Metronidazole is bactericidal. It occurs in bacterial cell walls and disturb the DNA and inhibits DNA synthesis in certain microorganisms. Pharmacology Metronidazole is well absorbed after oral administration. It is iv only generally administered when patients can not be treated orally. It is distributed widely in the body fluids and penetrate into the cerebrospinal fluid, which leads to high concentrations. Metronidazole is probably metabolized by the liver and excreted largely in the urine, the elimination is not decreased but in patients with renal insufficiency. Indications Metronidazole is effective against all obligate anaerobic bacteria (it is not effective against facultative anaerobic and aerobic bacteria) Certain one-celled parasites (eg. B., Trichomonas vaginalis, Entamoeba histolytica, Giardia intestinalis [lamblia]) Metronidazole is used mainly for infections caused by obligate anaerobes, often in combination with other antibiotics. Metronidazole is drug of choice for bacterial vaginosis. The drug has other clinical applications (see table: Some clinical use of metronidazole). Some clinical use of metronidazole indications comments infections due to obligate anaerobes (. Eg intra-abdominal, pelvic, soft tissue, periodontal and odontogenic infections and lung abscesses) Often used in combination with other anti-infectives Bacterial vaginosis drug of choice Crohn’s disease – CNS infections (meningitis , brain abscess) – endocarditis – septicemia – prophylaxis of intestinal surgery – Clostridium difficile-induced diarrhea (pseudomembranous colitis) Oral ingestion is preferable in gastric ulcers due to Helicobacter pylori for the treatment and prevention of relapse use with other drugs Acne rosacea topical or oral application contraindications metronidazole in patients who have already had an allergic reaction to contraindicated. Use during pregnancy and lactation Metronidazole is in pregnancy category B (animal studies show no risk, human experience is incomplete or animal studies show risk, but studies are not human). Nevertheless, metronidazole should be avoided in the first trimester of pregnancy because of hereditary defects are to be feared. Metronidazole is excreted in breast milk, from taking while breastfeeding is not recommended. Side effects Side effects include GI disorders CNS effects, and peripheral neuropathy disulfiram-like reaction nausea, vomiting, headache, seizures, syncope, other CNS effects and peripheral neuropathy may occur; about rashes, fever and reversible neutropenia was reported. Metronidazole can cause a metallic taste in the mouth and dark urine. A disulfiram-like reaction may occur when up to 7 days after application alcohol is consumed. Considerations dose metronidazole is dosed normal in patients with renal failure in patients with significant liver disease, the dose is reduced, however, as a rule by 50%. Metronidazole inhibits the metabolism of warfarin and may increase its anticoagulant effect.