Peripheral neuropathy metronidazole

Convulsive seizures, headache, nausea, and peripheral neuropathy (numbness and tingling of the extremities) have been reported with the use of metronidazole... 

Antibiotics have been studied based on the rationale that they may interrupt the inflammatory response directed against endogenous bacterial flora. Metronidazole and ciprofloxacin have been the two most widely-studied agents.32 Metronidazole may benefit some patients with pouchitis (inflammation of surgically-created intestinal pouches) and patients with CD who have had ileal resection or have perianal fistulas. Ciprofloxacin has shown some efficacy in refractory active CD. Both drugs may cause diarrhea, and long-term use of metronidazole is associated with the development of peripheral neuropathy. 

Insufficiency SO years) peripheral neuropathy Enterobacteriaceae, P. aeruginosa, Enterococcus spp., anaerobes Vancomycin PLUS (1) piperacillin/tazobactam (2) imipenem/cilastatin or meropenem (3) cefepime or ceftazidime and clindamycin or metronidazole (4) ciprofloxacin or levofloxacin and clindamycin or metronidazole... 

Neurologic effects Convulsive seizures and peripheral neuropathy, the latter characterized mainly by numbness or paresthesia of an extremity, have been reported in patients treated with nitroimidazole drugs including tinidazole and metronidazole. The appearance of abnormal neurologic signs demands the prompt discontinuation of tinidazole therapy. Administer tinidazole with caution to patients with central nervous system diseases. 

Adverse effects include nausea, diarrhea, stomatitis, and peripheral neuropathy with prolonged use. Metronidazole has a disulfiram-like effect, and patients should be instructed to avoid alcohol. Although teratogenic in some animals, metronidazole has not been associated with this effect in humans. Other properties of metronidazole are discussed in Chapter 52. 

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. 

METRONIDAZOLE DIDANOSINE, STAVUDINE t adverse effects (e.g. peripheral neuropathy) with didanosine and possibly stavudine Additive effect Monitor closely for peripheral neuropathy during intensive or prolonged combination... 

Corticosteroids are commonly prescribed for moderate to severe Crohn s disease with short term efficacy probably related to their effect on inflammation. Anti-bacterials are commonly used as primary therapy in Crohn s disease. Common adverse effects of metronidazole are nausea and a metallic taste, hov ever peripheral neuropathy may result from long term use. Ciprofloxacin and similar antibacterials can be beneficial in those patients intolerant to mefi onidazole. 

In contrast to ulcerative colitis, about 50% of patients with Crohn s colitis will respond to metronidazole given for up to 3 months, although adverse effects including alcohol intolerance, and peripheral neuropathy from such prolonged therapy often limit its use. The drug is also helpful in controlling perianal and small bowel disease and it decreases the incidence of anastamotic recurrence after surgery. Other antimicrobials, particularly ciprofloxacin may also be effective. 

Metronidazole Up to 99% of the intestinal anaerobes that are largely responsible for the bacterial formation of ammonia are affected by metronizadole. Its efficacy corresponds to that of neomycin and paromomycin. The mode of action is still unresolved. The dosage is 3(-4) X 0.4 g/day with subsequent reduction to 2 x 0.4 g/day provided two or three stools can be produced each day. When used for longer periods, peripheral neuropathies can occur. For this reason, initial treatment with metronidazole should be replaced as soon as possible by long-term lactulose therapy. (147)... 

Peripheral neuropathy was associated in one case with intermittent use of metronidazole (2 g/day for 5 days every other month) (7). 

Acute myopia occurred after 11 days of treatment with metronidazole for Trichomonas infection it resolved within 4 days after withdrawal but recurred on rechallenge. The combined figures of two major American reporting systems for adverse reactions listed seven cases of retrobulbar or optic neuritis associated with oral metronidazole two had a concurrent peripheral neuropathy. However, there is insufficient information to evaluate these reports (SEDA-17, 333). 

Freedman B, Shah S, Lau A. Metronidazole-induced peripheral neuropathy. J Appl Ther Res 2000 3 49-54. 

Dreger LM, Gleason PP, Chowdhry TK, Gazzuolo DI. Intermittent-dose metronidazole-induced peripheral neuropathy. Ann Pharmacother 1998 32(2) 267-8. 

Metronidazole 500 mg IV q. 6 hr 20% No renal adjustment required Peripheral neuropathy disulfiram reaction with alcoholic beverages increase frequencv of liver function tests (1 %) Dose after dialysis Dose for GFR<10 ml/min Dose for GFR 10-50 ml/min... 

Most patients receiving metronidazole for Crohn s disease tolerate the agent fairly well however, mild adverse effects occur frequently. They commonly include paresthesias and reversible peripheral neuropathy, metallic taste, urticaria, and glossitis. Other effects include a disulflram-like reaction if alcohol is ingested in conjunction. 

Metronidazole 500 mg IV q6hrs 20% No renal adjustment is required Peripheral neuropathy, increase LFTs, disulfiram reaction with alcoholic beverages... 

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