Top 5 Metronidazole Clinical Pearls

Metronidazole is a unique antibiotic and is in a class of its own. While not used as frequently as cephalosporins or penicillin antibiotics, it does serve useful roles in practice. In this blog post, I outline my top 5 metronidazole clinical pearls.

Alcohol Use and Metronidazole

Using alcohol with metronidazole has been associated with a disulfiram reaction. In general, I recommend against the use of alcohol when taking metronidazole. I think it is the smart and cautious thing to do. This is especially true in newer or acute patients (likely all patients will be using antibiotics acutely). While historically labeled a contraindication, the more recent data has been considered controversial on this reaction and who has this reaction may be hard to predict.

Anaerobic Coverage

Metronidazole is used most frequently to target anaerobic bacteria. Recall that anaerobic bacteria do not grow in the presence of oxygen. Examples of anaerobic bacteria include Bacteroides and Fusobacterium species.

Metallic Taste

Metronidazole has a very unique side effect. Patients can have a distinct metallic taste associated with taking this medication. I’ve had some patients even report this adverse effect as being unbearable and wanting to be prescribed a different antibiotic because of this reason. This is a good nugget to remember and something that may show up on board exams.

C. Diff and H. Pylori

There are a couple of infamous infections that metronidazole may help treat. Clostrioidies Difficile is a GI infection that causes significant diarrhea and is problematic in healthcare institutions like hospitals and long term care facilities. Metronidazole has fallen out of favor for C. Diff. according to the guidelines. Helicobacter pylori is a well-known cause of GI ulcers and metronidazole may be a part of combination therapy for treating this infection.

PO/IV Bioavailability

Metronidazole is available as an IV and oral product. A convenient fact with metronidazole is that it has virtually full bioavailability as an oral medication. This makes it easy if we ever have to convert a patient from IV metronidazole to oral or vice versa.

What other important metronidazole clinical pearls have come up in your practice?

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