e. Some of the adverse reactions associated with the use of this drug include
aplastic anemia (which is irreversible and fatal when it occurs), gastrointestinal tract
discomfort, and "gray baby syndrome" in infants. This is an absence or deficiency of
certain enzymes during early neonatal life that prolongs the half-life of certain drugs and
increases the half life of others, thus increasing the risk of toxicity. For example,
immaturity of hepatic glucuronyl transferase activity in neonates diminishes conjugation
(metabolism) of chloramphenicol to the inactive form, causing cardiovascular collapse
f. To avoid these reactions, baseline blood studies, prior to therapy and periodic
checks every 2 days during therapy, is recommended. The drug should not be used in
a. Metronidazole is a chemically synthesized drug with trichomonacidal
properties selective for obligatory and facultative anaerobic organisms.
b. Oral absorption of the drug is good with both oral and IV administration
resulting in wide distribution to all body tissues to include the CSF and saliva.
c. The bulk of the drug remains unchanged, but active metabolites are formed.
Sixty to 80 percent of the drug is eliminated in the urine with a small portion excreted
through the feces.
d. Adverse reactions associated with this agent are not usually severe and
include nausea, anorexia, diarrhea, abdominal cramping, vertigo, and numbness of the
extremities. Convulsive seizures have been reported with the use of this drug.
e. Patients using this drug should be monitored for candidiasis superinfection. It
should not be used in the first trimester of pregnancy or in breast-feeding mothers
because of its carcinogenic potential. Patients should avoid alcoholic beverages while
taking the drug.
f. Examples of metronidazole preparations are:
Flagyl IV RTU.
Flagyl 250 mg.