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metronidazole (me-troe-nye-da-zole)

Apo-Metronidazole, Flagyl, Flagyl ER, Metric 21, MetroCream, MetroGel, MetroGel-Vaginal, MetroLotion, Metro IV, Metryl, imageNidagel, Noritate, imageNovonidazol, Protostat, imageTrikacide


Therapeutic: anti-infectives, antiprotozoals, antiulcer agents

Pharmacologic: Nitroimidazole derivatives


PO, IV: Treatment of the following anaerobic infections: Intra-abdominal infections (may be used with a cephalosporin), Gynecologic infections, Skin and skin structure infections, Lower respiratory tract infections, Bone and joint infections, CNS infections, Septicemia, Endocarditis. IV: Perioperative prophylactic agent in colorectal surgery. PO: Amebicide in the management of amebic dysentery, amebic liver abscess, and trichomoniasis: Treatment of peptic ulcer disease caused by Helicobacter pylori. Topical: Treatment of acne rosacea. Vaginal: Management of bacterial vaginosis.

Unlabeled Use: Treatment of giardiasis. Treatment of anti-infective–associated pseudomembranous colitis.


Disrupts DNA and protein synthesis in susceptible organisms. Therapeutic Effects: Bactericidal, trichomonacidal, or amebicidal action. Spectrum: Most notable for activity against anaerobic bacteria, including Bacteroides, Clostridium. In addition, is active against Trichomonas vaginalis, Entamoeba histolytica, Giardia lamblia, H. pylori, C. difficile.

Adverse Reactions/Side Effects

CNS: SEIZURES, dizziness, headache. EENT: tearing (topical only). GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting. Derm: rashes, urticaria: topical only— burning, mild dryness, skin irritation, transient redness. Hemat: leukopenia. Local: phlebitis at IV site. Neuro: peripheral neuropathy. Misc: superinfection, disulfiram-type reaction with alcohol.


Examination and Evaluation

  • Watch for seizures; notify physician immediately if patient develops or increases seizure activity.

  • Monitor signs of peripheral neuropathy (numbness, tingling). Perform objective tests (nerve conduction, monofilaments) to document any neuropathic changes.

  • Monitor signs of disulfiram-like reaction (i.e., toxicity occurring when this drug is taken with alcohol). Signs include throbbing headache, difficulty breathing, nausea, vomiting, sweating, thirst, chest pain, palpitations, tachycardia, hypotension, syncope, agitation, confusion, weakness, vertigo, and blurred vision. Report these signs to the physician immediately.

  • Assess dizziness that might affect gait, balance, and other functional activities (see Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

  • Be alert for confusion, agitation, headache, or other alterations in mental status. Notify the physician promptly if these symptoms develop.

  • Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.


  • Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

  • Instruct patient to report signs of leukopenia, including fever, sore throat, and signs of infection.

  • Instruct patient to notify physician ...

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