Presentation
Initial neurological symptoms followed by mucocutaneous manifestation of SJS following metronidazole use is probably a new presentation of this case. [ncbi.nlm.nih.gov]
Entire Body System
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Intravenous Administration
Intravenous administration produces similar maternal plasma and milk levels to equivalent oral doses, although the data are limited. Short-course IV metronidazole is considered to be compatible with breastfeeding. [sps.nhs.uk]
Peak serum concentrations are quite similar after oral or intravenous administration and average approximately 10 μg/ml after a single 500mg dose. After an oral dose the peak serum concentration is reached approximately 1 hour after administration. [link.springer.com]
The preferred route of administration is intravenous administration. The compounds are administered prior to the ' radiation therapy treatment, generally in doses ranging between 10 mg/m 2 and 3000 mg/m 2. [patents.google.com]
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Fatigue
Chronic Fatigue Syndrome (CFS) Symptoms and Diagnosis Chronic fatigue syndrome (CFS) can occur at any age for men or women. Learn more about the causes of chronic fatigue syndrome... [medicinenet.com]
Side effects: irritated heartbeat, palpatations, breathlessness, dizziness, anxiety, flue like symptoms, extreme fatigue, tingling, pain in arm Comments: prescribed tablets by Dentist for gum infection. i was told i should take antibiotics but nothing [druglib.com]
Adverse reactions CNS: dizziness, headache, ataxia, vertigo, incoordination, insomnia, fatigue EENT: rhinitis, sinusitis, pharyngitis GI: nausea, vomiting, diarrhea, abdominal pain, furry tongue, glossitis, dry mouth, anorexia GU: dysuria, dark urine, [medical-dictionary.thefreedictionary.com]
Gastrointestinal
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Nausea
The most common side effects that have been reported are nausea, vomiting and hypersensitivity reactions. However, neurotoxicity has been reported with the use of metronidazole but rather rare. [ncbi.nlm.nih.gov]
Potential side effects Uncoordinated gait, confusion, dizziness, hives, disulfiram-like reaction (flushing, nausea, vomiting), nausea, vomiting, constipation, diarrhea, metallic taste, darkened urine, blood disorders (low white blood cell count), weakness [nmihi.com]
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Abdominal Pain
Blastocystis sp. is a gastrointestinal (GI) protozoan parasite reported to cause non-specific GI symptoms including diarrhea, flatulence, abdominal pain, and nausea. [ncbi.nlm.nih.gov]
Symptoms of giardiasis include abdominal pain, stomach cramping, bloating, nausea, and fatigue. Treatment for giardiasis is with antibiotic medication. [medicinenet.com]
Metallic taste in the mouth, nausea, upper abdominal pain or headaches sometimes occur following usual therapeutic doses. Convulsions, ataxia, skin problems (skin rashes, urticaria), and vaginal candidiasis are not as common. [infomed.ch]
Abdominal pain, bloat, chronic or intermitant diarrhea and steaturrhea which cause malabsorption are the main clinical signs. The etilogic agent is Giardia lamblia which is found in the form of trophozite (pathogenic form) and cyst (infective form). [nature.com]
pain, nausea, change in stool color or jaundice, and to contact their healthcare provider When metronidazole tablets are prescribed to treat a bacterial infection, patients should be told that the medication should be taken exactly as directed; skipping [reference.medscape.com]
Jaw & Teeth
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Metallic Taste
Adverse Reactions: Nausea, headache, anorexia, vomiting, diarrhea, epigastric distress, abdominal cramping, constipation, metallic taste, dysuria, cystitis; seizures, encephalopathy, optic/peripheral neuropathy, aseptic meningitis. [empr.com]
Metallic taste in the mouth, nausea, upper abdominal pain or headaches sometimes occur following usual therapeutic doses. Convulsions, ataxia, skin problems (skin rashes, urticaria), and vaginal candidiasis are not as common. [infomed.ch]
A metallic taste in the mouth is commonly noted. metronidazole Noritate Dermatology An antibiotic used for managing dermatitides and erythema of rosacea. [medical-dictionary.thefreedictionary.com]
[…] rashes, urticaria, pruritus, bronchospasm, serum sickness Other: Metallic taste Dosage: IV: 500mg/100ml solution PO: 250mg, 500mg tablets, 750mg extended release tablet Topical: 1% cream, 0.75% gel Adult dose: Amebiasis – Entamoeba histolytica treatment [antimicrobe.org]
[Ref] Nervous system Very common (10% or more): Headache (up to 18%) Common (1% to 10%): Dysgeusia/taste perversion (e.g., metallic taste, sharp unpleasant metallic taste, taste of alcoholic beverages modified), dizziness Rare (0.01% to 0.1%): Encephalopathy [drugs.com]
Skin
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Eczema
Demodex mites are more frequently found in rosacea (51%) compared to 28 percent in eczema and 31 percent in discoid lupus erythematosus [ 13 ]. [dermatology.cdlib.org]
Some physicians use a thick ointment to replace the waterproof barrier of the inflamed skin in the treatment of eczema, and a cream might not accomplish the same clinical intention Classes[edit] There are many general classes, with no clear dividing line [en.wikipedia.org]
Musculoskeletal
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Arthralgia
[…] pressure[Ref] Respiratory Common (1% to 10%): Upper respiratory tract infection, rhinitis, sinusitis, pharyngitis Frequency not reported: Dyspnea, nasal congestion, hiccup[Ref] Musculoskeletal Common (1% to 10%): Myalgia Very rare (less than 0.01%): Arthralgia [drugs.com]
Neurologic
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Headache
During the metronidazole treatment, loss of sight, vertigo, ataxia, and headache occurred as the adverse effects. By this report, we want to express the rare adverse effects of drugs in the differential diagnoses of nervous system diseases. [ncbi.nlm.nih.gov]
A disulfiram-like reaction (including flushing, headache, nausea, and vomiting) may occur if alcohol is ingested within 7 days of use. [msdmanuals.com]
Common side effects of Flagyl are loss of appetite, headaches, and nausea. Serious side effects are encephalopathy, seizures, and aseptic meningitis. You can take metronidazole taken with or without food. [medicinenet.com]
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Peripheral Neuropathy
Overall, metronidazole is generally well tolerated, but serious neurotoxicity, including peripheral neuropathy, has been reported. The overall incidence of peripheral neuropathy associated with metronidazole is unknown. [ncbi.nlm.nih.gov]
The duration and total dosage of metronidazole received is the primary determinant for patients developing peripheral neuropathy. [pharmaceutical-journal.com]
Workup
Microbiology
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Clostridium Botulinum in Stool
Botulism was confirmed by identification of botulinum toxin and Clostridium botulinum in stools. [ncbi.nlm.nih.gov]
Treatment
1 4 Completed Treatment Gingival Inflammation 1 4 Completed Treatment Helicobacter Infection 1 4 Completed Treatment Helicobacter Infections 2 4 Completed Treatment Helicobacter Pylori Treatment Failure 1 4 Completed Treatment Human Immunodeficiency [drugbank.ca]
Medical treatment of peptic ulcer disease. JAMA. 1996; 275:622-9. 377. Soll AH. Practice guidelines for treatment of peptic ulcer disease. JAMA. 1996; 276:1136-7. 378. [drugs.com]
Medical treatment of peptic ulcer disease. JAMA. 1996; 275:622-9. [IDIS 361115] [PubMed 8594244] 377. Soll AH. Practice guidelines for treatment of peptic ulcer disease. JAMA. 1996; 276:1136-7. 378. [web.archive.org]
Patients with disease unresponsive to first-line treatments pose a major challenge, as therapeutic options are limited. [ncbi.nlm.nih.gov]
Prognosis
We advocate that metronidazole can be associated with severe neurotoxicity, but its prompt cessation leads to better outcome and prognosis. [ncbi.nlm.nih.gov]
[…] medulla, and pons ADC: ADC values of lesions of the dentate nucleus, midbrain, medulla, and pons are similar or higher than those of normal white matter, whilst corpus callosum lesions can show lower values than in normal white matter 3 Treatment and prognosis [radiopaedia.org]
When skin detachment is extensive, however, the prognosis is poor. [doi.org]
Usually, the prognosis for peripheral neuropathy is good if the cause can be successfully treated or prevented. [medicinenet.com]
Etiology
Recall dermatitis from primary cutaneous exposure and subsequent oral exposure are rare, and the etiology remains unknown. We report a case of recall dermatitis with a drug eruption secondary to metronidazole. [ncbi.nlm.nih.gov]
Martin Tomy and Hui LI, Severe cutaneous adverse drug reactions: a review on epidemiology, etiology, clinical manifestation and pathogenesis, Chinese Medical Journal, 10.1097/00029330-200804020-00019, 121, 8, (756-761), (2008) ., Current awareness: Pharmacoepidemiology [oadoi.org]
Epidemiology
The incidence and microbiologic epidemiology of NIP and VAP were studied. RESULTS: There were 873 patients enrolled. [ncbi.nlm.nih.gov]
Martin Tomy and Hui LI, Severe cutaneous adverse drug reactions: a review on epidemiology, etiology, clinical manifestation and pathogenesis, Chinese Medical Journal, 10.1097/00029330-200804020-00019, 121, 8, (756-761), (2008) ., Current awareness: Pharmacoepidemiology [oadoi.org]
Pathophysiology
Tran and Joseph Poku, Hemodynamic Considerations in the Pathophysiology of Peripheral Neuropathy, Blood Pressure - From Bench to Bed, 10.5772/intechopen.75872, (2018). J. Morera-Montes and M. [oadoi.org]
Pathophysiological mechanisms of metronidazole neurotoxicity remain unclear. MRI Nearly all cases show lesions in the cerebellum (93-100%) 1,3, particularly of the cerebellar dentate nuclei. [radiopaedia.org]
Hepatic encephalopathy: Pathophysiology and emerging therapies. Med Clin N Am 2008;93:819-836. Morgan MH, Read AE, Speller DC. Treatment of hepatic encephalopathy with metronidazole. Gut 1982;23:1-7. Schiano Thomas D. [medigraphic.com]
Discussion The exact pathophysiology of hemorrhoidal disease remains poorly studied and understood. [scielo.isciii.es]
Prevention
Recurrent Bacterial Vaginosis 1 3 Completed Prevention Appendicitis Acute / Perforated Gastroduodenal Ulcer / Small intestinal obstruction 1 3 Completed Prevention Bacterial Vaginosis (BV) 2 3 Completed Prevention Human Immunodeficiency Virus (HIV) Infections [drugbank.ca]
KEYWORDS: H. pylori; bactericidal dynamics; human lysozyme; metronidazole; mutant prevention concentration [ncbi.nlm.nih.gov]
Yoon (Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention) and Dr Umesh D. [doi.org]