- the treatment of documented or suspected infections caused by susceptible anaerobic bacteria
- used as perioperative prophylaxis in infants undergoing contaminated or potentially contaminated GI surgery (eg. perforation due to NEC)
- metronidazole is active against most obligately anaerobic bacteria (including several Bacteroides species, Clostridium, Peptococcus and Peptostreptococcus) and many protozoa (including Trichomonas vaginalis and Giardia lamblia)
- the exact mechanism of action has not been determined
- metronidazole is well absorbed when given orally
- in adults, up to 60 % of an IV or oral dose is metabolized in the liver
- half-life in neonates is reported to be 25-75 hours
- diarrhea, vomiting, constipation
- peripheral neuropathy, seizures
- thrombophlebitis, leukopenia
- may cause the urine to be dark or reddish-brown in colour; this is the result of water-soluble pigments which come from metabolism of the drug
- use with caution in infants with CNS disease, liver failure or renal failure
|1200 - 2000 g < 7 days old||7.5 mg/kg IV (or po) q24h|
|1200 - 2000 g > 7 days old||7.5 mg/kg IV (or po) q12h|
|> 2000 g and < 7 days old||7.5 mg/kg IV (or po) q12h|
|> 2000 g and > 7 days old||15 mg/kg IV (or po) q12h|
- it is unclear at the present what the dosage recommendation should be in infants less than 1200 g. A dose of 7.5 mg/kg q48h has been suggested for infants less than 1200 g and less than 28 days old; however, the Clinician will have to weigh the clinical situation and the properties of the drug to make a dosage decision
- give IV by slow infusion
- give oral suspension with feeds to minimize GI upset
- 5 mg/mL syringe, prepared by Pharmacy
- 500 mg/100mL IV solution for after hours use
- 20 mg/mL oral suspension, prepared by Pharmacy
- McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
- Nelson JD: Pocketbook of Pediatric Antimicrobial Therapy, 7th Edition, 1987, Williams and Wilkins, Baltimore.
- Krogh CME et al (ed): Compendium of Pharmaceuticals and Specialties, Canadian Pharmaceutical Association, 1992.
- Gomella TL (Ed): Neonatology - Management, Procedures, On-Call Problems, Diseases, Drugs, 1992, Appleton and Lange, Norwalk, Connecticut.
- Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.
- Prober CG, Stevenson DK and Benitz WE: The use of antibiotics in neonates weighing less than 1200 grams, Pediatr Infect Dis J 1990; 9: 111-121.