Metrogil, 5 mg/ml 100 ml

Metrogil has antibacterial, antiprotozoal (trichomonacid) action.

The nitrogroup of metronidazole is reduced in anaerobic microorganisms and protozoa and interacts with the DNA of the microbial cell, inhibiting the synthesis of their nucleic acids, which leads to the death of the bacteria.

Metronidazole is active against Trichomonas vaginalis, Gardnerella vaginalis, Giardia intestinalis, Entamoeba histolytica, Lamblia, anaerobic bacteria: Bacteroides spp.

In combination with amoxicillin it shows activity against Helicobacter pylori (amoxicillin suppresses the development of resistance to metronidazole).

Metronidazole is insensitive to aerobic microorganisms and facultative anaerobes, but in the presence of mixed flora (aerobes and anaerobes) metronidazole acts synergistically with antibiotics effective against common aerobes.

It increases the sensitivity of tumors to radiation, causes disulfiram-like reactions and stimulates reparative processes.

When applied topically, it has an anti-acne effect, the exact mechanism of which is unknown.

Indications

Prevention and treatment of anaerobic infections in surgical procedures mainly on the abdominal organs and urinary tract;

Severe mixed aerobic-anaerobic infections (combination therapy), intestinal and hepatic amoebiasis, sepsis, peritonitis, osteomyelitis, gynecological infections, pelvic and brain abscesses, abscessed pneumonia, gas gangrene, skin and soft tissue, bone and joint infections.

The radiotherapy of patients with tumors – as a radiosensitizing drug in cases where tumor resistance is due to hypoxia in the tumor cells.

Active ingredient

Composition

Active substance:

metronidazole 5 mg

How to take, the dosage

Intravenous

Adults and children over 12 years of age in an initial dose of 0.5-1 g by IV drip (infusion duration 30-40 minutes), and then every 8 hours 500 mg at a rate of 5 ml/min. If tolerated well, after the first 2-3 infusions, switch to jet injection. The course of treatment is 7 days. If necessary, intravenous infusion is continued for a longer period. Maximal daily dose is 4 g. If indicated, switch to maintenance oral administration at a dose of 400 mg 3 times a day.

Children under 12 years of age are indicated with the same regimen and a single dose of 7.5 mg/kg.

In purulent-septic diseases usually it is carried out 1 course of treatment.

For prophylactic purposes in adults and children over 12 years old it is administered by IV drops of 0.5-1 g the day before surgery, on the day of surgery and the next day – 1.5 g/day (500 mg every 8 hours). After 1-2 days switch to oral maintenance therapy.

In patients with CKD and IQ less than 30 ml/min and/or liver failure the maximal daily dose is not more than 1 g and the dose should be taken 2 times per day.

As a radiosensitizer the drug is administered by intravenous drops at the rate of 160 mg/kg or 4-6 g/sq.m of body surface 0.5-1 h before irradiation. It is administered before each session of irradiation for 1-2 weeks. Metronidazole is not used during the remaining period of radiotherapy. The maximum single dose should not exceed 10 g, the course dose – 60 g. Drip administration of 5% dextrose solution, Hemodez or 0.9% NaCl solution is used to relieve intoxication caused by radiation.

Interaction

It enhances the effect of indirect anticoagulants, which leads to prolongation of prothrombin formation time. Similar to disulfiram causes ethanol intolerance.

The concomitant use with disulfiram may lead to the development of various neurological symptoms (interval between prescriptions – at least 2 weeks).

Intravenous metronidazole should not be mixed with other drugs.

Cimetidine inhibits metabolism of metronidazole which may increase its serum concentrations and increase the risk of side effects.

The concomitant administration of drugs stimulating enzymes of microsomal oxidation in the liver (phenobarbital, phenytoin) may accelerate elimination of metronidazole, resulting in lower plasma concentrations.

Concomitant use with Li+ drugs may increase the plasma concentration of the latter and the development of intoxication symptoms.
It is not recommended to combine with nondepolarizing myorelaxants (vecuronium bromide). Sulfonamides increase the antimicrobial effect of metronidazole.

Special Instructions

During long-term treatment, systematic monitoring of peripheral blood counts is necessary. In case of leukopenia, the possibility of continuing treatment depends on the danger of an infectious process.

The treatment should be discontinued in case of ataxia, dizziness, worsening of patients’ neurological status.

It should be taken into account that metronidazole may immobilize treponemes, which leads to a false-positive Nelson’s test.

Darker staining of urine is observed during use of the drug.

In combination with amoxicillin, it is not recommended for use in patients under 18 years of age; should not be used in gastrointestinal disease with prolonged diarrhea or vomiting; use with caution in liver disease.

Contraindications

Children under 6 years of age; individual intolerance to metronidazole, chlorhexidine as well as nitroimidazole derivatives and other components of the drug.

Limitations on use:

Side effects

Digestive system disorders: diarrhea, decreased appetite, nausea, vomiting, intestinal colic, constipation, “metallic” taste in the mouth, dry mouth, glossitis, stomatitis, pancreatitis.

Nervous system disorders: dizziness, movement coordination disorders, ataxia, confusion, irritability, depression, increased excitability, weakness, insomnia, headache, seizures, hallucinations, peripheral neuropathy.

Allergic reactions: urticaria, skin rash, skin hyperemia, nasal congestion, fever, arthralgia.

Urinary system disorders: dysuria, cystitis, polyuria, urinary incontinence, candidiasis, staining of urine red-brown.

Local reactions: thrombophlebitis (pain, hyperemia or swelling at the injection site).

Others: neutropenia, leukopenia, flattening of the T wave on the ECG.

Overdose

Symptoms: nausea, vomiting, ataxia, in severe cases – peripheral neuropathy and epileptic seizures.

Treatment: symptomatic; there are no specific antidotes.

Similarities