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Symposium on antimicrobial agents. Metronidazole.

J E Rosenblatt1, R S Edson

  • 1Division of Infectious Diseases and Internal Medicine, Mayo Clinic.

Mayo Clinic Proceedings
|November 1, 1987
PubMed
Summary

Metronidazole is a key antimicrobial for anaerobic bacterial and parasitic infections, including trichomoniasis and C. difficile. While generally safe, it

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Area of Science:

  • Pharmacology and Microbiology
  • Antimicrobial Agents
  • Nitroimidazole Derivatives

Background:

  • Metronidazole, a nitroimidazole derivative, exhibits antimicrobial activity against anaerobic bacteria and protozoa.
  • Established efficacy in treating trichomoniasis, amebiasis, and giardiasis.
  • Increasingly recognized for its role in managing anaerobic infections.

Purpose of the Study:

  • To review the therapeutic applications and efficacy of metronidazole in treating anaerobic infections.
  • To highlight metronidazole's role in surgical prophylaxis and specific conditions like bacterial vaginosis and C. difficile infections.
  • To compare metronidazole with newer nitroimidazole derivatives.

Main Methods:

  • Review of clinical studies and existing literature on metronidazole's efficacy and safety.
  • Analysis of its spectrum of activity against various anaerobic organisms, including the Bacteroides fragilis group.
  • Evaluation of its pharmacokinetic profile and side effects.

Main Results:

  • Metronidazole is highly effective against most anaerobes and is the only agent rapidly bactericidal against the Bacteroides fragilis group.
  • Demonstrates efficacy in colorectal surgical prophylaxis, abdominal sepsis, bacterial vaginosis, and Clostridium difficile-related colitis.
  • Hydroxy metabolite shows significant (65%) efficacy; newer agents like tinidazole and ornidazole possess greater antimicrobial activity.

Conclusions:

  • Metronidazole remains a principal agent for treating anaerobic infections and specific protozoal diseases.
  • Its favorable safety profile and effectiveness in various clinical scenarios support its continued use.
  • Caution is advised during the first trimester of pregnancy due to potential mutagenicity concerns.

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