INDICATIONS AND USAGE
SymptomaticTrichomoniasis.MetronidazoleisindicatedforthetreatmentofT.vaginalisinfectioninfemalesandmaleswhenthe presenceofthetrichomonadhasbeenconfirmedbyappropriatelaboratoryprocedures(wetsmearsand/orcultures).
Asymptomatic Trichomoniasis. Metronidazole is indicated in the treatment of asymptomatic T. vaginalis infection in 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 Sexual Partners.
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 sexual partner 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 sexual partner should be treated with metronidazole in cases of reinfection.
Amebiasis.Metronidazoleisindicatedinthetreatmentofacuteintestinalamebiasis(amebicdysentery)andamebicliverabscess. Inamebicliverabscess,metronidazoletherapydoesnotobviatetheneedforaspirationordrainageofpus.
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.
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 species, and Peptostreptococcus species.
SKIN AND SKIN STRUCTURE INFECTIONS caused by Bacteroides species including the B. fragilis group, Clostridium species, Peptococcusspecies, Peptostreptococcus species, and Fusobacterium species.
GYNECOLOGICINFECTIONS,includingendometritis,endomyometritis,tubo-ovarianabscess,andpostsurgicalvaginalcuffinfection, causedbyBacteroidesspeciesincludingtheB.fragilisgroup,Clostridiumspecies,Peptococcusspecies,Peptostreptococcusspecies, andFusobacteriumspecies.
BACTERIAL SEPTICEMIA caused by Bacteroides species including the B. fragilis group and Clostridium species.
BONEANDJOINTINFECTIONS,(asadjunctivetherapy),causedbyBacteroidesspeciesincludingtheB.fragilisgroup.
CENTRAL NERVOUS SYSTEM (CNS) INFECTIONS, including meningitis and brain abscess, caused by Bacteroides species including the B. fragilis group.
LOWER RESPIRATORY 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 and other antibacterial drugs, metronidazoleshouldbeusedonlytotreatorpreventinfectionsthatareprovenorstronglysuspectedtobecausedbysusceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy.Intheabsenceofsuchdata,localepidemiologyandsusceptibilitypatternsmaycontributetotheempiricselectionoftherapy.