Metronidazole gastrointestinal infections

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. 

The value of pharmacological interventions is not as firmly established as is desirable. Control of pre-cipitants notably gastrointestinal haemorrhage, systemic infection, constipation and electrolyte, particularly potassium imbalance is important. Despite lack of consistent evidence, use of synthetic sugars by mouth and oral antibiotics (neomycin or metronidazole) remains standard. Oral neomycin, though poorly absorbed, can still cause eighth cranial nerve damage. 

As patients improve clinicaUy, the route of administration should be reevaluated. Streamlining therapy from parenteral to oral (switch therapy) has become an accepted practice for many infections outside the bloodstream and CNS. Criteria that should be present to justify a switch to oral therapy include (1) overall clinical improvement, (2) lack of fever for 24 to 48 hours, (3) decreased WBC count, and (4) a functioning gastrointestinal tract. Drugs that exhibit excellent oral bioavaUabifity when compared with intravenous formulations include ciprofloxacin, clindamycin, doxycycline, gatifloxacin, levofloxacin, metronidazole, moxifloxacin, linezolid, and trimethoprim-sulfamethoxazole. 

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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