Pregnancy metronidazole

Metronidazole is contraindicated in patients with known hypersensitivity. Metronidazole is contraindicated during the first trimester of pregnancy (Category B). Metronidazole is given during the second and third trimesters of pregnancy. Metronidazole is used cautiously in patients with blood dyscrasias, seizure disorders, and severe hepatic impairment. The patient must avoid alcohol while taking metronidazole... 

Metronidazole is effective in the treatment of acne rosacea although for this indication its mechanism of action is not clearly understood. Long-term topical use for this indication is not recommended. This advice is founded on experiments in animals showing a carcinogenic effect by oral administration of metronidazole. There is inadequate evidence of the safety of metronidazole in human pregnancy. Metronidazole is classified in Lactation Risk Category L3 (moderately safe). 

Metronidazole (Flagyl) Vulvovaginal Candidiasis 250 mg three times daily for 7 days First-line agent in pregnancy avoid during lactation... 

Metronidazole (Flagyl) Antenatal Steroids 2 g orally once Safe during pregnancy. During lactation, temporarily stop breast-feeding for 12-24 hours. 

O All symptomatic adults and children over the age of 8 years should be treated with metronidazole 250 mg three times daily for 7 days, or tinidazole 2 gas a single dose, or nitazoxanide 500 mg twice daily for 3 days.3 The pediatric dose of metronidazole is 15 mg/kg per day three times daily far 7 days. Alternative drugs include furazolidone 100 mg four times daily or paromomycin 25 to 30 mg/kg per day in divided doses daily for 7 days. Paromomycin may be used in pregnancy instead of metronidazole. Pediatric patients can also be treated with suspensions of either furazolidone 8 mg/kg per day in four divided doses far 7 days, or nitazoxanide (Alina) 100 to 200 mg every 12 hours for 3 days. 

Metronidazole or methotrexate should not be used during pregnancy. Azathioprine and mercaptopurine may be associated with fetal deformities. 

Topical agents with minimal pregnancy risk include bacitracin, benzoyl peroxide, ciclopirox, clindamycin, erythromycin, metronidazole, mupi-rocin, permethrin, and terbinafine. 

At present, no satisfactory treatment is available for pregnant women with Trichomonas infections. Metronidazole and tinidazole are contraindicated during the first trimester of pregnancy. 

Hypersensitivity to metronidazole or other nitroimidazole derivatives pregnancy (first trimester in patients with trichomoniasis). 

Pregnancy Category B. Do not administer to pregnant women during the first trimester. Restrict metronidazole for trichomoniasis in the second and third... 

Diloxanide furoate is considered by many the drug of choice for asymptomatic luminal infections. It is not available commercially in the USA, but can be obtained from some compounding pharmacies. It is used with a tissue amebicide, usually metronidazole, to treat serious intestinal and extraintestinal infections. Diloxanide furoate does not produce serious adverse effects. Flatulence is common, but nausea and abdominal cramps are infrequent and rashes are rare. The drug is not recommended in pregnancy. 

Topical metronidazole is effective in the treatment of rosacea. The mechanism of action is unknown, but it may relate to the inhibitory effects of metronidazole on Demodex brevis alternately, the drug may act as an anti-inflammatory agent by direct effect on neutrophil cellular function. Oral metronidazole has been shown to be a carcinogen in susceptible rodent species, and topical use during pregnancy and by nursing mothers and children is therefore not recommended. 

Tests for embryotoxicity and teratogenicity in different animal species have been negative, and there have been no reports of adverse effects on the fetus in pregnant women given metronidazole for trichomoniasis. Despite this, it is still wise to avoid metronidazole during the first trimester of pregnancy. 

Sorensen HT, Larsen H, Jensen ES, Thnlstmp AM, Schonheyder HC, Nielsen GL, Czeizel A. Safety of metronidazole dnring pregnancy a cohort stndy of risk of congenital abnormalities, preterm delivery and low birth weight in 124 women. J Antimicrob Chemother 1999 44(6) 854-6. 

Diav-Citrin O, Shechtman S, Gotteiner T, Arnon J, Ornoy A. Pregnancy outcome after gestational exposure to metronidazole a prospective controlled cohort study. Teratology 2001 63(5) 186-92. 

There are conflicting data about the teratogenicity of metronidazole in animals. While metronidazole has been taken during all stages of pregnancy with no apparent adverse effects, its use during the first trimester generally is not advised. 

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. 

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