Military Obstetrics & Gynecology
Metronidazole (Flagyl, MetroGel, MetroGel Vaginal)

Category:

• Antibiotic

Description:

• Antiprotozoal

Indications:

• Anaerobic infections

• Wet Mount Video Showing Trichomonas

  Trichomoniasis

• Amebia

• Colorectal surgery prophylaxis

• Acne rosacea

• Bacterial vaginosis

Contraindications:

Trichomoniasis infections in the first trimester of pregnancy

Precautions:

• Pregnancy category B

• Use with caution in patients with organic CNS disease or severe hepatic dysfunction

• Applying a Condom Video

  Use condoms during therapy to avoid re-infection with trichomoniasis

• Counsel patient to finish all medication

• Avoid using alcohol during therapy and 1-2 days post-therapy to avoid “disulfiram-type” reaction

• Will cause a metallic taste in the mouth

• Take with food to avoid GI side effects

• Will darken the color of urine  

Adverse Reactions (Side Effects):

• Seizures and peripheral neuropathy

• Gastrointestinal: anorexia, nausea, diarrhea, cramping, metallic taste

• Headache

• Rash

• Dysuria and darkened urine

  Dosage:

  • Administered orally, topically and IV injection

  • Acute intestinal amebiasis:

    • 750mg tid for 5-10 days

  • Amebic liver abscess amebiasis:

    • Adult: 500-750mg tid for 5-10 days

    • Children: 35-50mg/kg/day in three divided doses for 10 days

  • Trichomoniasis (treat sexual partner(s) also):

    • One day therapy: 2 grams in one or two doses

    • Seven day therapy: 250mg tid for 7 days

  • Anaerobic bacterial infections:

    • Initial: 15mg/kg infused over one hour

    • Maintenance: Six hours post loading dose, 75mg/kg (max 4 grams per day) oral or IV (infused over 1 hour) q6h for 7-10 days

  • Colorectal surgery prophylaxis:

    • 15mg/kg infused IV (over 1 hour) and completed one hour prior to surgery, then 7.5mg/kg at 6 and 12 hour intervals after initial dose.

  • Acne rosacea :

    • Apply a thin film twice a day for 3-9 weeks

  • Bacterial vaginosis :

    • Insert 1 applicatorful (5 grams or 37.5mg metronidazole) once or twice a day for 5 days

    • For once daily dosing, dose at bedtime