Metronidazole + Tetracycline Pharmacology
Metronidazole + Tetracycline
Metronidazole
Metabolism: Metabolized in liver by oxidation & glucuronide conjugation, Excretion: Excreted in urine.
2.Metallic taste
3.Nausea
4.Vomiting
5.Diarrhoea
6.Headache
7.Looseness of stool.
8.Peripheral neuropathy &CNS effects.
9.Mutagenesis.
10.Radiosensitisation.
11.Transient leucopenia
12.Dry mouth
13.Abdominal distress
14.Dizziness
15.Vertigo
16.Thrombophlebitis at site of injection
17.Ototoxicity
2.Blood dyscrasias
3.CNS disorders
2.Hepatic impairment
3.Alcoholic cirrhosis
4.Use cautiously along with other hepatotoxic drugs & In visual field changes
First trimester:contra indicated
Neonates: Contraindicated
2.Giardiasis
3.Trichomonas vaginitis
4.Pseudo membranous enterocolitis
5.Anaerobic bacterial infections after surgery, Brain abscess, & Endocarditis
6.Helicobacter pylori infections
7.Ulcerative gingivitis
Alcohol: A disulfiram-like reaction. Abdominal cramps, nausea, vomiting, headache & flushing.
Disulfiram: Acute psychotic reaction or confusional state.
Phenobarbital & Phenytoin: Increased metabolism of metronidazole resulting in decreased efficacy.
Lithium: Increased lithium levels and toxicity.
Flurouracil: Increased toxicity of flurouracil.
Lab tests: May interfere with chemical analysis for AST,SGOT, ALT, SGPT, LDH, triglycerides and hexokinase glucose. Zero values may occur.
Amoebiasis:400 to 800 mg 8hourly for 5 to 10days depending up on the severity of infection
In severe infections and liver abscess: 1gm as slow I.V. infusion followed by 0.5 gm twice daily till oral therapy is started
Giardiasis:200mg 8hourly for 1week or 2gm/day for 3days or I.V.500mg thrice daily
Trichomonas vaginitis: 400mg 8 hourly for a week or 2gm once daily for a week.
Male partner should be concurrently treated with the drug
Pseudo membranous enterocolitis:800 mg 8hourly
Anaerobic bacterial infections after surgery, Brain abscess, & Endocarditis:400 to 800 mg 8hourly
In severe cases: 15mg/kg I.V. infusion for 1hour followed by 7.5mg/kg 4 times daily till oral therapy is substituted
Helicobacter pylori infections:400mg 8hourly along with amoxicillin/clarithromycin and a proton pump inhibitor
Ulcerative gingivitis:200 to 800mg 8hourly
Children
Amoebiasis: 30 to 50mg/kg/day for 5to10 days.
Giardiasis:10 to 15mg/kg/day thrice daily
Children (below 12years): 7.5mg/kg I.V.
Tetracycline
2.Aggravates renal & hepatic impairment
3.Nausea
4.Vomiting
5.Epigastric distress
6.Super infection
7.Skin rashes
8.Arrhythmia, Cardiac arrest
9.Neutropenia, Thrombocytopenia
10.Elevated liver enzymes
11.Discoloration of teeth & Retardation of bone growth
12.Esophageal ulceration
1.Tetracycline aggravates renal impairment & leads to negative nitrogen balance. So avoid use of drug in renal impairment.
Hepatic impairment:
High dose causes hepato toxicity, so dose adjustments is required & avoid
Other precautions:
1.Avoid use together with milk & milk products, Antacids, Cations, Vitamins, Products which contain divalent or trivalent cations
2.Potentiation of action of anticoagulants; so avoid use together
3.Diabetes mellitus, Hyperthyroidism, & Hypertensions
Neonates: Contraindicated
2. Chlamydia infections
3. Rickettsial infections
4. Cholera
5. Brucellosis
6. Sexually transmitted diseases like syphilis, gonorrhea, Chancroid
7. Urinary tract infections
8. H-pylori infection
9. Acne
10. Lyme disease
11. Malaria
Anticoagulants: Increase the hypothrombinemic effects of anti-coagulants.
Cimetidine: Decreases GI absorption leading to decreased efficacy of tetracyclines.
Digoxin: Increased serum levels leading to digoxin toxicity.
Methoxyflurane: Nephrotoxic effects of both increased.
Oral contraceptives: Breakthrough bleeding, pregnancy due to decreased efficacy.
Penicillins: Efficacy reduced.
Food: Dairy products decrease efficacy of tetracyclines.
Lab tests: Bacterio-suppressive levels of Demeclocycline persist in both urine and blood for several days after cessation of therapy interfering with culture studies.
Children: 15 to 25mg/kg bodyweight. Maximum dose 50mg/kg. Administer 6hourly or 12 hourly as required
Infections of cervix, urethra&rectum caused by Chlamydia trachomatis:2gm daily; orally; in four divided doses for a week.
Gonorrhea: Starts with 1.5gm oral administration & then administer 500mg tablets four times daily for four days
Syphilis: oral administration of 1-2 gm daily in four divided doses for two weeks
Brucellosis: 2gm daily in four divided doses for 28 days (along with streptomycin 1gm for first 21 days)
Ulcer caused by H-pylori infection: 2gm daily in four divided doses for 10 - 14 days.
Lyme disease: 0.25-0.5gm; orally four times daily for 10 days to One month.
Acne: Initial dose-0.5gm to 1gm orally four times daily; maintenance dose 0.12 to 0.5mg daily
Malaria: 1 g daily in 2 - 4 divided doses
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