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Metronidazole

Flagyl


Presentation

  • This case exemplifies a stroke mimic to be considered when a patient presents with an acute focal neurological deficit.[ncbi.nlm.nih.gov]
  • Mostly, metronidazole is a tolerable drug but rarely presents serious adverse effects on the nervous system.[ncbi.nlm.nih.gov]
  • Initial neurological symptoms followed by mucocutaneous manifestation of SJS following metronidazole use is probably a new presentation of this case.[ncbi.nlm.nih.gov]
  • We present the case of a patient with presumed resistant infection during pregnancy, and the additional treatment issues that this presented.[ncbi.nlm.nih.gov]
  • : A patient with ALD presenting with encephalopathy creates a diagnostic dilemma for the emergency physician regarding whether to continue metronidazole and treat for hepatic encephalopathy or to suspect for MIE and withhold the drug.[ncbi.nlm.nih.gov]
Intravenous Administration
  • Intravenous administration is commonly associated with thrombophlebitis.[en.wikipedia.org]
  • 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]
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]
  • 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]
  • A 25-year-old caucasian lady presented to the Accident & Emergency department complaining of acute onset severe epigastric pain radiating through to the back with associated nausea and vomiting. A diagnosis of acute pancreatitis was made.[ncbi.nlm.nih.gov]
  • She admitted to Emergency Department with newly onset myalgia, nausea, vomiting, blurred vision and cerebellar signs. She had nystagmus in all directions of gaze, ataxia and incompetence in tandem walk.[ncbi.nlm.nih.gov]
  • Consuming alcohol while taking metronidazole has long been thought to have a disulfiram-like reaction with effects that can include nausea, vomiting, flushing of the skin, tachycardia, and shortness of breath.[en.wikipedia.org]
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]
  • Not at all hard to take Dosage: 1500 mg Daily Cost: 25 monthly 0 helpful marks Jul 1, 2013 (Started Jul 01, 2013) Effectiveness Major (for clostridium difficile) Effectiveness Major (for pseudomembranous colitis) Side effects Moderate (upset stomach, metallic[patientslikeme.com]
  • Metronidazole is available by mouth, as a cream, and by injection into a vein.Common side effects include nausea, a metallic taste, loss of appetite, and headaches. Occasionally seizures or allergies to the medication may occur.[en.wikipedia.org]
  • 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]
Progressive Visual Loss
  • We report a patient who developed progressive visual loss after an 8‐month course of Metronidazole. Electrophysiology confirmed a bilateral optic neuropathy. Her vision improved dramatically with cessation of the drug.[dx.doi.org]
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 present case is of a patient who used the drug for 4 months and developed peripheral neuropathy, convulsions, and cerebellar ataxia. He was treated with diazepam and levetiracetam.[ncbi.nlm.nih.gov]
  • Abstract Metronidazole-induced central nervous system (CNS) toxicity causes a spectrum of neurological symptoms including ataxia, encephalopathy and peripheral neuropathy.[ncbi.nlm.nih.gov]
  • The most common neurological manifestation is peripheral neuropathy involvement in the form of sensory loss. It is worth mentioning that central neurotoxicity is a rare side effect of metronidazole use but reversible.[ncbi.nlm.nih.gov]
  • […] symptoms are generally reversible within days to weeks upon discontinuation of therapy; lesions seen on MRI have also been described as reversible Peripheral neuropathy, mainly of sensory type reported and characterized by numbness or paresthesia of[reference.medscape.com]
Altered Mental Status
  • The manifestations vary from a headache, altered mental status to focal neurological deficits. The diagnosis is mainly by neuroimaging in the setting of acute neurological change in the patient status.[ncbi.nlm.nih.gov]
  • Among 64 patients, 48 (77%) had cerebellar dysfunction, 21 (33%) had altered mental status, and 8 (15%) had seizures. Patients' ages averaged 53.3 years (range, 12-87 years), and 64% were male.[ncbi.nlm.nih.gov]
Slurred Speech
  • A 65-year-old woman with a diagnosis of Clostridium difficile colitis undergoing prolonged treatment with metronidazole was admitted to hospital for altered mentation, slurred speech and weakness.[ncbi.nlm.nih.gov]
Aphasia
  • We report a 37-year-old man with a history of cirrhosis and methicillin-sensitive staphylococcus aureus (MSSA) bacteremia who presented from a nursing home with 1 week of progressive confusion followed by acute onset of aphasia, forced left eye deviation[ncbi.nlm.nih.gov]

Workup

Liver Function Tests Abnormal
  • Two subjects discontinued because of an adverse event (rash, liver function test abnormal); both events were considered to be study drug-related.[ncbi.nlm.nih.gov]
Staphylococcus Aureus
  • The determination of FPC-M activity against Staphylococcus aureus showed that it could target the bacterial cell.[ncbi.nlm.nih.gov]
  • We report a 37-year-old man with a history of cirrhosis and methicillin-sensitive staphylococcus aureus (MSSA) bacteremia who presented from a nursing home with 1 week of progressive confusion followed by acute onset of aphasia, forced left eye deviation[ncbi.nlm.nih.gov]
  • Due to the emergence of drug-resistant "superbugs," like methicillin-resistant Staphylococcus aureus (MRSA), traditional antibiotics such as penicillin and its derivatives are in danger of becoming obsolete.[books.google.es]
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]
  • The primary outcomes assessed were cure, treatment failure, and relapse. Cure was defined as resolution of diarrhea by day 6 of treatment and a negative result of a C. difficile toxin A assay at days 6 and 10 of treatment.[doi.org]
  • CONCLUSIONS: There seems to be a relationship between the clinical and microbiological response to B. hominis treatment. The microbiological response to MTZ treatment is insufficient in our geographical setting.[ncbi.nlm.nih.gov]
  • CONCLUSION: CDI treatment with metronidazole was not associated with a 30% increase in TAC levels compared with vancomycin.[ncbi.nlm.nih.gov]
  • The incidence and severity of Clostridium difficile-associated diarrhea (CDAD) has been increasing, and there have been recent reports of metronidazole treatment failure.[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]
  • Prognosis is excellent with metronidazole cessation.[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]

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]
  • Diarrhea after hematopoietic stem cell transplantation (HSCT) can be life-threatening, and its etiology includes conditioning regimens, graft-versus-host disease (GVHD), infections, and transplantation-associated microangiopathy (iTAM).[ncbi.nlm.nih.gov]
  • A viral etiology was ruled out as well as vascular, metabolic and malignant etiology.[ncbi.nlm.nih.gov]
  • Acute encephalopathy in a patient with alcoholic liver disease (ALD) is a commonly encountered emergency situation occurring most frequently due to liver failure precipitated by varying etiologies.[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[dx.doi.org]

Epidemiology

  • The incidence and microbiologic epidemiology of NIP and VAP were studied. RESULTS: There were 873 patients enrolled.[ncbi.nlm.nih.gov]
  • However, due to inadequate epidemiological evidence, it is not considered as a risk factor for cancer in humans.[ncbi.nlm.nih.gov]
  • Serum concentrations were compared to minimum inhibitory concentrations (MIC) and epidemiological cut-off values (ECOFFs) for relevant pathogens.[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[dx.doi.org]
Sex distribution
Age distribution

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.[dx.doi.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]
  • Epidemiology and pathophysiology of Campylobacter pylori infections. Clin Infect Dis. 1990; 12(Suppl 1):S99-106. 248. Barthel JS, Everett ED. Diagnosis of Campylobacter pylori infections: The “gold standard” and the alternatives.[drugs.com]

Prevention

  • KEYWORDS: H. pylori; bactericidal dynamics; human lysozyme; metronidazole; mutant prevention concentration[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Centers for Disease Control and Prevention recently changed treatment recommendations for HIV women to multidose rather than single-dose. These data suggest that those recommendations should be considered for all women.[ncbi.nlm.nih.gov]
  • 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]
  • For prevention of SSI among obese women after cesarean delivery, prophylactic oral cephalexin and metronidazole may be warranted. Trial Registration: clinicaltrials.gov Identifier: NCT01194115 .[ncbi.nlm.nih.gov]
  • We herein describe 4 patients who developed moderate to severe hepatotoxicity after exposure to a commercially - available combination of two antibiotics - spiramycin and metronidazole - commonly used for the treatment and prevention of periodontal infections[ncbi.nlm.nih.gov]

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