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
- Epilepsy
The following medicines, in particular, may affect how metronidazole works so do inform your doctor first, these include: Blood-thinning drugs such as warfarin Lithium to treat depression Medicines to treat epilepsy Disulfiram used in the treatment of [imeds.com]
[…] taking any of these medicines: warfarin, a medicine that helps to treat and prevent blood clots lithium, used to treat some types of mental health conditions disulfiram, used to help people stay off alcohol phenytoin or phenobarbitone, used to treat epilepsy [nhs.uk]
You should make sure to mention if you are taking any other medicines, including medicines obtained without a prescription, especially if you take anti-coagulants, lithium, medicines used to treat epilepsy, 5-fluorouracil, busulfan, ciclosporin or disulfiram [oxfordonlinepharmacy.co.uk]
Check with your doctor or pharmacist before taking Metronidazole tablets if you: have kidney disease, particularly if you require dialysis treatments have ever suffered from any liver disease are in the 4th-9th month of pregnancy have epilepsy or have [drugs.com]
In particular, you should highlight these following medicines if you are currently using them: Blood thinning agents (anti-coagulants) such as warfarin Lithium (for treating mental illness) Medicines that treat epilepsy such as primidone, phenytoin, phenobarbitone [doctor-4-u.co.uk]
- Sepsis
Dose adjustment may not be appropriate in ACUTE renal impairment secondary to SEPSIS. In this case it is important to treat the infection aggressively for the first 24hrs and re-check renal function before reducing the dose accordingly. [gloshospitals.nhs.uk]
Discussion In 1978 ( 7 ), one study reported (in the form of a letter to the editor) the putrid odor that some pressure ulcers exuded and other cases in which patients progressed to sepsis caused by anaerobic bacteria. [scielo.br]
Bacterial infection of the blood following childbirth (puerperal fever/sepsis). A serious form of pneumonia (necrotising pneumonia). Brain abscesses. Eradicating Helicobacter pylori bacteria from the gut in people with peptic ulcers. [netdoctor.co.uk]
Among these case patients, 5 with TEN died of sepsis. No cases of SJS/TEN occurred in these laborers’ 12 000 Taiwanese coworkers during the study period. [doi.org]
Metronidazole and anaerobic sepsis. British Medical Journal 2: 1418–1421 (1976). PubMed CrossRef Google Scholar Feldman, W.E.: Bacteroides fragilis ventriculitis and meningitis. Report of two cases. [link.springer.com]
- 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]
With the pill I experienced daily headaches, a feeling of being distorted, fatigue, dizziness, nausea, diarrhea, a stiff neck, and a metal taste in my mouth. I never had BV until the year 2011 after being sex-free for 3 years after my divorce. [webmd.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]
- 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]
For both intravenous and oral administration, a linear dose-concentration curve pertained for usual therapeutic doses between 200 and 2000mg. [link.springer.com]
Intravenous administration is commonly associated with thrombophlebitis. [en.wikipedia.org]
In therapeutic use as radiosensitizers for radiation therapy of tumors, the compounds of the present invention may be administered to a patient either orally or intravenously. The preferred route of administration is intravenous administration. [patents.google.com]
Respiratoric
- Nasal Congestion
[…] feeling of pelvic pressure frequent or painful urination loss of voice nasal congestion pinpoint red spots on the skin runny nose skin rash, hives, redness, itching sneezing stomach and back pain (severe) unusual bleeding or bruising vaginal irritation [drugs.com]
Reported reactions include urticaria; erythematous rash; Stevens-Johnson Syndrome, toxic epidermal necrolysis, flushing; nasal congestion; dryness of the mouth, vagina, or vulva; fever; pruritus; fleeting joint pains. [ndrugs.com]
congestion Tell your doctor or nurse as soon as possible if you notice any of the following: confusion, irritability, depression, disorientation clumsiness, lack of co-ordination, problems with moving or balancing difficulty in speaking headache, stiff [news-medical.net]
Hypersensitivity: Urticaria, erythematous rash, flushing, nasal congestion, dryness of the mouth (or vagina or vulva), and fever. Renal: Dysuria, cystitis, polyuria, incontinence, and a sense of pelvic pressure. [web.archive.org]
Gastrointestinal
- 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]
Symptoms of overdose may include: nausea, vomiting, unsteadiness. Notes Do not share this medication with others. [healthlinkbc.ca]
- 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 peptic or stomach ulcers include abdominal burning or hunger pain, indigestion, and abdominal discomfort after meals. Treatment for stomach ulcers depends upon the cause. [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]
Depression Sleep disorder Nervousness Perineal pain Urinary difficulties Headache Musculoskeletal pain Vaginal estradiol: Headache Vulvovaginal mycotic (fungal) infection Vulvovaginal pruritus (itching) Back pain Abdominal pain Diarrhea Vaginal metronidazole [rxlist.com]
Metronidazole is well tolerated with mild to moderate side effects such as nausea, abdominal pain, and diarrhea. Nevertheless, serious neurotoxicity, optic neuropathy, peripheral neuropathy, and encephalopathy have been reported in rare cases. [europeanreview.org]
- Food Poisoning
Multimedia: Slideshows, Images & Quizzes Bacterial Infections 101: Types, Symptoms, and Treatments Get more information on bacterial skin infections, which bacteria cause food poisoning, sexually transmitted bacteria, and more.... [medicinenet.com]
Cardiovascular
- Tachycardia
[…] e.g., diplopia, myopia) Frequency not reported: Optic neuropathy/neuritis, saccadic eye movement, blurred vision, decreased visual acuity, changed color vision, light sensitivity[Ref] Cardiovascular Frequency not reported: Flattening of T-wave on ECG, tachycardia [drugs.com]
Consuming alcohol while taking metronidazole causes a disulfiram-like reaction with effects that can include nausea, vomiting, flushing of the skin, tachycardia (accelerated heart rate), shortness of breath, and even death. [emedexpert.com]
A typical disulfiram reaction causes flushing, tachycardia, palpitations, nausea, and vomiting. [ncbi.nlm.nih.gov]
[…] combined with mebendazole.[37] Drug interactions[edit] Alcohol[edit] Consuming alcohol while taking metronidazole has been suspected in case reports to cause a disulfiram-like reaction with effects that can include nausea, vomiting, flushing of the skin, tachycardia [en.wikipedia.org]
Jaw & Teeth
- Metallic Taste
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]
Can the use of Metronidazole cause metallic taste? Yes, Metronidazole may cause a temporary metallic taste. This metallic taste can be reduced by staying hydrated, brushing teeth after the meals and chewing sugar-free gum or mints. Q. [1mg.com]
The metal taste in my mouth is a little irritating, my appetite is decreased, and I feel a little groggier than usual, but it's really not so bad. Just thought I would write a review to ease some people's mind... [webmd.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]
[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]
Ears
- Tinnitus
[…] impaired, nystagmus, tremor), drowsiness, convulsions, incoordination Frequency not reported: Dysarthria, hypoesthesia, paresthesia, peripheral sensory neuropathy, transient epileptiform seizures, hearing impaired/hearing loss (including sensorineural), tinnitus [drugs.com]
[…] lack of co-ordination, problems with moving or balancing difficulty in speaking headache, stiff neck and extreme sensitivity to bright light problems with sleeping fits or seizures dizziness or spinning sensation ringing/ persistent noise in the ears (tinnitus [news-medical.net]
- Hearing Impairment
nystagmus, tremor), drowsiness, convulsions, incoordination Frequency not reported: Dysarthria, hypoesthesia, paresthesia, peripheral sensory neuropathy, transient epileptiform seizures, hearing impaired/hearing loss (including sensorineural), tinnitus [drugs.com]
Eyes
- Redness of Eye
[…] skin lesions, often with a purple center red, irritated eyes redness of the face, neck, arms, and occasionally, upper chest redness of the skin Some side effects of metronidazole may occur that usually do not need medical attention. [drugs.com]
Skin
- 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
- 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]
Urogenital
- Dark Urine
Metronidazole can cause a metallic taste and dark urine. A disulfiram-like reaction (including flushing, headache, nausea, and vomiting) may occur if alcohol is ingested within 7 days of use. [merckmanuals.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]
Get medical help right away if you have any signs of liver disease during treatment (such as nausea/vomiting that doesn't stop, loss of appetite, severe stomach/abdominal pain, yellowing eyes/skin, dark urine). [healthlinkbc.ca]
- Dysuria
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]
[…] cefamandole naftate dopamine hcl Adverse Reactions CNS: lethargy, weakness, poor coordination Blood: transient neutopenia, leukopenia Endocrine: hypoglycemia, hypocalcemia GI: anorexia, diarrhea, stomatitis GU: darkened or red-brown urine, cystitis, polyuria, dysuria [ratguide.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]
(up to 15%) Common (1% to 10%): Genital pruritus, abnormal urine, dysmenorrhea, moniliasis, urinary tract infection Rare (0.01% to 0.1%): Chromaturia Very rare (less than 0.01%): Darkened urine Frequency not reported: Vaginal dryness, vulva dryness, dysuria [drugs.com]
Other side effects include vomiting, diarrhea, rashes, furry tongue, glossitis, dizziness, vertigo, dysuria, cystitis. Metronidazole is an antiprotozoal drug but it is also active against bacteria and it belongs to the nitroimidazole group. [antibiotics-info.org]
- Polyuria
[…] cefamandole naftate dopamine hcl Adverse Reactions CNS: lethargy, weakness, poor coordination Blood: transient neutopenia, leukopenia Endocrine: hypoglycemia, hypocalcemia GI: anorexia, diarrhea, stomatitis GU: darkened or red-brown urine, cystitis, polyuria [ratguide.com]
[…] pruritus, abnormal urine, dysmenorrhea, moniliasis, urinary tract infection Rare (0.01% to 0.1%): Chromaturia Very rare (less than 0.01%): Darkened urine Frequency not reported: Vaginal dryness, vulva dryness, dysuria, vaginal candidiasis, dyspareunia, polyuria [drugs.com]
GU: darkened urine, polyuria, dysuria, cystitis, dyspareunia, dryness of vagina and vulva, vaginal candidiasis. Hematologic: transient leukopenia, neutropenia, thrombocytopenia. Musculoskeletal: fleeting joint pain. Skin: rash. [glowm.com]
If significant side effects are caused by prednisone, such as severe polyuria/polydipsia, panting, lethargy, pruritus, behavioral changes, and/or increasing serum liver enzymes activity, oral dexamethasone can be tried instead. [web.archive.org]
Neurologic
- 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. [merckmanuals.com]
- 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]
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. [IDIS 361115] [PubMed 8594244] 377. Soll AH. Practice guidelines for treatment of peptic ulcer disease. JAMA. 1996; 276:1136-7. 378. [web.archive.org]
Treatment of antibiotic-associated pseudomembranous colitis. Rev Infect Dis. 1984; 6(Suppl 1):S235-41. 129. Fekety R, Silva J, Buggy B et al. Treatment of antibiotic-associated colitis with vancomycin. [drugs.com]
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]
Biology and Epidemiology 3.2.1.1.2. Chemotherapy 3.2.1.2. American Trypanosomiasis 3.2.1.2.1. Biology and Epidemiology 3.2.1.2.2. Chemotherapy 3.2.1.3. Leishmaniasis 3.2.1.3.1. Biology and Epidemiology 3.2.1.3.2. Chemotherapy 3.2.2. [doi.org]
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
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]
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]
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]
Article Navigation From the Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, and the Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine [doi.org]
KEYWORDS: H. pylori; bactericidal dynamics; human lysozyme; metronidazole; mutant prevention concentration [ncbi.nlm.nih.gov]
It is broadly used to prevent and treat oral anaerobic infections. [chemicalbook.com]