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Metronidazole (Flagyl) is an antibiotic used against anaerobic bacteria Peptostreptococcus, Clostridium sp., Bacteroides sp., Prevotella, Fusobacterium, Veillonella and certain parasites such as Trichomonas vaginalis (vaginitis), Giardia intestinalis (lambliosis of bowels and liver), Entamoeba histolytica.
This medication is used to treat such conditions: bacterial peritonitis, liver abscesses, abscesses of the ovaries and the Fallopian tubes. Your dose should be administered by your physician depending on your condition, disease and age.
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It may be taken orally with or without food. In the hospital sometimes, Metronidazole is prescribed intravenously to treat serious infections. Take the extended-release tabs of Metronidazole at least 1-2 hours before or after a meal (on an empty stomach).
Do not chew, break or crush extended-release tabs and swallow them whole. Do not stop to take this drug even if you feel fine and your symptoms disappeared unless your doctor recommended it.Long treatment requires complete blood count on a regular basis. Avoid drinking alcohol. Intake of Metronidazole in patients is not advised during first trimester of pregnancy.
Let your doctor know if you are pregnant or plan to become pregnant, have liver disease, a stomach or intestinal disease such as Crohn's disease, a blood cell disorder such as anemia or leukopenia, epilepsy or other seizure and nerve disorders.
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Indications for use
- Intestinal amoebiasis (amebic dysentery) and extraintestinal amoebiasis (including amebic liver abscess)
- giardiasis, balantidiasis, cutaneous leishmaniasis
- Trichomoniasis (including chronic complicated)
- Combination therapy of severe mixed aerobic-anaerobic infections
- bacterial vaginosis (gardnerellosis)
- pseudomembranous colitis associated with antibiotic use
- Eradication of H. pylori in treatment of gastric and duodenal ulcer, chronic gastritis (as a part of combined therapy)
- Prophylaxis of postoperative infections during interventions on the colon, perirectal area, appendectomy, gynecological interventions
- Radiotherapy in cancer patients as a radio sensitizer
- In the treatment of chronic alcoholism to form an aversion to alcohol.
Dosage and administration
The drug is taken orally, during or immediately after a meal, with a little water or milk, without chewing.
In trichomoniasis in women (vaginitis, urethritis) is prescribed once in a dose of 2.0 g or as a course of treatment for 10 days, 2 tablets 3 times a day. For women it is recommended to appoint simultaneously vaginal forms containing 0.25 g of metronidazole. If necessary, the course of treatment is repeated or the metronidazole dose is increased to 750-1000 mg/day. An alternative regimen is to use metronidazole once in a dose of 2000 mg (8 tablets) in the patient and his or her sexual partner. In trichomoniasis in men (urethritis), metronidazole is prescribed once in a dose of 2.0 g or as a course treatment for 10 days, 1 tablet (0.25 g) 2 times a day.Children aged 5 years are prescribed 250 mg/day; 5-10 years - 250-375 mg/day; over 10 years - 500 mg/day in 2 doses for 10 days. Between courses of treatment a break of 3-4 weeks should be made with repeated control examination for trichomonas.
In giardiasis adults are prescribed 500 mg (2 tablets) 2 times a day for 5-7 days. For children aged 6-8 years old - 375 mg/day, over 8 years old - 500 mg/day in 2 doses. The course of treatment is 5-8 days. If symptoms persist for 3-4 weeks after treatment, it is recommended to analyze feces for lactase activity determination, since some patients have lactase deficiency for several months after giardiasis cure.
In treatment of amebiasis with asymptomatic course adults are prescribed 500 mg (2 tablets) 2-3 times a day for 5-7 days, in chronic amebiasis metronidazole is used 500 mg (2 tablets) 3 times a day for 5-10 days. In acute amebic dysentery, metronidazole is used 750 mg (3 tablets) 3 times a day until symptoms disappear. In amebic liver abscess, metronidazole is used in a daily dose of 2500 mg (10 tablets) in 1-3 doses in combination with tetracyclines for 3-5 days.
In balanceidiasis 750 mg (3 tablets) 3 times daily for 5-6 days.
In case of ulcerative stomatitis in adults 500 mg (2 tablets) 2 times daily for 3-5 days. Metronidazole is not used in children for this indication.
In treatment of pseudomembranous colitis 500 mg (2 tablets) 3-4 times a day is used.
During treatment of anaerobic infections, a daily dose of 1500-2000 mg (6-8 tablets) is used in 2-3 doses.
For prevention of infectious complications 750-1500 mg daily (3-6 tablets) are prescribed in 3 doses 3-4 days before surgery. During postoperative period, intravenous metronidazole is used during the first day, from the 2nd day it is administered orally by 750 mg/d in 3 doses during 7 days.
For eradication therapy of H. pylori in peptic ulcer of the stomach and duodenum, 500 mg 2 times daily for 7 days is administered in combination with amoxicillin/clarithromycin and omeprazole in first-line therapy or in dose 500 mg 3 times daily in combination with tetracycline, bismuth subcitrate and omeprazole in second-line therapy.
In treatment of chronic alcoholism it is used 500 mg/day for 10 days and then the treatment is continued for up to 6 months.
In patients with impaired renal function with creatinine clearance less than 10 ml/min, the daily dose of metronidazole for oral administration is reduced by half.
List of drugs with the active substance Metronidazole
- Metronidazole Nicomed