metronidazole
Sources réglementaires consultées
Indications approuvées
- Urétrite et vaginite à Trichomonas.
Contre-indications
Absolues
- Hypersensibilité au métronidazole, aux autres imidazolés ou aux excipients.
Mises en garde cliniques
- Mise en garde majeure · Lors d’un traitement prolongé, surveiller la numération sanguine et les symptômes neurologiques ; arrêter et évaluer en cas de paresthésies, ataxie, vertiges ou convulsions. Utiliser avec prudence en cas d’encéphalopathie hépatique ou de maladie neurologique grave. — CIMA/AEMPS, ficha técnica 34985
- Les comprimés vaginaux peuvent fragiliser les préservatifs ou diaphragmes en latex. — CIMA/AEMPS, ficha técnica 34985
- Mise en garde majeure · Une hépatotoxicité sévère irréversible et une insuffisance hépatique aiguë d’apparition rapide, avec des issues fatales, ont été rapportées avec le métronidazole systémique chez des personnes atteintes du syndrome de Cockayne. Ne pas utiliser sauf si le bénéfice dépasse le risque et en l’absence d’alternative ; contrôler la fonction hépatique avant, pendant et après le traitement, et arrêter en cas d’élévation marquée ou de symptômes d’atteinte hépatique. — CIMA/AEMPS, ficha técnica 34985
- Mise en garde majeure · Des réactions cutanées sévères potentiellement mortelles ont été rapportées, notamment syndrome de Stevens-Johnson, nécrolyse épidermique toxique et pustulose exanthématique aiguë généralisée. Arrêter immédiatement le métronidazole en présence de signes ou symptômes compatibles. — CIMA/AEMPS, ficha técnica 34985
Interactions médicamenteuses
- SévèreAlcool et médicaments contenant de l’alcool
Mécanisme: Une réaction de type disulfirame peut survenir.
Recommandation: Éviter pendant le traitement et au moins 24 heures après.
CIMA/AEMPS, ficha técnica 34985https://cima.aemps.es/cima/dochtml/ft/34985/FT_34985.html
- SévèreWarfarine et autres anticoagulants coumariniques
Mécanisme: Le métronidazole peut renforcer l’anticoagulation et augmenter le risque hémorragique.
Recommandation: Surveiller l’INR ou le temps de prothrombine et ajuster l’anticoagulant.
CIMA/AEMPS, ficha técnica 34985https://cima.aemps.es/cima/dochtml/ft/34985/FT_34985.html
- SévèreDisulfirame
Mécanisme: L’administration concomitante a été associée à des réactions psychotiques.
Recommandation: Ne pas administrer de métronidazole aux personnes ayant pris du disulfirame au cours des deux semaines précédentes.
CIMA/AEMPS, ficha técnica 34985https://cima.aemps.es/cima/dochtml/ft/34985/FT_34985.html
- SévèreBusulfan
Mécanisme: Le métronidazole peut augmenter les concentrations plasmatiques de busulfan et provoquer une toxicité sévère.
Recommandation: Éviter l’administration concomitante sauf si le bénéfice dépasse le risque ; si elle est indispensable, surveiller fréquemment les concentrations de busulfan et ajuster sa dose.
CIMA/AEMPS, ficha técnica 34985https://cima.aemps.es/cima/dochtml/ft/34985/FT_34985.html
- SévèreMédicaments allongeant l’intervalle QT
Mécanisme: Un allongement de l’intervalle QT a été rapporté, notamment lorsque le métronidazole est administré avec d’autres médicaments susceptibles de l’allonger.
Recommandation: Évaluer le risque avant l’association ; le RCP mentionne des cas d’allongement de l’intervalle QT avec cette association.
CIMA/AEMPS, ficha técnica 34985https://cima.aemps.es/cima/dochtml/ft/34985/FT_34985.html
- SévèreLithium
Mécanisme: Le métronidazole peut augmenter les concentrations plasmatiques de lithium et provoquer une toxicité.
Recommandation: Surveiller la lithémie, la créatinine et les électrolytes pendant l’administration concomitante.
CIMA/AEMPS, ficha técnica 34985https://cima.aemps.es/cima/dochtml/ft/34985/FT_34985.html
- SévèreCiclosporine
Mécanisme: Le métronidazole peut augmenter les concentrations plasmatiques de ciclosporine.
Recommandation: Si l’administration concomitante est nécessaire, surveiller étroitement les concentrations de ciclosporine et la créatinine.
CIMA/AEMPS, ficha técnica 34985https://cima.aemps.es/cima/dochtml/ft/34985/FT_34985.html
- ModéréePhénytoïne ou phénobarbital
Mécanisme: Ils peuvent augmenter l’élimination du métronidazole et réduire ses concentrations plasmatiques.
Recommandation: Surveiller la réponse clinique au métronidazole et ses concentrations lorsqu’elles sont disponibles pendant l’administration concomitante.
CIMA/AEMPS, ficha técnica 34985https://cima.aemps.es/cima/dochtml/ft/34985/FT_34985.html
- Sévère5-fluorouracile
Mécanisme: Le métronidazole peut réduire la clairance du 5-fluorouracile et augmenter sa toxicité.
Recommandation: Si l’association est nécessaire, surveiller étroitement la toxicité du 5-fluorouracile et réévaluer son traitement avec l’équipe responsable.
CIMA/AEMPS, ficha técnica 34985https://cima.aemps.es/cima/dochtml/ft/34985/FT_34985.html
Effets indésirables
Rares mais graves
Angio-œdème ou choc anaphylactique · Agranulocytose, neutropénie ou thrombopénie
Grossesse et allaitement
Évaluer soigneusement le rapport bénéfice-risque pendant la grossesse. Éviter l’utilisation non nécessaire pendant l’allaitement, car le métronidazole passe dans le lait.
Bibliographie récente (PubMed)
Bacterial vaginosis affects one third of reproductive-aged women, and recurrence is common. Evidence of sexual exchange of bacterial vaginosis-associated organisms between partners suggests that male-partner treatment may increase the likelihood of cure. This open-label, randomized, controlled trial involved couples in which a woman had bacterial vaginosis and was in a monogamous relationship with a male partner. In the partner-treatment group, the woman received first-line recommended antimicrobial agents and the male partner received oral and topical antimicrobial treatment (metronidazole 400-mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for 7 days). In the control group, the woman received first-line treatment and the male partner received no treatment (standard care). The primary outcome was recurrence of bacterial vaginosis within 12 weeks. A total of 81 couples were assigned to the partner-treatment group, and 83 couples were assigned to the control group. The trial was stopped by the data and safety monitoring board after 150 couples had completed the 12-week follow-up period because treatment of the woman only was inferior to treatment of both the woman and her male partner. In the modified intention-to-treat population, recurrence occurred in 24 of 69 women (35%) in the partner-treatment group (recurrence rate, 1.6 per person-year; 95% confidence interval [CI], 1.1 to 2.4) and in 43 of 68 women (63%) in the control group (recurrence rate, 4.2 per person-year; 95% CI, 3.2 to 5.7), which corresponded to an absolute risk difference of -2.6 recurrences per person-year (95% CI, -4.0 to -1.2; P<0.001). Adverse events in treated men included nausea, headache, and metallic taste. The addition of combined oral and topical antimicrobial therapy for male partners to treatment of women for bacterial vaginosis resulted in a lower rate of recurrence of bacterial vaginosis within 12 weeks than standard care. (Funded by the National Health an
Rosacea is a chronic cutaneous disorder affecting primarily the face, characterized by erythema, transient or persistent, telangiectasia, and inflammatory lesions including papulo-pustules and swelling. The essential component of the disease is the persistent erythema of facial skin. Episodes of flushing (acute-subacute intermittent vasodilation) are common. Swelling and erythema of the nose along with dilatation of the pilosebaceous poral orifices, known as rhinophyma, can be noted in chronic cases. Rosacea affects up to 10% of the world population and is especially noted in fair-skinned individuals aged 35-50. Women are affected more often than men. Several treatment modalities including topical medications, systemic drugs, lasers, and light-based therapies have been used for the management of rosacea with variable results. Topical medications such as azelaic acid, metronidazole, and sulfacetamide/sulfur, oral antibiotics such as tetracyclines, and oral retinoids alone or, most commonly, in combination form the mainstay of treatment. Light therapies such as intense pulsed light and pulsed dye laser are best used for the erythemato-telangiectatic type. Topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimecrolimus, low-dose modified-release tetracyclines and botulinum toxin are the new additions to the therapeutic armamentarium. This article provides a comprehensive review of the various therapies used for rosacea.
The infection caused by Helicobacter pylori is the most common on the planet, affecting half of the global population. It is usually transmitted during childhood and persists for life if untreated. It is the primary cause of chronic gastritis, peptic ulcer, and gastric cancer. In young dyspeptic patients without alarm symptoms, the test-and-treat strategy (detection of H. pylori through a non-invasive test and subsequent eradication) is the preferred approach. The causal role of the infection in the development of gastric adenocarcinoma provides an opportunity to implement preventive strategies. The infection can be diagnosed through invasive methods (requiring endoscopy, such as the rapid urease test or histology) and non-invasive methods (such as the breath test or stool antigen test). The treatment for H. pylori combines a proton pump inhibitor with several antibiotics or bismuth salts. Benznidazole is an orally available, broad spectrum antimicrobial agent used in the treatment of Chagas disease (American trypanosomiasis). Benznidazole is a nitroimidazole similar to metronidazole and is associated with serum enzyme elevations during therapy in up to 10% of patients but has not linked to cases of clinically apparent acute liver injury.
Acne is one of the most common dermatological conditions to affect women of childbearing age, so it is important to consider the safety of long-term acne treatments on women who could become pregnant. In this review article, we clarify what management options are available to treat acne during pregnancy. Topical treatments, typically first-line for acne, such as azelaic acid, clindamycin, erythromycin, metronidazole, benzoyl peroxide, salicylic acid, dapsone, and retinoids, were reviewed. Systemic treatments, such as zinc supplements, cephalexin, cefadroxil, amoxicillin, azithromycin, erythromycin, and corticosteroids, typically second-line for acne, were also reviewed. Alternative treatments such as light therapy and cosmetic procedures were also evaluated. Due to recommendation of sunscreen utilization during acne treatments, sunscreen usage during pregnancy was also assessed. Management of acne during unplanned pregnancy was discussed in further detail regarding safety and adverse effects. Through summarized tables and examples of studies demonstrating safety and efficacy of treatments, the following is a resource for providers and patients to utilize for management of acne during pregnancy.