Metronidazole gastrointestinal effects

Antibiotics with activity against urease-producing bacteria, such as neomycin [42], paromomycin [44] or metronidazole [45], also reduce the production of intestinal ammonia and have proved to be of value. Vancomycin has also been used in patients with lactulose-resistant chronic encephalopathy [46]. The efficacy of neomycin is similar to that of lactulose [42]. However, a small percentage of this drug is absorbed from the gastrointestinal tract and may cause ototoxic and nephrotoxic effects, especially with continuous use over several months [47]. This drug should be used with particular caution by patients with renal insufficiency. The efficacy of metronidazole for... 

Balantidiasis Lower gastrointestinal tract Iodoquinol [tetracycline antibiotics are also effective] Metronidazole... 

Adverse Effects. Gastrointestinal disturbances including nausea, vomiting, diarrhea, stomach pain, and an unpleasant taste in the mouth are relatively common with metronidazole. Other adverse effects such as hypersensitivity reactions, peripheral neuropathy, hematologic abnormalities, and genitourinary problems have been reported, but their incidence is relatively low. 

Secnidazole is more active and gives more prolonged blood concentrations than metronidazole it is effective in hepatic amebiasis. Gastrointestinal adverse effects are less common (SEDA-11, 597) (1). 

Inhibiting the activity of urease-producing bacteria by using neomycin, metronidazole, or vancomycin can decrease production of ammonia. Neomycin at doses of 2 to 8 g daily in divided oral doses results in clinical improvement in as many as 80% of patients. At these doses, however, absorption is 1% to 5% and can result in irreversible ototoxicity and nephrotoxicity. As such, even though efficacy is equivalent to lactulose, neomycin should not be first-line therapy. Metronidazole produces response rates similar to neomycin, but side effects, particularly gastrointestinal, limit its use. In patients... 

In spite of its in vitro activity against H. pylori, dirithromycin has not been effective in eradicating this organism in vivo, even in combination with metronidazole or proton pump inhibitor [133]. Dirithromycin is well tolerated, with gastrointestinal discomfort as the most frequently reported adverse effect [134]. The incidence and nature of abnormal clinical laboratory evaluation are similar to those of other macrolides, and these infrequent test abnormalities do not result in clinical manifestations, even in elderly patients [135]. 

Answer C In amebic dysentery caused by Entamoeba histolytica and gastrointestinal infections with diarrhea ( backpackers diarrhea ) due to Giardia lamblia, metronidazole is the drug of choice. Diloxanide is a backup drug for noninvasive intestinal amebiasis, but it has minimal activity in Giardia infections. Quinacrine has effectiveness in giardiasis but not amebiasis. TMP-5MX has antiprotozoal effectiveness in Pneumocystis carinii pnemnonia. Ciprofloxacin is devoid of antiprotozoal activity. 

Toxicity Adverse effects include gastrointestinal irritation, headache, and dark coloration of urine. More serious toxicity includes leukopenia, dizziness, and ataxia. Drag interactions with metronidazole include a disulfiram-like reaction with ethanol and potentiation of coumarin anticoagulant effects. Although it is not contraindicated in pregnancy, the drug should be used with caution. 

Sastry et al. reported on the use of metronidazole in the treatment of drac-unculosis (24 ). The compound was found to be highly effective and only minor gastrointestinal side effects were noted. 

TEM groups. Tazobactam is beta-lactamase inhibitor that helps piperacillin work better. Recently, its combination with ceftolozane and metronidazole was found to be a safe and effective new antimicrobial combination approved for the treatment of complicated gastrointestinal and urinary-tract infection [129]. 

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