Metronidazole - instructions for use, analogs, reviews and release forms (tablets 250 mg, suppositories 100 mg and 500 mg, cream, gel and injection solution) of the drug for the treatment of infections in adults, children and pregnancy
In this article, you can read the instructions for using the drug Metronidazole. Comments of visitors of the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Metronidazole in their practice are presented. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues Metronidazole in the presence of existing structural analogues. Use to treat infectious diseases of the sexual and intestinal sphere in adults, children, as well as during pregnancy and breast-feeding.
Metronidazole - antiprotozoal and antimicrobial drug, a derivative of 5-nitroimidazole. The mechanism of action is the biochemical reduction of the 5-nitro group by intracellular transport proteins of anaerobic microorganisms and protozoa. The reduced 5-nitro group interacts with the DNA of a cell of microorganisms, inhibiting the synthesis of their nucleic acids, which leads to the death of bacteria.
Metronidazole is not sensitive to aerobic microorganisms and facultative anaerobes, but in the presence of mixed flora (aerobes and anaerobes) metronidazole acts synergistically with antibiotics effective against conventional aerobes.
Increases the sensitivity of tumors to radiation, causes sensitization to alcohol (disulfiram-like action), stimulates reparative processes.
Pharmacokinetics
Has a high penetrating ability, reaching bactericidal concentrations in most tissues and body fluids, including lungs, kidneys, liver, skin, cerebrospinal fluid, brain, bile, saliva, amniotic fluid, abscess cavities, vaginal secretion, seminal fluid, breast milk, penetrates through blood-brain and placental barrier. It is excreted by the kidneys 60-80% (20% unchanged), through the intestine - 6-15%.
Indications
- protozoal infections: extraintestinal amoebiasis, including amoebic liver abscess, intestinal amoebiasis (amoebic dysentery), trichomoniasis, giardiasis, balantidiasis, cutaneous leishmaniasis, trichomonas vaginitis, trichomonas urethritis;
- infections caused by Bacteroides spp. (including V. fragilis, V. distasonis, V. ovatus, V. thetaiotaomicron, V. vulgalus): infections of bones and joints, infection of the central nervous system (including meningitis, brain abscess), bacterial endocarditis, pneumonia , empyema and abscess of the lungs;
- Infections caused by Bacteuroides species, including B. fragilis group, Clostridium, Peptococcus and Peptostrеptococcus species: peritoneal infection (peritonitis, liver abscess), pelvic infections (endometritis, endometriometritis, fallopian tube and ovarian abscess, vaginal vagina infections after surgical operations) , skin and soft tissue infections;
- infections caused by species of Bacteroides, including the B. fragilis group and Clostridium species: sepsis;
- pseudomembranous colitis (associated with the use of antibiotics);
- gastritis or duodenal ulcer associated with Helicobacter pylori;
- alcoholism;
- prevention of postoperative complications (especially interference on the colon, near-rectal area, appendectomy, gynecological operations);
- radiation therapy of patients with tumors - as a radiosensitizing agent, in cases,when tumor resistance is due to hypoxia in tumor cells.
Forms of release
Tablets 250 mg.
Vaginal Candles 500 mg and 100 mg.
Cream for external use 1%.
Gel for external use 1%.
Gel for vaginal application 1%.
Solution for infusions (injections) 0,5%.
Instructions for use and dosing regimen
Inside, during or after a meal, (or squeezed milk), without chewing.
When trichomoniasis - 250 mg twice a day for 10 days or 400 mg 2 times a day for 5-8 days. Women should additionally be prescribed Metronidazole in the form of vaginal suppositories or tablets. If necessary, you can repeat the course of treatment or increase the dose to 0.75-1 g per day. Between the courses should be a break in 3-4 weeks with the conduct of repeated control laboratory tests. An alternative scheme of therapy is the appointment of 2 g once to the patient and his sexual partner. Children 2-5 years - 250 mg per day; 5-10 years - 250-375 mg per day, over 10 years - 500 mg per day. The daily dose should be divided into 2 divided doses. The course of treatment is 10 days.
With giardiasis, 500 mg twice a day for 5-7 days. Children under 1 year - 125 mg per day, 2-4 years - 250 mg per day, 5-8 years - 375 mg per day, over 8 years - 500 mg per day (in 2 divided doses). The course of treatment is 5 days.
With giardiasis - 15 mg / kg per day in 3 divided doses for 5 days.
Adults: with asymptomatic amoebiasis (if a cyst is detected), the daily dose is 1-1.5 g (500 mg 2-3 times a day) for 5-7 days.
In chronic amoebiasis, the daily dose is 1.5 g in 3 divided doses for 5-10 days.
In acute amoebic dysentery - 2.25 g in 3 doses until the symptoms stop.
In liver abscess - the maximum daily dose - 2.5 g in 1 or 2-3 doses, for 3-5 days, in combination with antibiotics (tetracyclines) and other methods of therapy. Children 1-3 years - 1/4 of the adult dose, 3-7 years - 1/3 of the adult dose, 7-10 years - 1/2 dose of the adult.
When balantidase - 750 mg 3 times a day for 5-6 days.
With ulcerative stomatitis, adults are prescribed 500 mg twice a day for 3-5 days; children in this case, the drug is not shown.
With pseudomembranous colitis, 500 mg 3-4 times a day.
To eradicate Helicobacter pylory - 500 mg 3 times a day for 7 days (as part of combination therapy, for example, combination with Amoxicillin 2.25 g per day).
In the treatment of anaerobic infection, the maximum daily dose is 1.5-2 g.
In the treatment of chronic alcoholism, 500 mg per day for a period up to 6 (not more than) months are prescribed.
For the prevention of infectious complications - 750-1500 mg per day in 3 doses 3-4 days before surgery, or once 1 g in the 1-st day after the operation.1-2 days after the operation (when already allowed ingestion) - 750 mg per day for 7 days.
Ointment and gel
Assign intravaginally. The recommended dose is 5 g (one complete applicator) 2 times a day (morning and evening). The course of treatment is 5 days.
Side effect
- diarrhea;
- anorexia;
- nausea, vomiting;
- intestinal colic;
- constipation;
- metallic taste in the mouth;
- dry mouth, glossitis;
- stomatitis;
- dizziness, impaired coordination of movements;
- ataxia;
- confusion of consciousness;
- irritability;
- depression;
- increased excitability;
- weakness;
- insomnia;
- headache;
- convulsions;
- hallucinations;
- urticaria, skin rash;
- hyperemia of the skin;
- nasal congestion;
- fever;
- candidiasis;
- neutropenia, leukopenia.
Contraindications
- leukopenia (including in the anamnesis);
- organic lesions of the central nervous system (including epilepsy);
- hepatic failure (in the case of the appointment of large doses);
- pregnancy (1 trimester);
- lactation period;
- hypersensitivity.
Application in pregnancy and lactation
Contraindicated in the 1st trimester of pregnancy and lactation. Use with caution in the 2nd and 3rd trimesters of pregnancy.
special instructions
During the treatment, the use of ethanol (alcohol) is contraindicated (it is possible to develop a disulfiram-like reaction: spastic abdominal pain, nausea, vomiting, headache, sudden rush of blood to the face).
In combination with amoxicillin it is not recommended to use in patients younger than 18 years.
With prolonged therapy, it is necessary to monitor the blood picture.
The appearance of ataxia, dizziness and any other deterioration in the neurological status of patients requires discontinuation of treatment.
Can immobilize treponema and lead to Nelson's false positive test.
Stains urine in a dark color.
When treating trichomonadal vaginitis in women and trichomoniasis in men, it is necessary to abstain from sexual activity. It is necessary to simultaneously treat sexual partners. Treatment does not stop during menstruation. After trichomoniasis therapy, control tests should be performed for three consecutive cycles before and after menstruation.
After the treatment of giardiasis, if symptoms persist, after 3 to 4 weeks, 3 feces should be analyzed at intervals of several days (in some successfully treated patients lactose intolerance caused by invasion may persist for several weeks or months, recalling the symptoms of giardiasis).
Drug Interactions
Increases the effect of indirect anticoagulants, which leads to an increase in the time of prothrombin formation.
Similarly to disulfiram, causes intolerance to ethanol (alcohol).
Simultaneous use with Disulfiram can lead to the development of various neurologic symptoms (the interval between appointments is at least 2 weeks).
Cimetidine inhibits metronidazole metabolism, which can lead to an increase in its serum concentration and an increased risk of side effects.
Simultaneous administration of drugs that stimulate enzymes of microsomal oxidation in the liver (phenobarbital, phenytoin) can accelerate the elimination of metronidazole, as a result of which its concentration in the plasma decreases.
With simultaneous administration with lithium preparations, the concentration of the latter in the plasma and the development of symptoms of intoxication may increase.
It is not recommended to combine with nondepolarizing muscle relaxants (vecuronium bromide).
Sulfonamides increase the antimicrobial effect of metronidazole.
Analogues of the drug Metronidazole
Structural analogs for the active substance:
- Bacimex;
- Deflamon;
- Clion;
- Metrovagin;
- Metrogil;
- Metroxan;
- Metrolacker;
- Metron;
- Metronidazole Nycomed;
- Metronidazole-AKOS;
- Metronidazole-Altpharm;
- Metronidazole-LekT;
- Metronidazole-UBF;
- Metronidal;
- Metroseptol;
- Orvagil;
- Rosamet;
- Rosex;
- Siptrogyl;
- Tricho-PIN;
- Trichobrol;
- Trichopol;
- Trichosept;
- Flagel;
- Efloran.
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