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# Metronidazole ## Overview Metronidazole is an antimicrobial agent effective against anaerobic bacteria and certain protozoa. ## Primary Indications * **Bacterial Vaginosis:** Treatment of bacterial vaginosis. * **Trichomoniasis:** Treatment of symptomatic trichomoniasis. * **Amebiasis:** Treatment of intestinal amebiasis. * **Giardiasis:** Treatment of symptomatic giardiasis. * **Anaerobic Bacterial Infections:** Treatment of serious anaerobic bacterial infections (e.g., intra-abdominal infections, gynecologic infections, skin and soft tissue infections, bone and joint infections, CNS infections, lower respiratory tract infections, endocarditis). Often used in combination with other antibiotics. * **Pseudomembranous Colitis (C. difficile):** Treatment of antibiotic-associated pseudomembranous colitis. ## Adult Dosing * **Bacterial Vaginosis:** 500 mg orally twice daily for 7 days OR 2 grams orally as a single dose OR 0.75% vaginal gel applied intravaginally once daily for 5 days. * **Trichomoniasis:** 2 grams orally as a single dose OR 250 mg orally three times daily for 7 days. * **Amebiasis (intestinal):** 500 mg to 750 mg orally three times daily for 5 to 10 days. * **Giardiasis:** 250 mg orally three times daily for 5 days. * **Anaerobic Bacterial Infections:** 500 mg IV or orally every 8 hours. Duration varies based on infection severity and response. * **Pseudomembranous Colitis:** 250 mg to 500 mg orally every 6 to 8 hours. ## Pediatric Dosing Dosing in pediatric patients is weight-based and depends on the indication and severity of infection. Consult specific pediatric guidelines or protocols. * **Trichomoniasis/Giardiasis:** 15 mg/kg orally once daily or divided every 8 hours, not to exceed 250 mg per dose, for 5-7 days (for Giardiasis) or single dose (for Trichomoniasis) - consult specific guidelines. * **Intestinal Amebiasis:** 35-50 mg/kg/day orally divided into 3 doses for 5-10 days. * **Anaerobic Bacterial Infections:** 7.5 mg/kg IV or orally every 8 hours. ## Dose Adjustments * **Renal Impairment:** No dose adjustment typically needed for mild to moderate impairment. In severe impairment (CrCl < 30 mL/min), the dosing interval may need to be extended or the dose reduced for IV formulations due to accumulation of metabolites. Oral formulations may not require adjustment. * **Hepatic Impairment:** Use with caution. May require dose reduction due to impaired metabolism. ## Contraindications * Hypersensitivity to metronidazole or other nitroimidazole derivatives. * Active CNS disease. * Disulfiram-like reaction with alcohol. ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal discomfort, metallic taste, headache, dizziness. * **Serious:** Peripheral neuropathy (especially with prolonged use), seizures, encephalopathy, aseptic meningitis, Stevens