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Glossary of Abbreviations
Brand name: Apo-Metronidazole, Flagyl, Metizol, Metric 21, Neo-Metric, Noonidazole, PMS-Metronidazole, Trikacide, Protostat
Dose/route: Adult: IV INF 15 mg/kg over 1 hr, then 7.5 mg/kg IV or PO q6h, not to exceed 4 g/day. 2. Adult periodontitis: Adult: PO 250 mg tid for 7-10 days. This drug is absorbed well PO; is concentrated in therapeutic levels in bone and cerebrospinal fluid; and is metabolized in the liver and excreted in bile and urine.
Drug action: Reduction of nitro group, which in turn disrupts DNA synthesis, leading to cell death.
How supplied: Tabs 250, 500 mg; film-coated tabs 250, 1500 mg; inj IV 5 mg/vial; Hcl inj IV 500 mg
Spectrum covered: A bactericidal antimicrobial effective only against obligate anaerobic bacteria, but this list comprises many microbes associated with chronic periodontal disease. Metronidazole has been demonstrated to show some effectiveness in patients with juvenile or refractory periodontitis when combined with amoxicillin or Augmentin. Susceptible microbes: Fusobacterium, Clostridium, Eubacterium, Peptococcus, Peptostreptococus, Bacterodides, Treponema, Campylobacter, Veillonella.
Indications: For the penicillin-allgergic patient and gram-negative anerobic infections. Can be used in chronic infections and in patients where penicillin has failed. Because of it poor effects on aerobic and facultative microorganisms this drug should not be used for acute infections or cellulitis. Can be considered in patients who have been diagnosed with refractory periodontitis or ANUG with antimicrobial susceptibility testing as part of the diagnostics. This drug is concentrated within the crevicular fluid at levels higher than what is found within the serum which allows a concentration buildup that is lethal to many plaque bacteria. But alone this antibiotic shows a nondramatic change in periodontitis; however, when combined with good oral hygiene and subgingival debridment metronidazole has been shown to have a beneficial effect on periodontitis.
Drug interactions: Toxic reactions with disulfiram. Possible antabuse effect with alcohol. Potentiates the effects of anticoagulants. Metallic taste, nausea, large doses may cause peripheral neuropathy. May decrease the effectiveness of oral contraceptives
Contraindications: Hepatic or renal disease, hypersensitiviy to this drug, contracted visual or color fields, blood dyscrasias, pregnancy (in first trimester), lactation, CNS disorders.
Side effects: Frequent adverse effects are gastrointestinal disturbances, headache, dry mouth, Candidal superinfections. Metallic taste, nausea, diarrhea, insomnia, stomatitis, paresthesias (in large doses may cause peripheral neuropathy) and are occasional adverse effects. Rare adverse effects are pseudomembranous colitis, leukopenia, pancreatitis, ataxia, and encephalopathy.