INDICATIONS AND USAGE
Symptomatic Trichomoniasis
Metronidazole is indicated for the treatment of symptomatic
trichomoniasis in females and males when the presence of the trichomonad has
been confirmed by appropriate laboratory procedures (wet smears and/or
cultures).
Asymptomatic Trichomoniasis
Metronidazole is indicated in the treatment of asymptomatic
females when the organism is associated with endocervicitis, cervicitis, or
cervical erosion. Since there is evidence that presence of the trichomonad can
interfere with accurate assessment of abnormal cytological smears, additional
smears should be performed after eradication of the parasite.
Treatment of Asymptomatic Consorts
T. vaginalis infection is a venereal
disease. Therefore, asymptomatic sexual partners of treated patients should be
treated simultaneously if the organism has been found to be present, in order to
prevent reinfection of the partner. The decision as to whether to treat an
asymptomatic male partner who has a negative culture or one for whom no culture
has been attempted is an individual one. In making this decision, it should be
noted that there is evidence that a woman may become reinfected if her consort
is not treated. Also, since there can be considerable difficulty in isolating
the organism from the asymptomatic male carrier, negative smears and cultures
cannot be relied upon in this regard. In any event, the consort should be
treated with metronidazole in cases of reinfection.
Amebiasis
Metronidazole is indicated in the treatment of acute intestinal
amebiasis (amebic dysentery) and amebic liver abscess.
In amebic liver abscess, metronidazole therapy does not obviate the need for
aspiration or drainage of pus.
Anaerobic Bacterial Infections
Metronidazole is indicated in the treatment of serious infections
caused by susceptible anaerobic bacteria. Indicated surgical procedures should
be performed in conjunction with metronidazole therapy. In a mixed aerobic and
anaerobic infection, antimicrobials appropriate for the treatment of the aerobic
infection should be used in addition to metronidazole.
In the treatment of most serious anaerobic infections, the intravenous form
of metronidazole is usually administered initially. This may be followed by oral
therapy with metronidazole at the discretion of the physician.
INTRA-ABDOMINAL INFECTIONS, including peritonitis, intra-abdominal abscess,
and liver abscess, caused by Bacteroides species
including the B. fragilis group (B. fragilis, B. distasonis,
B. ovatus,
B. thetaiotaomicron, B. vulgatus), Clostridium species, Eubacterium species, Peptococcus niger,
and Peptostreptococcus species.
SKIN AND SKIN STRUCTURE INFECTIONS caused by Bacteroides
species including the B . fragilis group,
Clostridium species, Peptococcus
niger, Peptostreptococcus species, and Fusobacterium
species.
GYNECOLOGIC INFECTIONS, including endometritis, endomyometritis, tubo-ovarian
abscess, and post-surgical vaginal cuff infection, caused by Bacteroides species including the B.
fragilis group, Clostridium species, Peptococcus niger, and Peptostreptococcus species.
BACTERIAL SEPTICEMIA caused by Bacteroides species
including the B. fragilis group, and Clostridium species.
BONE AND JOINT INFECTIONS, as adjunctive therapy, caused by Bacteroides species including the B.
fragilis group.
CENTRAL N E RVOUS SYSTEM (CNS) INFECTIONS, including meningitis and brain
abscess, caused by Bacteroides species including the
B. fragilis group.
LOWER RESPIRATO RY TRACT INFECTIONS, including pneumonia, empyema, and lung
abscess, caused by Bacteroides species including the
B. fragilis group.
ENDOCARDITIS caused by Bacteroides species
including the B. fragilis group.
To reduce the development of drug-resistant bacteria and maintain the
effectiveness of metronidazole tablets and other antibacterial drugs,
metronidazole tablets should be used only to treat or prevent infections that
are proven or strongly suspected to be caused by susceptible bacteria. When
culture and susceptibility information are available, they should be considered
in selecting or modifying antibacterial therapy. In the absence of such data,
local epidemiology and susceptibility patterns may contribute to the empiric
selection of therapy.