This document discusses the drug metronidazole, including its structure, mechanism of action, indications, side effects, dosing, and drug interactions. Metronidazole is an antibacterial and antiprotozoal medication commonly used to treat anaerobic bacterial infections and parasites. It works by inhibiting nucleic acid synthesis in anaerobic cells. Common uses include treating bacterial vaginosis, trichomoniasis, C. difficile infections, and giardiasis. Side effects include nausea, vomiting, and neurological effects. Care should be taken with alcohol and other drug interactions.

1. METRONIDAZOLE
PHARMACOLOGICAL
TREATMENT OF
TRICHOMONIASUS
Prepared by Sufi Zukiya
&
Hakim Budin

2. METRONIDAZOLE
Metronidazole (flagyl) is a synthetic antiprotozoal and antibacterial
agent,( l-β-hydroxyethyl)-2-methyl-5-nitroimidazole, which has the
following structural formula:

3. It belongs to the group of nitro
imidazoles
Other members related to metronidazole
are tinidazole and others
Flagyl tablets contain 250 mg or 500 mg
of metronidazole. Inactive ingredients
include cellulose, hydroxypropyl
cellulose, polyethylene glycol, stearic

4. STRUCTURE OF
METRONIDAZOLE

5. MECHANISM OF ACTION
Metronidazole acts by inhibiting
nucleic acid synthesis by disrupting
the DNA of microbial cells. This
function only occurs when
metronidazole is partially reduced,
and because this reduction usually
happens only in anaerobic cells, it has
relatively little effect upon human

6. SUMMARY

7. INDICATIONS
Anaerobe infections
C. difficile
H. pylori
Bacterial vaginosis
Trichomonas vaginitis
Amebiasis
Giardiasis

8. SIDE EFFECTS OF
METRONIDAZOLE
epigastric distress
Seisures
Metallic taste
Darkening of urine
Peripheral neuropathy
Pancreatitis
Hepatitis
Fever
Reversible neutropenia

9. DRUG INTERACTIONS
DRUG INTERACTION
ALCOHOL Mild disulfiram like reaction (Nausea,
headache, vomiting, abdominal cramps)
ANTICOAGULANTS (WARFARIN) Prolonged PT(Prothrombin time)
CIMETIDINE Prolong half life & decrease clearance of
Metronidazole
PHENYTOIN & PHENOBARBITONE Decrease serum concentration and
increase metabolism of Metronidazole

10. DOSING FOR VAGINATIS
Vagina Gel
0.75 % - One applicatorful intravaginal
qDay/ BID x 5 days
1.3 % - One applicatorful intravaginal
once as a single dose at bedtime

11. WHAT HAPPENS IF ONE
MISSES THE DOSE
The decision of drug dose is a
practical issue after many complicated
trials both in-vitro and in-vivo
Missing a dose in any cause of
treatment will disturb the optimal
therapeutic concentration which in
turn may compromise treatment, and
hence impair healing.

12. WHAT IF ACCIDENTALY THE
FIRST TRIMESTER PREGNANT
MOTHER HAS TAKEN
METRONIDAZOLEThe ideal practice is to prevent any incidence of taking Metronidazole
by a lactating and the pregnant women, especially during the first
trimester, however it might happen accidentaly. The following
measures should be taken:
 Advice the patient to stop taking the next dose and immediately meet her doctor
 Based on the assumption that the doctor/prescriber doesn’t remember what should
be done:
 Advice the doctor since there is no specific antidote for metronidazole, the patient should be treated
symptomatically accompanied by supportive treatment

13. IMPORTANT THINGS TO
REMEMBER BEFORE
DISPENSING
METRONIDAZOLEAny woman in child bearing age should be asked if
she is pregnant
Any old man should be asked about history of
chronic illness, especially hepatic and renal
diseases.
Social history must inquire alcohol consumption of
the patient
Patient should be asked about other medications
he/she is taking as well as other important
questions like allergies and intolerances