 g orally once a day for 7 days should be considered

Comments:
-Sexual partner(s) should be treated simultaneously with the same dose; appropriate treatment of sexual partner(s) may increase reported cure rates.
-Women can be treated with 2 g orally as a single dose at any stage of pregnancy.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Helicobacter pylori Infection

The manufacturer gives no specific dosing instructions.

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

The manufacturer gives no specific dosing instructions.

The CDC recommends:
Mild to moderately severe acute pelvic inflammatory disease (PID):
-Immediate-release tablets: 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 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: Should be taken under fasting conditions at least 1 hour before or 2 hours after meals.

Use: For the treatment of bacterial vaginosis in non-pregnant women

The CDC recommends:
-Immediate-release tablets: 500 mg orally twice a day for 7 days

Comments:
-Treatment is recommended for all women with symptoms.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Intraabdominal Infection

IV:
-Loading dose: 15 mg/kg IV once infused over 1 hour
-Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

ORAL:
Immediate-release capsules and tablets: 7.5 mg/kg orally every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

Comments:
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-IV therapy may be changed to oral when conditions warrant, based upon severity of disease and response of the patient.
-Infections of the bone and joint, lower respiratory tract, and endocardium may require longer treatment.

Uses: For the treatment of intraabdominal infections, including intra-abdominal abscess and liver abscess, caused by Bacteroides species including the B fragilis group (B fragilis, B distasonis, B ovatus, B thetaiotaomicron, B vulgatus), Clostridium species, Eubacterium species, Peptococcus species, and Peptostreptococcus species

The IDSA and SIS recommend:
-Immediate-release tablets: 500 mg IV every 8 to 12 hours or 1500 mg IV every 24 hours

Use: For empiric treatment of complicated intraabdominal infection

Usual Adult Dose for Peritonitis

IV:
-Loading dose: 15 mg/kg IV once infused over 1 hour
-Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

ORAL:
Immediate-release capsules and tablets: 7.5 mg/kg orally every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

Comments:
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-IV therapy may be changed to oral when conditions warrant, based upon severity of disease and response of the patient.
-Infections of the bone and joint, lower respiratory tract, and endocardium may require longer treatment.

Uses: For the treatment of intraabdominal infections, including intra-abdominal abscess and liver abscess, caused by Bacteroides species including the B fragilis group (B fragilis, B distasonis, B ovatus, B thetaiotaomicron, B vulgatus), Clostridium species, Eubacterium species, Peptococcus species, and Peptostreptococcus species

The IDSA and SIS recommend:
-Immediate-release tablets: 500 mg IV every 8 to 12 hours or 1500 mg IV every 24 hours

Use: For empiric treatment of complicated intraabdominal infection

Usual Adult Dose for Liver Abscess

IV:
-Loading dose: 15 mg/kg IV once infused over 1 hour
-Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

ORAL:
Immediate-release capsules and tablets: 7.5 mg/kg orally every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

Comments:
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-IV therapy may be changed to oral when conditions warrant, based upon severity of disease and response of the patient.
-Infections of the bone and joint, lower respiratory tract, and endocardium may require longer treatment.

Uses: For the treatment of intraabdominal infections, including intra-abdominal abscess and liver abscess, caused by Bacteroides species including the B fragilis group (B fragilis, B distasonis, B ovatus, B thetaiotaomicron, B vulgatus), Clostridium species, Eubacterium species, Peptococcus species, and Peptostreptococcus species

The IDSA and SIS recommend:
-Immediate-release tablets: 500 mg IV every 8 to 12 hours or 1500 mg IV every 24 hours

Use: For empiric treatment of complicated intraabdominal infection

Usual Adult Dose for Joint Infection

IV:
-Loading dose: 15 mg/kg IV once infused over 1 hour
-Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

ORAL:
Immediate-release capsules and tablets: 7.5 mg/kg orally every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

Comments:
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-IV therapy may be changed to oral when conditions warrant, based upon severity of disease and response of the patient.
-Infections of the bone and joint, lower respiratory tract, and endocardium may require longer treatment.

Uses: As adjunctive therapy for the treatment of bone and joint infections caused by Bacteroides species including B fragilis group

The IDSA recommends:
Native Vertebral Osteomyelitis (NVO): 500 mg orally 3 to 4 times a day

Comments:
-Can be used in the initial course of NVO due to Bacteroides species and other susceptible anaerobes.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Osteomyelitis

IV:
-Loading dose: 15 mg/kg IV once infused over 1 hour
-Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

ORAL:
Immediate-release capsules and tablets: 7.5 mg/kg orally every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

Comments:
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-IV therapy may be changed to oral when conditions warrant, based upon severity of disease and response of the patient.
-Infections of the bone and joint, lower respiratory tract, and endocardium may require longer treatment.

Uses: As adjunctive therapy for the treatment of bone and joint infections caused by Bacteroides species including B fragilis group

The IDSA recommends:
Native Vertebral Osteomyelitis (NVO): 500 mg orally 3 to 4 times a day

Comments:
-Can be used in the initial course of NVO due to Bacteroides species and other susceptible anaerobes.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Skin or Soft Tissue Infection

IV:
-Loading dose: 15 mg/kg IV once infused over 1 hour
-Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

ORAL:
Immediate-release capsules and tablets: 7.5 mg/kg orally every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

Comments:
-The first IV maintenance dose should be started 6 hours after the start of the loading dose.
-IV therapy may be changed to oral when conditions warrant, based upon severity of disease and response of the patient.
-Infections of the bone and joint, lower respiratory tract, and endocardium may require longer treatment.

Use: Skin and skin structure infections caused by Bacteroides species including the B fragilis group, Clostridium species, Peptococcus species, Peptostreptococcus species, and Fusobacterium species

The IDSA recommends:
Necrotizing infection: 500 mg IV every 6 hours in combination with cefotaxime

Comments:
-Antimicrobial therapy should be continued until further debridement is no longer needed, the patient has improved clinically, and fever has been absent for 48 to 72 hours.
-Current guidelines should be consulted for additional information.

Use: For the treatment of necrotizing infections of the skin, fascia, and muscle

Usual Adult Dose for Giardiasis

The manufacturer gives no specific dosing instructions.

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

Usual Adult Dose for STD Prophylaxis

The manufacturer gives no specific dosing instructions.

The CDC recommends:
-Immediate-release tablets: 2 g orally once as a single dose in combination with ceftriaxone and azithromycin

Use: For sexually transmitted disease (STD) prophylaxis following sexual assault or abuse

Usual Adult Dose for Nongonococcal Urethritis

The manufacturer gives no specific dosing instructions.

The CDC recommends:
Recurrent or persistent urethritis:
-Immediate-release tablets: 2 g orally once as a single dose

Comments:
-Use should be reserved for recurrent or persistent urethritis in men who have sex with women in areas where T vaginalis is prevalent.
-Sexual partners should be referred for evaluation and appropriate treatment.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Balantidium coli

The manufacturer gives no specific dosing instructions.

The CDC recommends
-Immediate-release tablets: 500 to 750 mg orally 3 times a day for 5 days

Usual Adult Dose for Dientamoeba fragilis

The manufacturer gives no specific dosing instructions.

The CDC recommends
-Immediate-release tablets: 500 to 750 mg orally 3 times a day for 10 days

Usual Adult Dose for Wound Infection

The manufacturer gives no specific dosing instructions.

The IDSA recommends:
-Oral: 250 to 500 mg orally 3 times a day
-IV: 500 mg IV every 8 hours

Comments:
-May be used in combination with other antibiotics.
-Current guidelines should be consulted for additional information.

Uses: For the treatment of infections following animal or human bites

Usual Pediatric Dose for Bacterial Infection

The manufacturer gives no specific dosing instructions.

The American Academy of Pediatrics (AAP) recommends:
Neonates:
7 days or less:
-Up to 2 kg: 7.5 mg/kg IV every 12 hours
-Greater than 2 kg: 7.5 mg/kg IV every 8 hours
8 to 28 days:
-Up to 2 kg: 7.5 mg/kg IV every 12 hours
-Greater than 2 kg: 7.5 mg/kg IV every 6 hours

Postmenstrual age less than 34 weeks: 7.5 mg/kg IV every 12 hours
Postmenstrual age 34 to 40 weeks: 7.5 mg/kg IV every 8 hours
Postmenstrual age greater than 40 weeks: 7.5 mg/kg IV every 6 hours

Comments:
-All categories (for body weight 2 kg or less and greater than 2 kg; for 7 days or less and 8 to 28 days of age; and all categories of postmenstrual age) should receive a loading dose of 15 mg/kg IV once.
-The longer dosing interval may be used in extremely low birth weight (less than 1 kg) neonates until 2 weeks of life.
-Current guidelines should be consulted for additional information.

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

Usual Pediatric Dose for Amebiasis

Immediate release capsules and tablets: 35 to 50 mg/kg/day orally in 3 divided doses for 10 days

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

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

Usual Pediatric Dose for Pseudomembranous Colitis

The manufacturer gives no specific dosing instructions.

The AAP recommends.
1 month or older: 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.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Trichomoniasis

The manufacturer gives no specific dosing instructions.

The AAP recommends:
Children less than 45 kg: 45 mg/kg/day orally in 3 divided doses for 7 days
-Maximum dose: 2 g per day

Adolescent vulvovaginitis: 2 g orally once as a single dose

Comments:
-The patient's sexual partner(s) should be treated simultaneously.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bacterial Vaginosis

The manufacturer gives no specific dosing instructions.

The AAP recommends:
Children less than 45 kg: 45 mg/kg/day orally in 3 divided doses for 7 days
-Maximum dose: 2 g per day

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

Comments:
-All women with symptoms should be treated.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Giardiasis

The manufacturer gives no specific dosing instructions.

Some experts 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

The manufacturer gives no specific dosing instructions.

The CDC recommends:
-Adolescents: 2 g orally once as a single dose in combination with ceftriaxone and azithromycin

Use: For sexually transmitted disease (STD) prophylaxis following sexual assault or abuse

Usual Pediatric Dose for Balantidium coli

The manufacturer gives no specific dosing instructions.

The AAP recommends: 35 to 50 mg/kg/day orally in 3 divided doses for 5 days
Maximum dose: 750 mg/dose

Usual Pediatric Dose for Dientamoeba fragilis

The manufacturer gives no specific dosing instructions.

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

Usual Pediatric Dose for Pelvic Inflammatory Disease

The manufacturer gives no specific dosing instructions.

The CDC recommends:
Adolescents:
Mild to moderately severe acute pelvic inflammatory disease (PID):
-Immediate-release tablets: 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 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 Pediatric Dose for Surgical Prophylaxis

The manufacturer gives no specific dosing instructions.

The IDSA, SHEA, ASHP, and SIS recommend:
Less than 1 month:
-Less than 1.2 kg: 7.5 mg/kg IV once
-Greater than or equal to 1.2 kg: 15 mg/kg IV once

1 month or older: 15 mg/kg IV once

Comments:
-The maximum pediatric doses should not exceed the usual adult dose of 500 mg.
-Duration of prophylaxis for all procedures should be less than 24 hours.
-Current guidelines should be consulted for additional information.

Colorectal Surgery Prophylaxis:
1 year or older:
-Oral: 15 mg/kg orally in 3 divided doses over about 10 hours beginning after the mechanical bowl preparation the afternoon or evening before the procedure

Renal Dose Adjustments

No adjustment recommended; accumulation of metabolites may occur in end-stage renal disease, warranting monitoring for associated adverse events.

Liver Dose Adjustments

Mild to moderate liver dysfunction: No adjustment recommended.

Severe liver dysfunction (Child-Pugh C):
Immediate-release tablet, capsule, and IV formulations: Dose should be reduced by 50%

Indication specific adjustments for capsule formulation:
-Amebiasis: 375 mg orally every 8 hours for 5 to 10 days
-Trichomoniasis: 375 mg orally every 24 hours for 7 days

Extended-release tablets: Should not be used unless benefits considered to outweigh risks

Precautions

US BOXED WARNING: CARCINOGENICITY:
-This drug has been shown to be carcinogenic in mice and rats.
-Unnecessary use should be avoided.
-Use should be reserved for the conditions for which it is indicated.

Consult WARNINGS section for additional precautions

Dialysis

Hemodialysis: If use of this drug cannot be separated from hemodialysis session, a supplemental dose after the hemodialysis session should be considered, depending on clinical situation of patient.

Other Comments

Administration advice:
-Extended release tablets: Do not split, crush, or chew; should be taken at least 1 hour before or 2 hours after meals (under fasting conditions).
-IV: Should be administered via slow IV drip infusion only, either as continuous or intermittent infusion; cannot be given via direct IV injection (IV bolus) due to low pH (0.5 to 2) of the reconstituted product; it must be further diluted and neutralized for IV infusion.
-Equipment that contains aluminum and would come in contact with IV solution (e.g., needles, cannulae) must not be used.
-IV therapy may be changed to oral metronidazole when conditions warrant, based upon severity of disease and response of patient.

Storage requirements:
-Capsules and Tablets: Protect from light.
-IV: Store below 25C (77F) and protected from light before reconstitution; reconstituted vials are stable for 96 hours when stored below 30C (86F) in room light; diluted and neutralized IV solutions should be used within 24 hours of mixing; neutralized solutions should not be refrigerated (precipitation may occur).

Reconstitution/preparation techniques:
-Order of mixing is important; first step is reconstitution; second step is dilution in IV solution followed by pH neutralization with sodium bicarbonate injection into the dilution.
-The manufacturer's product information should be consulted.

IV compatibility:
-IV admixtures containing this drug and other drugs should be avoided.
-Primary IV fluid should be stopped during infusion.
-The manufacturer product information should be consulted.

General:
-To reduce the development of drug-resistant bacteria and maintain the effectiveness, this drug should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.
-When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy; in absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Monitoring:
-General: Monitor for drug-related side effects in elderly patients and patients with renal and/or liver dysfunction.
-Hematologic: Total and differential leukocyte counts should be made before and after therapy and if re-treatment occurs.

Patient advice:
-Discontinue use of alcoholic beverages or products containing propylene glycol while taking this drug and for at least 3 days after discontinuing use.

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