Metronidazole-induced neurotoxicity

Quickfall, Danica; Daneman, Nick; Dmytriw, Adam A.; Juurlink, David N.

doi:10.1503/cmaj.201671

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…It is still unclear whether metronidazole neurotoxicity is dose-dependent or an idiosyncratic reaction; some authors suggest that prolonged treatment and higher doses are risk factors for the onset of the disease [14]. In addition, patients with concomitant liver and kidney disease, alcohol use, and neurotropic medications are at increased risk of complications [5,15].…”

Section: Discussionmentioning

confidence: 99%

Sensory-motor polyneuropathy due to the use of antiparasitic drugs: A case report

Orsini Neves,

Cwajgenberg,

Pereira

et al. 2023

Int J Case Rep Images

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Introduction: The term polyneuropathy refers to a generalized involvement of peripheral nerves, usually involving mainly the distal nerves and, more often, presenting with sensory, motor, and autonomic symptoms and clinical findings. Drug-induced peripheral neuropathy (DIPN) is a persistent condition, most often associated with anticonvulsants, chemotherapy, cardiovascular, psychotropic, and antimicrobial drugs, such as Metronidazole. In this article, we report the case of a patient who developed polyneuropathy secondary to the use of Metronidazole. Case Report: D.D.S.L., a 45-year-old female, previously healthy, presented with abdominal discomfort. Entamoeba histolytica was detected after investigation, and she started a 7-day cycle of 500 mg of Metronidazole three times a day for seven days, without clinical response. A new therapeutic approach was attempted, with three cycles of 2 grams of Secnidazole single dose and Tinidazole for four weeks. However, the patient presented dysesthesia in the distal third of the thighs, followed by allodynia in the four limbs and trunk. After new abdominal discomfort, three months after the first medication cycle, another pharmacological cycle was started. Neurological examination and electroneuromyography (ENM) examination suggested axonal sensorimotor polyneuropathy in all four limbs. Conclusion: Polyneuropathy can be caused by many factors, including some frequently prescribed drugs such as Metronidazole and other medications in the 5-nitroimidazole group. Therefore, although the relationship between these drugs and polyneuropathy is not fully elucidated, their neurotoxicity is indisputable, even in rare cases, but with significant variability in terms of the dose-dependent potential for this disease.

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Section: Discussionmentioning

confidence: 99%

Sensory-motor polyneuropathy due to the use of antiparasitic drugs: A case report

Orsini Neves,

Cwajgenberg,

Pereira

et al. 2023

Int J Case Rep Images

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“…Neurotoxicity risk is also reported to be higher in patients with IBD, osteomyelitis, and undrained abscesses. In the majority of cases, patients showed complete recovery from neurotoxic symptoms upon discontinuation of medication within a few days of discontinuing metronidazole [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Exacerbation of Mania due to Metronidazole in a Bipolar Disorder Patient

AlShakori

Arain

Thorakkattil

et al. 2022

Case Reports in Psychiatry

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Bipolar disorder is a mental health disorder where the patient experiences extreme shifts in mood marked by depression, mania, or hypomania. It affects their overall daily life activities and sleep patterns. This case report is of a 74-year-old female patient with bipolar disorder who experienced a manic episode after initiation of antibiotics to treat gallbladder perforation with abscess formation. The patient’s past medical history included Parkinson’s disease, diabetes mellitus, bipolar disorder, and acalculous cholecystitis. The patient required hospitalization for a cholecystostomy tube insertion for drainage. During hospitalization, the patient was started on empiric treatment with broad-spectrum antibiotics, including piperacillin/tazobactam and metronidazole. The patient remained stable during the inpatient stay and was discharged home one week later. She was prescribed cefuroxime and metronidazole to complete a 2-week duration of antibiotics. However, upon discharge, she developed manic symptoms, including lack of need to sleep, excessive talking, and severe agitation. Upon assessment, the psychiatric team decided to hold metronidazole as it has an adverse effect of mania as evidenced in drug information resources. The patient started to show immediate recovery from the symptoms with complete resolution of manic symptoms on the 3rd day following the discontinuation of metronidazole. This case emphasizes the increased need for vigilance in bipolar patients upon prescribing metronidazole. Also, further research is needed to predict the time to onset of manic symptoms and improvement in patient symptoms upon drug discontinuation.

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“…Metronidazole causes mild to moderate gastrointestinal side effects such as diarrhea, nausea, and abdominal pain, but is well tolerated [2]. In the central nervous system, it is reported that it commonly causes dysarthria, mental changes, and ataxia, and more rarely, neurotoxicity, optic neuropathy, encephalopathy, and peripheral neuropathy [5,6,7]. It has been reported that the drug, which is in the IARC 2B class, has genotoxic and carcinogenic properties in animals.…”

Section: Introductionmentioning

confidence: 99%

Determination of the embryotoxic effect of Metronidazole using an in ovo model

Uslu,

Canbar,

Arslan

et al. 2024

RC FCV-LUZ

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Metronidazole is an imidazole group bactericidal antibiotic used against anaerobic bacteria and some protozoa. There is no detailed information about the embryotoxic effect of Metronidazole. This study aims to determine the embryotoxic activity of Metronidazole using an in ovo method. A total of 210 fertile chicken eggs were placed in an incubator, divided into seven equal groups of 30. The first group was considered as the control group. On the seventh day of the study, Metronidazole was administered to the other six groups within 50 µL saline solution at doses of 250, 125, 62.5, 31.25, and 15.62 µg·egg-1 (5; 2.5; 1.25; 0.625; 0.312 mg·kg-1). At the end of the incubation period, the eggs hatched, and the number of live and dead embryos was determined. There were no significant differences in deaths between the groups (P>0.05 in all cases). No anomaly was detected in the macroscopic morphology of the embryos. As a result, it can be stated that Metronidazole may be safe for use during pregnancy. However, it is necessary to conduct molecular and histopathological studies to investigate the effects of this drug on organogenesis, especially in mammalian embryos.

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Metronidazole-induced neurotoxicity

Cited by 5 publications

References 4 publications

Sensory-motor polyneuropathy due to the use of antiparasitic drugs: A case report

Sensory-motor polyneuropathy due to the use of antiparasitic drugs: A case report

Exacerbation of Mania due to Metronidazole in a Bipolar Disorder Patient

Determination of the embryotoxic effect of Metronidazole using an in ovo model

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