MRI findings of metronidazole neurotoxicity in a pediatric patient with chronic diarrhea

Yazdani, Rana M.; Kayfan, Samar; Cao, Joseph; Clarke, Rebekah; Pfeifer, Cory M.

doi:10.1016/j.radcr.2018.09.026

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…Metronidazole may increase the risk of selection of multidrug resistant E coli 50 51 and possibly favours bacterial translocation 52. Finally, metronidazole can cause a potentially severe neurotoxicity in dogs,53–55 as well in humans56–59 and should therefore be used cautiously.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial prescriptions and adherence to prudent use guidelines for selected canine diseases in Switzerland in 2016

Lutz

Lehner

Schmitt

et al. 2020

Veterinary Record Open

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BackgroundAntimicrobial resistance is an increasing problem in human and veterinary medicine and is closely linked to the use of antimicrobials. The objective of this study was to describe antimicrobial prescriptions for selected canine diseases in Switzerland during 2016.MethodsDogs presented to two university hospitals and 14 private practices for acute diarrhoea (AD; n=371), suspected or confirmed urinary tract infections (UTIs; n=245), respiratory tract infections (RTIs; n=274) or wound infections (WIs; n=175) were included. Clinical history, diagnostic work-up and antimicrobial prescription (class, dosage and duration) were retrospectively assessed. A justification score was applied to evaluate appropriateness of antimicrobial therapy based on available national and international consensus guidelines.ResultsAntimicrobials were prescribed in 65 per cent of dogs with AD, 88 per cent with UTI, 62 per cent with RTI and 90 per cent with WI. The most prescribed antimicrobial classes (monotherapy and combination therapy) were potentiated aminopenicillins (59 per cent), nitroimidazoles (22 per cent), non-potentiated aminopenicillins (16 per cent) and fluoroquinolones (13 per cent). Overall, 38 per cent (95 per cent CI 0.35 to 0.41) of the prescriptions were in accordance with consensus guidelines. In dogs with AD, antimicrobial therapy was associated with the presence of haemorrhagic diarrhoea (P<0.05) and complied in 32 per cent with consensus guidelines, which recommend antimicrobial treatment only when sepsis is suspected. A bacterial aetiology was confirmed via culture and/or sediment examination in 36 per cent of dogs with suspected UTI.ConclusionsOverall, adherence to consensus guidelines was poor both, at university hospitals and private practices. Antimicrobial stewardship measures are therefore needed to improve prudent use.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial prescriptions and adherence to prudent use guidelines for selected canine diseases in Switzerland in 2016

Lutz

Lehner

Schmitt

et al. 2020

Veterinary Record Open

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“…Though common adverse effects of the medication include nausea, vomiting and abdominal pain, rare neurological symptoms have been reported. Metronidazole may cross the blood–brain barrier with consequent axonal swelling or reversible localized ischemia [ 9 , 10 ], diagnosable by brain MRI that can detect bilateral increased T2 and FLAIR signal in the dentate nuclei, pons and cerebellum without contrast enhancement [ 9 ]. Symptoms usually resolve shortly after discontinuing the medication but about 10% of patients have severe morbidity or mortality [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Stemming the Tide of Gastrointestinal Chronic Granulomatous Disease

et al. 2022

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“…Most cases of MIE are reported in adults. To our knowledge, 13 cases in children have been published thus far, of which three children had CD [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. They all had resolution of symptoms or markedly improved with the discontinuation of metronidazole.…”

Section: Discussionmentioning

confidence: 99%

“…Metronidazole-induced encephalopathy (MIE) is a rare and unpredictable complication that is reported most frequently in adults. The most common symptoms in children are gait instability, altered mental status, seizures, visual disturbances, limb dyscoordination, dizziness, and vomiting [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Here, we present the case of MIE in a patient with Crohn’s disease (CD) treated with rectal, oral, and intravenous metronidazole.…”

Section: Introductionmentioning

confidence: 99%

Metronidazole-Induced Encephalopathy in a 16-Year-Old Girl with Crohn’s Disease: Case Report and Review of the Pediatric Literature

et al. 2022

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Metronidazole-induced encephalopathy (MIE) is a rare and unpredictable complication that is most commonly reported in adults. Here, we present the case of MIE in a patient treated with rectal, oral, and intravenous metronidazole. This is the first case of MIE reported after suppositories. A 16-year-old girl with Crohn’s disease treated with mesalazine and exclusive enteral nutrition was operated on due to perianal fistulas and abscesses. She received oral metronidazole for 25 days and rectal metronidazole for 15 days as an adjuvant before surgery. Moreover, 2.5 g of intravenous metronidazole was administrated during the perioperative period. The second day after the surgery, symptoms of cerebellar syndrome appeared. She presented with an inability to coordinate balance and gait. Although she showed accurate verbal responses, her speech was slow, slurred, and scanning. The finger–nose test was positive. The T2-weighted magnetic resonance imaging revealed an increased symmetrical signal within the dentate nuclei of the cerebellum and in the corpus callosum. The changes were characterized by restricted diffusion. Based on the clinical picture and magnetic resonance imaging findings, MIE was diagnosed. Treatment with metronidazole was discontinued. The cumulative dose of metronidazole that she received for 29 days was 54 g: 38 g p.o., 13.5 g p.r., and 2.5 g i,v. The first symptoms appeared on the 28th day of antibiotic therapy after receiving 52 g of metronidazole. The neurological symptoms resolved after six days; however, three days after the resolution, paresthesia appeared in the distal phalanges of both feet and lasted for approximately two months. Our report highlights that neurologic symptoms related to metronidazole treatment should raise the suspicion of MIE.

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MRI findings of metronidazole neurotoxicity in a pediatric patient with chronic diarrhea

Cited by 6 publications

References 9 publications

Antimicrobial prescriptions and adherence to prudent use guidelines for selected canine diseases in Switzerland in 2016

Antimicrobial prescriptions and adherence to prudent use guidelines for selected canine diseases in Switzerland in 2016

Stemming the Tide of Gastrointestinal Chronic Granulomatous Disease

Metronidazole-Induced Encephalopathy in a 16-Year-Old Girl with Crohn’s Disease: Case Report and Review of the Pediatric Literature

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