Use of metronidazole in the treatment of trichomoniasis

Schram, Maxwell; Kleinman, Herman

doi:10.1016/s0002-9378(16)36036-7

Cited by 18 publications

(3 citation statements)

References 4 publications

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“…Neutropenia usually presents after 1 week of therapy. All reported cases were reversible (McKendrick & Geddes 1979;Pereyra & Lansing 1964;Schram & Kleinman 1962;Smith 1980;Zacharias et al 1963).…”

Section: Adverse Reactions To Metronidazolementioning

confidence: 96%

Clinical Pharmacokinetics of Metronidazole and Other Nitroimidazole Anti-Infectives

Lau

Lam

Piscitelli

et al. 1992

Clinical Pharmacokinetics

184

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Metronidazole was first introduced for the treatment of trichomoniasis. Its therapeutic use has subsequently been expanded to include amoebiasis, giardiasis and, more recently, anaerobic infections. Most of the early pharmacokinetic studies employed nonspecific assays such as microbiological and chemical assays. These assays were not able to differentiate the parent drug from the metabolites or other interfering substances. Pharmacokinetic data obtained through the use of specific chromatographic techniques provide the basis for this review of recent pharmacokinetic findings concerning metronidazole and other nitroimidazole antibiotics. When given intravenously or orally at usual recommended doses, metronidazole attains concentrations well above the minimum inhibitory concentrations for most susceptible micro-organisms. The drug has an oral bioavailability approaching 100%. Rectal and vaginal administration results in a smaller amount of drug absorption and lower serum concentrations. Metronidazole has limited plasma protein binding but can attain very favourable tissue distribution, including into the central nervous system. The drug is extensively metabolised by the liver to form 2 primary oxidative metabolites: the hydroxy and acetic acid metabolites. The kidney is responsible for the elimination of only a small amount of the parent drug; however, normal excretion of the 2 metabolites is dependent on the integrity of kidney function. The metabolism of metronidazole was found to vary among patient groups. Preterm and term infants have lower total body clearance (CL) and prolonged elimination half-lives. However, children older than 4 years old were observed to have pharmacokinetic parameters similar to those in adults. Reduced CL was also observed in children who are malnourished. Elderly patients have reduced renal excretion of both the parent drug and hydroxy metabolite. Pharmacokinetic parameters in pregnant patients were not significantly different from those in nonpregnant women; however, the drug is distributed into breastmilk and the infant will be exposed to the drug through the nursing mother. Patients undergoing gastrointestinal surgery or having enteric diseases and those who are hospitalised or critically ill also have altered pharmacokinetics. Metabolism of the drug is reduced in patients with liver dysfunction, giving delayed production of metabolites. In contrast, renal failure has little effect on the elimination of the parent drug, but affects the excretion of the metabolites more significantly. Haemodialysis was found to remove a substantial amount of the metronidazole while the effect of peritoneal dialysis was more limited. Energy and protein deficient diets as well as occupational exposure to gasoline did not alter metronidazole pharmacokinetics. However, the effect of alcohol consumption on metronidazole CL requires further study.(ABSTRACT TRUNCATED AT 400 WORDS)

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Section: Adverse Reactions To Metronidazolementioning

confidence: 96%

Clinical Pharmacokinetics of Metronidazole and Other Nitroimidazole Anti-Infectives

Lau

Lam

Piscitelli

et al. 1992

Clinical Pharmacokinetics

184

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“…The studies they reviewed are included in Tables 1, 2, and 3. Other studies, summarized in Table 1, have reported results that allowed similar conclusions to be drawn. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Summarizing these 37 studies (which include three case reports of defects in offspring of metronidazole-treated mothers 30,40 ), 5,333 mothers were treated with metronidazole during pregnancy, and 5,369 infants were born to these mothers. Two hundred eleven major and minor malformations (3.93%) were recorded.…”

Section: Metronidazole Is Not a Human Teratogen Struthersmentioning

confidence: 99%

Metronidazole appears not to be a human teratogen: Review of literature

Struthers¹

1997

Infect. Dis. Obstet. Gynecol.

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Metronidazole is used to treat trichomoniasis, bacterial vaginosis, and other diseases. As is the case with many drugs, physicians often hesitate to use it during pregnancy, particularly in the first trimester. A review of the nearly four decades' worth of published literature on metronidazole use in pregnant women indicates that it is not teratogenic, regardless of the trimester in which it is used. On the other hand, a number of published studies indicate that bacterial vaginosis and trichomoniasis are associated with preterm birth and low birth weight. Treatment of these conditions with metronidazole during pregnancy may decrease the incidence of preterm birth and low birth weight, thus potentially decreasing the complications that can result from prematurity. Infect. Dis. Obstet. Gynecol. 5:326–335, 1997. © 1998 Wiley‐Liss, Inc.

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“…Other studies, summarized in Table 1, have reported results that allowed similar conclusions to be drawn. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Summarizing these 37 studies (which include three case reports of defects in offspring of metronidazole-treated mothers3'4), 5,333 mothers were treated with metronidazole during pregnancy, and 5,369 infants were born to these mothers. Two hundred eleven major and minor malformations (3.93%) were recorded.…”

Section: Human Studiesmentioning

confidence: 99%