Metronidazol Hikma (Metronidazole)

Metronidazole is used to treat infections caused by anaerobic bacteria and certain protozoa.

• Anaerobic bacterial infections: eradicates susceptible anaerobic organisms, reducing infection severity.
• Intra‑abdominal infections: controls mixed aerobic‑anaerobic infections within the abdominal cavity.
• Pelvic inflammatory disease: eliminates causative anaerobic pathogens, improving pelvic health.
• Bacterial vaginosis: restores normal vaginal flora by targeting Gardnerella and other anaerobes.
• Trichomoniasis: kills Trichomonas vaginalis, relieving symptoms and preventing transmission.
• Clostridioides difficile‑associated diarrhea: suppresses toxin‑producing C. difficile, aiding resolution of severe diarrhea.

• Metronidazole enters susceptible anaerobic cells by passive diffusion. Inside, its nitro group is reduced by microbial electron transport proteins, generating reactive nitro radicals that damage DNA, inhibit nucleic acid synthesis and disrupt essential metabolic enzymes, leading to cell death. The same reduction process occurs in susceptible protozoa such as Trichomonas vaginalis, where DNA damage similarly impairs replication and leads to parasite death.

Metronidazole may be associated with a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Metallic taste: transient metallic sensation in mouth.
• Diarrhea: loose stools that may be self‑limiting.
• Headache: mild headache.
• Abdominal pain: cramping or discomfort.
• Rash: mild skin erythema.

Serious or Rare Side Effects

• Seizures: neurological events requiring immediate care.
• Peripheral neuropathy: tingling or numbness in extremities.
• Severe allergic reaction: anaphylaxis, swelling, or hives.
• Hepatotoxicity: elevated liver enzymes or jaundice.
• Hematologic abnormalities: neutropenia, thrombocytopenia.
• Stevens‑Johnson syndrome: severe skin and mucous membrane involvement.

When using Metronidazol Hikma, clinicians should consider several precautionary measures to ensure safe administration.

• Assess renal and hepatic function: adjust therapy if significant impairment is present.
• Monitor for neurotoxicity: watch for signs of seizures or peripheral neuropathy during prolonged use.
• Evaluate for alcohol use: avoid concurrent alcohol consumption due to disulfiram‑like reaction.
• Use caution in pregnancy: weigh benefits against potential risks as safety data are limited.
• Review concomitant medications: consider possible interactions that may increase toxicity.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Metronidazol Hikma can interact with other medicines, altering its effectiveness or increasing toxicity.

Major Interactions (Avoid)

• Disulfiram: combined use can cause severe flushing, tachycardia, and hypotension.
• Warfarin: increased anticoagulant effect, raising bleeding risk.
• Cyclosporine: heightened neurotoxic potential.

Moderate Interactions (Monitor Closely)

• Lithium: may increase lithium levels, requiring serum monitoring.
• Cimetidine: can raise metronidazole plasma concentrations.
• Phenytoin: may reduce metronidazole levels, decreasing efficacy.
• Alcohol: can precipitate a disulfiram‑like reaction, causing nausea and vomiting.