metronidazole
Sources réglementaires consultées
Indications approuvées
- Infections dues à des anaérobies et protozoaires sensibles, notamment trichomonase, amibiase et giardiase, selon des schémas propres à chaque indication.
Contre-indications
Absolues
- Hypersensibilité au métronidazole ou aux nitro-imidazolés ; utilisation de disulfirame au cours des 2 semaines précédentes. Pour la trichomonase, premier trimestre de grossesse selon l’étiquette FDA.
- Profil FDA : syndrome de Cockayne, en raison du risque d’insuffisance hépatique aiguë irréversible et mortelle. Le profil CIMA indique de ne pas utiliser sauf absence d’alternative et bénéfice supérieur au risque.
Mises en garde cliniques
- Mise en garde majeure · Il peut provoquer une encéphalopathie, des convulsions, une neuropathie périphérique, des cytopénies et des SCAR ; arrêter en cas de symptômes neurologiques ou cutanés et surveiller la numération lors d’un traitement prolongé. — DailyMed, set_id 5cc3fd98-d579-432e-a4b5-b6d5586991a6
- Une hépatotoxicité fulminante et mortelle a été rapportée dans le syndrome de Cockayne ; éviter sauf absence d’alternative et surveiller étroitement la fonction hépatique. — DailyMed, set_id 5cc3fd98-d579-432e-a4b5-b6d5586991a6
Interactions médicamenteuses
- ModéréeAlcool et propylène glycol
Mécanisme: Ils peuvent provoquer une réaction de type disulfirame.
Recommandation: Éviter pendant le traitement et pendant au moins 1 jour après selon le profil CIMA ; le profil FDA exige au moins 3 jours après.
DailyMed, set_id 5cc3fd98-d579-432e-a4b5-b6d5586991a6
- SévèreWarfarine
Mécanisme: Il peut potentialiser l’effet anticoagulant.
Recommandation: Surveiller l’INR et adapter la dose.
DailyMed, set_id 5cc3fd98-d579-432e-a4b5-b6d5586991a6
- SévèreLithium, ciclosporine, 5-fluorouracile ou busulfan
Mécanisme: Le métronidazole peut augmenter leurs concentrations ou leur toxicité.
Recommandation: Éviter ou surveiller les concentrations, la fonction rénale et la toxicité.
DailyMed, set_id 5cc3fd98-d579-432e-a4b5-b6d5586991a6
- SévèrePhénytoïne ou phénobarbital
Mécanisme: Les inducteurs peuvent réduire l’exposition au métronidazole ; le métronidazole peut aussi réduire la clairance de la phénytoïne.
Recommandation: Surveiller les concentrations, la réponse antimicrobienne et la toxicité neurologique ; adapter si nécessaire.
DailyMed, set_id 5cc3fd98-d579-432e-a4b5-b6d5586991a6
- SévèreMédicaments allongeant le QT
Mécanisme: Ils peuvent augmenter le risque d’allongement du QT et d’arythmie.
Recommandation: Éviter les associations à haut risque ou surveiller l’ECG et les électrolytes.
DailyMed, set_id 5cc3fd98-d579-432e-a4b5-b6d5586991a6
Effets indésirables
Communs (≥1%)
Nausées, goût métallique, douleur abdominale et céphalées
Rares mais graves
Convulsions, encéphalopathie, neuropathie périphérique, SCAR et hépatotoxicité sévère
Grossesse et allaitement
La contre-indication FDA au premier trimestre se limite à la trichomonase ; pour les autres infections, évaluer le bénéfice et le risque. Selon le profil FDA, tirer et jeter le lait pendant le traitement et pendant 48 heures après la dernière dose ; le profil CIMA recommande d’éviter l’allaitement.
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.