VIII.

DRUG STUDY
Metronidazole Classification: antiinfective; antitrichomonal; amebicide; antibiotic

Indication: Metronidazole is an antibiotic effective against anaerobic bacteria and certain parasites. Anaerobic bacteria are singlecelled, living organisms that thrive in environments in which there is little oxygen (anaerobic environments) and can cause disease in the abdomen (bacterial peritonitis), liver (liver abscess), and pelvis (abscess of the ovaries and the Fallopian tubes). Metronidazole selectively blocks some of the functions within the bacterial cells and the parasites resulting in their death. Adverse effects: Common adverse drug reactions (1% of patients) associated with systemic metronidazole therapy include: nausea, diarrhea, and/or metallic taste in the mouth. Intravenous administration is commonly associated with thrombophlebitis. Infrequent adverse effects include:hypersensitivity reactions (rash, itch, flushing, fever), headache, dizziness, vomiting, glossitis, stomatitis, dark urine, and/or paraesthesia. High doses and/or long-term systemic treatment with metronidazole is associated with the development of leukopenia, neutropenia, increased risk of peripheral neuropathy and/or CNS toxicity.

Mechanism of action: Metronidazole, taken up by diffusion, is selectively absorbed by anaerobic bacteria and sensitive protozoa. Once taken up by anaerobes, it is non-enzymatically reduced by reacting with reduced ferredoxin, which is generated by pyruvate oxido-reductase. This reduction causes the production of toxic products to anaerobic cells, and allows for selective accumulation in anaerobes. The metronidazole metabolites are taken up into bacterial DNA, and form unstable molecules. 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 cells or aerobic bacteria.

Nursing Implications: Assessment & Drug Effects Discontinue therapy immediately if symptoms of CNS toxicity develop. Monitor especially for seizures and peripheral neuropathy (e.g., numbness and paresthesia of extremities). Lab tests: Obtain total and differential WBC counts before, during, and after therapy, especially if a second course is necessary. Monitor for S&S of sodium retention, especially in patients on corticosteroid therapy or with a history of CHF. Monitor patients on lithium for elevated lithium levels. Report appearance of candidiasis or its becoming more prominent with therapy to physician promptly. Repeat feces examinations, usually up to 3 mo, to ensure that amebae have been eliminated. Patient & Family Education Adhere closely to the established regimen without schedule interruption or changing the dose. Refrain from intercourse during therapy for trichomoniasis unless male partner wears a condom to prevent reinfection. Have sexual partners receive concurrent treatment. Asymptomatic trichomoniasis in the male is a frequent source of reinfection of the female. Do not drink alcohol during therapy; may induce a disulfiramtype reaction. Avoid alcohol or alcohol-containing medications for at least 48 h after treatment is completed. Urine may appear dark or reddish brown (especially with higher than recommended doses). This appears to have no clinical significance. Report symptoms of candidal overgrowth: Furry tongue, color changes of tongue, glossitis, stomatitis; vaginitis, curdlike, milky vaginal discharge; proctitis. Treatment with a candidacidal agent may be indicated. Do not breast feed while taking this drug.