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an antibacterial and antiprotozoal agent effective against obligate anaerobes; used as the base, administered orally and intravaginally in Trichomonas vaginalis infection in females and orally in T. vaginalis infection in males and in intestinal amebiasis. It is used orally or intravenously in extraintestinal amebiasis and infection by obligate anaerobic bacteria and intravenously for the prophylaxis of colonic perioperative infection. It is also used topically in the treatment of rosacea. The hydrochloride salt is administered intravenously for the same indications for which the base is used intravenously.


Acea (UK), Anabact (UK), Apo-Metronidazole (CA), Elyzol (UK), Flagyl, Flagyl ER, Flagystatin (CA), Florazole ER, MetroCream, MetroGel, MetroGel-Vaginal, MetroLotion, Metrolyl (UK), Metrosa (UK), Metrotop, Metrozol (UK), Neutratop (UK), Nidagel (CA), Noritate, Novo-Nidazol (CA), PMS-Metronidazole (CA), Rosasol (CA), Rozex, Zidoval (UK), Zyomet (UK)

metronidazole hydrochloride

Flagyl IV

Pharmacologic class: Nitroimidazole derivative

Therapeutic class: Anti-infective, antiprotozoal

Pregnancy risk category B

FDA Box Warning

• Drug is carcinogenic in mice and rats. Avoid unnecessary use; reserve drug for indicated conditions.


Disturbs DNA synthesis in susceptible bacterial organisms


Capsules: 375 mg

Powder for injection: 5 mg/ml, 500-mg vials

Premixed injection: 500 mg/100 ml

Tablets: 250 mg, 500 mg

Tablets (extended-release): 750 mg

Topical cream, topical gel: 0.75% in 28.4-g tubes

Topical lotion: 0.75% in 59-ml bottle

Vaginal gel: 0.75% (37.5 mg/5-g applicator) in 70-g tubes

Indications and dosages


Adults: 2 g P.O. as a single dose or in two 1-g doses given on same day. Alternatively, 500 mg P.O. b.i.d. for 7 days.

Bacterial infections

Adults: Initially, 15 mg/kg I.V., followed by 7.5 mg/kg I.V. q 6 hours, not to exceed 4 g/day for 7 to 10 days


Adults: 750 mg P.O. q 8 hours for 5 to 10 days

Amebic liver abscess

Adults: 500 to 750 mg P.O. t.i.d. for 5 to 10 days. If drug can't be given orally, administer 500 mg I.V. q 6 hours for 10 days.

Children: 35 to 50 mg/kg/day P.O. in three divided doses for 10 days, to a maximum of 750 mg/dose

Bacterial vaginosis

Adults: In nonpregnant patients, 750 mg/day P.O. (extended-release) for 7 days or 5 g of 0.75% vaginal gel b.i.d. for 5 days. In pregnant patients, 250 mg P.O. t.i.d. for 7 days.

Perioperative prophylaxis in colorectal surgery

Adults: Initially, 15 mg/kg I.V. infusion over 30 to 60 minutes, completed 1 hour before surgery; if necessary, 7.5 mg/kg I.V. infusion over 30 to 60 minutes at 6 and 12 hours after initial dose


Adults: Rub a thin layer of topical lotion, gel, or cream onto entire affected area morning and evening. Improvement should occur within 3 weeks.


• Hypersensitivity to drug, other nitroimidazole derivatives, or parabens (topical form only)

• First-trimester pregnancy in patients with trichomoniasis


Use cautiously in:

• severe hepatic impairment

• history of blood dyscrasias, seizures, or other neurologic problems

• breastfeeding patients

• children.


• Reconstitute powder for injection by adding 4.4 ml of sterile or bacteriostatic water for injection, 0.9% sodium chloride injection, or bacteriostatic sodium chloride injection to 500-mg vial. Further dilute resulting

concentration (100 mg/ml) in 0.9% sodium chloride injection, 5% dextrose injection, or lactated Ringer's injection solution to a concentration of 8 mg/ml or less. Infuse each I.V. dose over 1 hour.

• Be aware that for I.V. injection, drug need not be diluted or neutralized.

• Don't use equipment containing aluminum to reconstitute or transfer reconstituted solution to diluent; solution may turn reddish-brown.

• Don't interchange vaginal gel with topical gel, cream, or lotion.

Adverse reactions

CNS: dizziness, headache, ataxia, vertigo, incoordination, insomnia, fatigue

EENT: rhinitis, sinusitis, pharyngitis

GI: nausea, vomiting, diarrhea, abdominal pain, furry tongue, glossitis, dry mouth, anorexia

GU: dysuria, dark urine, incontinence

Hematologic: leukopenia

Skin: rash, urticaria, burning, mild skin dryness, skin irritation, transient redness (with topical forms)

Other: unpleasant or metallic taste, superinfection, phlebitis at I.V. site


Drug-drug. Azathioprine, fluorouracil: increased risk of leukopenia

Cimetidine: decreased metronidazole metabolism, increased risk of toxicity

Disulfiram: acute psychosis and confusion

Lithium: increased lithium blood level

Phenobarbital: increased metronidazole metabolism, decreased efficacy

Warfarin: increased warfarin effects

Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase: altered levels

Drug-behaviors. Alcohol use: disulfiram-like reaction

Patient monitoring

• Monitor I.V. site. Avoid prolonged use of indwelling catheter.

• Evaluate hematologic studies, especially in patients with history of blood dyscrasias.

Patient teaching

• Advise patient to take drug with food if it causes GI upset. However, instruct him to take extended-release tablets 1 hour before or 2 hours after meals.

• Tell patient with trichomoniasis to refrain from sexual intercourse or to have male partner wear a condom to prevent reinfection. Explain that asymptomatic sex partners should be treated simultaneously.

• Advise patient to report fever, sore throat, bleeding, or bruising.

• Inform patient that drug may cause metallic taste and may discolor urine deep brownish-red.

• Tell patient using topical form to clean area thoroughly with mild cleanser before use and then wait 15 to 20 minutes before applying drug. Tell her she may apply cosmetics to skin after applying drug; with topical lotion, instruct her to let skin dry at least 5 minutes before applying cosmetics.

• Tell female patient to consult prescriber if she is pregnant or plans to become pregnant.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.


/met·ro·ni·da·zole/ (-ni´dah-zōl) an antiprotozoal and antibacterial effective against obligate anaerobes; used as the base or the hydrochloride salt. It is also used as a topical treatment for rosacea.


A synthetic antimicrobial drug, C6H9N3O3, used to treat vaginal trichomoniasis, anaerobic bacterial infections, and intestinal amebiasis.


an antimicrobial with activity against anaerobic bacteria and protozoa.
indications It is prescribed in the treatment of a variety of infections, including amebiasis, trichomoniasis, anaerobic infections, antibiotic-induced infections, pseudomembranous colitis, and bacterial vaginosis.
contraindications First trimester of pregnancy, blood dyscrasias, organic disease, central nervous system disorders, or known hypersensitivity to this drug prohibits its use. It is contraindicated in nursing mothers.
adverse effects Among the more serious adverse effects are severe GI distress, dizziness, neutropenia, and neurological disturbances. A metallic taste in the mouth is commonly noted.


Noritate® Dermatology An antibiotic used for managing dermatitides and erythema of rosacea. See Rosacea Infectious disease An antibiotic used to treat bacterial, fungal, and parasitic infections; it is the most effective agent for H pylori infections.


An antibiotic drug effective against Trichomonas vaginalis and Entamoeba histolytica as well as many other organisms. It is especially useful in the treatment of amoebic dysentery and amoebic liver abscesses as well as ANAEROBIC infections. The drug is on the WHO official list. Brand names are Acea Gel, Elyzol, Flagyl, Metrosa and Zidoval. The drug is also formulated with the antifungal drug nystatin under the brand name Flagyl Compak and, for external use only, under the brand names Anabact, Metrogel, Metrotop and Rozex.


An anti-infective agent regarded as the best available drug for treating trichomoniasis. It is sold under the trade names Flagyl and MetroGel.
Mentioned in: Trichomoniasis


; Flagyl antibacterial agent effective against anaerobic infections; adult dose = 500mg every 8 hours


n a generic synthetic antibacterial compound available for both oral and intravenous use. It is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. In dentistry, it is used in the treatment of HIV, periodontal disease, and aggressive periodontitis.
metronidazole HCl,
n brand name: Flagyl, Metro IV, Protostat;
drug class: trichomonacide, amebicide, antiinfective;
action: direct-acting amebicide/trichomonacide binds, degrades DNA in organisms;
uses: intestinal amebiasis, amebic abscess, trichomoniasis, refractory trichomoniasis, bacterial anaerobic infections.


an antimicrobial compound effective against protozoa and anaerobic bacteria. Commonly used to treat trichomoniasis, amebiasis, giardiasis and balantidiasis.
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In addition, demand for new cars is weakening, with customers increasingly reluctant to make large purchases or unable to find lenders willing to finance them, ACEA said.
The ACEA is also asking the EU to introduce incentives for car owners to scrap vehicles over eight years old in a bid to speed up rates of fleet renewal.
A total of 1,334,081 cars were registered in Europe last month, ACEA said, noting there was one fewer shopping days than a year earlier.
ACEA secretary Ivan Hodac, says: "CO2 related taxation of cars and of alternative fuels are an important tool in shaping consumer demand towards fuel-efficient cars.
Cars have become heavier and larger within their own different model segments, due to regulations on safety and air quality, and due to consumer preferences," says an ACEA report.
The ACEA report revealed a striking pattern in the registration statistics.
We are very excited about working with Ed2Go," says ACEA Executive Director Lora Jorgensen.
According to WRI, the ACEA agreement establishes industry-wide targets for average emissions from vehicles to reach 140 grams of CO2 per kilometer by 2008, with the possibility of extending the agreement to 120 grams of CO2 per kilometer by 2012.
He went on: ``These latest ACEA figures confirm just how well the market performed in contrast to the rest of Europe.
Under a voluntary agreement with the European Commission, the EU's executive branch, the ACEA is committed to achieving a target of average CO2 emissions of 140 grams-per-kilometer for new cars sold in the EU by 2008 -- a reduction of some 25% from the 1995 level, he said.
Other members of the ACEA - Ford, BMW, Renault and DaimlerChrysler - also have interests in teams.