Metronidazole
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| ID | DRUG-METRONIDAZOLE |
|---|---|
| Tipo | Fármaco |
| Alegais | Aço inoxidávelAparelhos de metrófiloAçúcarМетронідазол |
| Estado | reviewed 2026-04-27 | pending_clinical_signoff |
| Doenças | DIS-GASTRIC |
| Fontes | SRC-NCCN-BCELL-2025 SRC-NCCN-MM-2025 |
Fatos sobre as drogas
| Classe | Antibiotico nitroimidazol/antiprotozoário (cobertura anaeróbica + protozoária) |
|---|---|
| Mecanismo | Nitroimidazole prodrug that diffuses passively into bacteria and protozoa, where the low redox potential of anaerobic / microaerophilic organisms reduces its 5-nitro group to reactive radical intermediates (nitroso, hydroxylamine). These intermediates damage DNA via strand breakage and helix destabilization, producing bactericidal effect. Aerobic organisms cannot reduce the prodrug efficiently — hence the selective anaerobic spectrum. Active against Bacteroides fragilis group, Clostridioides spp. (including C. difficile and C. perfringens), Fusobacterium, Peptostreptococcus, Prevotella, and the protozoa Trichomonas, Giardia, Entamoeba histolytica. NO activity against aerobic bacteria. Standard add-on for anaerobic coverage in intra-abdominal, gynecologic, and dental infections, often paired with cefepime or aztreonam in febrile neutropenia with suspected intra-abdominal source. FDA-appr... |
| Dose típica | Anaerobic infection / FN add-on (adult): 500 mg IV every 8 hours via 30-60 min infusion (or 500 mg PO q8h if able to tolerate oral — >90% bioavailability). Pediatric: 7.5 mg/kg IV/PO q6h, max 4 g/day. C. difficile colitis: 500 mg PO q8h × 10-14 days (mild-moderate; vancomycin oral preferred for severe). Renal: no major adjustment for CrCl ≥10 (but accumulate in anuric patients — give post-dialysis on HD days, reduce to q12h on CRRT). Hepatic impairment: reduce dose by 50% in severe (Child-Pugh C). Duration in FN combinations: matched to primary β-lactam, typically 7-14 days. Maximum continuous duration ≤10 days where possible due to peripheral neuropathy risk with prolonged use. |
| Ucrânia registada | Verdade |
| NSZU reembolsado | Verdade |
| Ucrânia verificada pela última vez | 2026-04-27 |
Avisos
- Carcinogênica em camundongos e ratos; dados epidemiológicos em humanos inconclusivos mas listados na FDA; minimização da exposição desnecessária e ciclos prolongados
Notas
Cheap, ubiquitous, narrow-spectrum anaerobic coverage. In febrile neutropenia, added when intra-abdominal or perirectal source is suspected (classic context: severe mucositis with abdominal pain, perianal cellulitis / abscess, typhlitis / neutropenic enterocolitis) and the primary β-lactam lacks anaerobic activity (cefepime, aztreonam, ceftriaxone). NOT needed when pip-tazo or meropenem is the primary agent — these already cover anaerobes. CRITICAL interactions: warfarin (INR doubles — pre-emptively halve warfarin); alcohol (disulfiram-like reaction including IV preparations containing ethanol excipient — read drug labels). Peripheral neuropathy is the limiting toxicity for prolonged use (≥4-6 weeks) — often persistent even after discontinuation; minimize duration. C. difficile colitis: oral metronidazole 500 mg q8h is acceptable for mild-moderate disease but oral vancomycin (or fidaxomicin) is preferred for severe (WBC >15,000, creatinine ≥1.5×) per IDSA 2017. Ukraine: cheap and ubiquitous; NSZU-covered.
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