Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM:
Metronidazole is an antibiotic effective against anaerobic bacteria and certain
parasites. Anaerobic bacteria are single-celled, living organisms that thrive in
environments in which there is little oxygen (anaerobic environments) and can
cause disease in the abdomen (bacterial peritonitis), liver (liver abscess), and
pelvis (abscess of the ovaries and the Fallopian tubes). Giardia lamblia and
ameba are intestinal parasites that can cause abdominal pain and diarrhea in
infected individuals. Trichomonas is a vaginal parasite that causes inflammation
of the vagina (vaginitis). Metronidazole selectively blocks some of the
functions within the bacterial cells and the parasites resulting in their death.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS:
Tablets: 250 and 500 mg.
Tablets, extended release: 750 mg.
Capsule: 375 mg.
Cream: 0.75% and 1%.
Lotion: 0.75%.
Gel: 0.75%
1%.
Injection: 5 mg/ml
STORAGE: Metronidazole should be stored at room temperature and protected
from light.
PRESCRIBED FOR: Metronidazole is used to treat parasitic infections including
Giardia infections of the small intestine, amebic liver abscess, and amebic
dysentery (infection of the colon causing bloody diarrhea),
bacterial vaginosis,
trichomonas vaginal infections, and carriers of trichomonas (both sexual
partners) who do not have symptoms of infection. Metronidazole is also used
alone or in combination with other antibiotics in treating abscesses in the
liver, pelvis, abdomen, and brain caused by susceptible anaerobic bacteria.
Metronidazole is also used in treating infection of the colon caused by a
bacterium called C. difficile. (Many commonly-used antibiotics can alter the
type of bacteria that inhabit the colon. C. difficile is an anaerobic bacterium
that can infect the colon when the normal types of bacteria in the colon are
inhibited by common antibiotics. This leads to inflammation of the colon
(pseudomembranous colitis) with severe diarrhea and abdominal pain.)
Metronidazole also is used in combination with other drugs to treat
Helicobacter
pylori (H. pylori) that causes stomach or intestinal ulcers. Metronidazole
topical gel is used for treating acne rosacea, and the vaginal gel is used for
treating bacterial vaginosis.
DOSING: Metronidazole may be taken orally with or without food. In the
hospital, metronidazole can be administered intravenously to treat serious
infections. The liver is primarily responsible for eliminating metronidazole
from the body, and doses may need to be reduced in patients with liver disease
and abnormal liver function.
Various metronidazole regimens are used. Some examples are listed below.
Amebic dysentery: 750 mg orally 3 times daily for 5-10 days
Amebic liver
abscess: 500-750 mg orally three times daily for 5-10 days
Anaerobic infections:
7.5 mg/kg orally every 6 hours not to exceed 4 grams daily
Bacterial Vaginosis:
750 mg (extended release tablets) once daily for 7 days. One applicator-full of
0.75% vaginal gel, once or twice daily for 5 days.
Clostridium difficile
infection: 250-500 mg orally 4 times daily or 500-750 orally 3 times daily
Giardia: 250 mg orally three times daily for 5 days
Helicobacter pylori:
800-1500 mg orally daily for several days in combination with other drugs.
Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge resulting from an overgrowth of normal bacteria in the vagina. Although it may cause some disturbing symptoms (discharge and odor), it is not dangerous and cannot be passed by sex. Diagnosis becomes important to exclude serious infections like gonorrhea and Chlamydia. Many treatment options are available such as oral antibiotics and vaginal gels.
Diverticulitis is a condition in which diverticuli in the colon rupture. The rupture results in infection in the tissues that surround the colon. Diverticulitis symptoms include: abdominal pain, abdominal cramps, diarrhea, constipation, and bloating. Treatment methods include prescription medications, and in some cases, diverticulitis surgery.
Clostridium difficile (C. difficile) is a bacterium, and is one of the most common causes of infection of the colon. C. difficile spores are found frequently in hospitals, nursing homes, extended care facilities, and nurseries for newborn infants. They can be found on bedpans, furniture, toilet seats, linens, telephones, stethoscopes, fingernails, rings, floors, infants' rooms, and diaper pails. They even can be carried by pets. Antibiotic-associated (C. difficile) colitis is an infection of the colon caused by C. difficile that occurs primarily among individuals who have been using antibiotics. Treatment for C. difficile colitis hydration, replenishment of electrolyte deficiencies, discontinuing the antibiotic that caused the colitis, and using antibiotics to eradicate the C. difficile bacterium.
Rosacea is a skin disease that causes redness of the forehead, chin, and lower half of the nose. In addition to inflammation of the facial skin, symptoms include dilation of the blood vessels and pimples (acne rosacea) in the middle third of the face. Oral and topical antibiotics are treatments for rosacea. If left untreated, rhinophyma (a disfiguring nose condition) may result.
Jock itch is an itchy red rash that appears in the groin area. The rash may be caused by a bacterial or fungal infection. People with diabetes and those who are obese are more susceptible to developing jock itch. Antifungal shampoos, creams, and pills may be needed to treat fungal jock itch. Bacterial jock itch may be treated with antibacterial soaps and topical and oral antibiotics.
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. There are many conditions associated with small intestinal bacterial overgrowth, to include: diabetes, scleroderma, Crohn's disease, and others. There is a striking similarity between the symptoms of irritable bowel syndrome and SIBO. It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. Symptoms of SIBO include: excess gas, abdominal bloating, diarrhea, and abdominal pain.
Folliculitis is a skin condition that causes small red bumps to form around the hair follicles. Skin bacteria such as Staphylococcus and Pseudomonas my infect the follicles. Treatment involves over-the-counter bacterial washes, topical antibiotics, and/or topical steroids.
Vaginitis is any type of vaginal infection or inflammation. The six most common types of vaginitis are Candida (yeast infections), bacterial vaginosis, trichomoniasis vaginitis, chlamydia vaginitis, viral vaginitis, and noninfectious vaginitis. Symptoms include itching, burning, and abnormal vaginal discharge. Treatment is different for each type of vaginitis.
Giardiasis (Giardia lamblia) is a parasite responsible for a common form of infectious diarrhea. The parasite lives in two stages: trophozoites and cysts. People at risk for giardiasis are those that live in areas where there is inadequate sanitation or treatment of drinking water. Giardiasis also is a common cause of outbreaks of diarrhea in day-care centers. Symptoms of giardiasis include abdominal pain and cramping, bloating, nausea, and fatigue. Treatment for giardiasis is with antibiotic medication.
Trichomoniasis is a sexually transmitted disease (STD) caused by a parasite passed from person to person. Trichomoniasis can be picked up from contact with damp, moist objects like towels, wet clothing, or toilet seat. Symptoms include yellow, green, or gray vaginal discharge with a strong odor, painful intercourse or urination, genital irritation and itching, and lower abdominal pain. Medication is the only treatment for trichomoniasis.
Jock itch is a common, itchy rash of the groin. It can be a very intense itch
with or without a visible red or pink rash in the groin folds and genitals. Jock
itch is primarily a skin condition in men.
The symptoms of jock itch may come and go, and many cases of jock itch resolve
spontaneously without any treatment. Jock itch is primarily seen in the groin,
although it may spread to the inner thighs, genitals (including penis, scrotum,
labia, and vaginal opening), and anus.
While jock itch is frequently noted in otherwise healthy patients, patients
with diabetes and/or obesity are more susceptible. Possible causes of this
common groin itch include irritation from tight or abrasive underwear, excess
moisture, sweating, skin rubbing or friction, allergic problems, fungal
infection, Candida (yeast) infection, and bacterial overgrowth or skin
infection.
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