Metrogyl dropper - pros and cons of intravenous treatment. "Metrogyl" intravenously: instructions for use, indications Metrogyl solution for infusion

Name:

Metrid

Pharmachologic effect:

Metrid is a drug for infusion administration that has a pronounced antimicrobial effect. The active component of the drug is metronidazole, which is metabolized inside the bacterial cell and disrupts the DNA of the bacterium. The activity of the enzyme involved in the formation of the active metabolite is observed only under anaerobic conditions. Metrid is highly effective against infectious diseases caused by anaerobic microorganisms, including protozoa.

The active component of the drug penetrates the cerebrospinal fluid, creating high concentrations in the lung and brain tissue, as well as in the bile ducts. Plasma concentrations of metronidazole are linearly dependent on the administered dose. It is excreted mainly in the form of metabolites by the kidneys. Some part is excreted by the intestines. If liver function is impaired, the clearance of metronidazole is reduced. The half-life in patients with normal liver function is approximately 8 hours.

Indications for use:

Metrid is intended for the treatment of patients suffering from severe forms of infectious diseases caused by anaerobic microorganisms sensitive to the action of the drug, including:

Abdominal and gynecological infectious diseases (pelvic abscess, peritonitis, parametritis).

Infectious diseases of the central nervous and respiratory systems (brain abscess and necrotizing pneumonia caused by Bacteroides fragilis).

Metride is also used in the treatment of patients suffering from osteomyelitis, sepsis and bacteremia caused by Bacteroides fragilis or Clostridium.

The drug can be prescribed to patients who have undergone surgery for the prevention and treatment of postoperative infections.

For mixed infections caused by aerobic and anaerobic microorganisms, the drug is recommended to be prescribed in combination with other antimicrobial agents.

Method of application:

Metrid is intended for parenteral use. Before the first use of the solution, a skin test should be performed to determine individual tolerance. Metrid infusion solution should be prescribed to patients in cases where oral administration of metronidazole is not possible. Parenteral forms of metronidazole should be used for a short period and, if possible, switch to oral forms. Metrid should be administered at a rate of no more than 5 ml/min. Before starting the infusion, the solution in the vial should be warmed to body temperature.

The maximum daily dose for adults is 4 mg.

The recommended therapeutic dose for children aged 6 to 12 years is 7.5 mg/kg body weight every 8 hours. After 3 days, you should either increase the interval between doses or switch to oral metronidazole.

The duration of metronidazole therapy is usually from 7 to 10 days, but can be increased at the discretion of the doctor.

The recommended prophylactic dose for adults is 500 mg as a single dose over at least 30 minutes. The interval between the end of the infusion and the start of surgery should be at least 1 hour. If there is a high risk of infection, 500 mg of the drug is re-administered 8 hours after surgery.

The recommended prophylactic dose for children aged 6 to 12 years is 7.5 mg/kg body weight once over at least 30 minutes. The interval between the end of the infusion and the start of surgery should be at least 1 hour.

Patients on hemodialysis may require an additional dose of metronidazole, which is calculated by the attending physician.

Patients with renal dysfunction and creatinine clearance less than 10 ml/min with prolonged use of metronidazole may require hemodialysis to prevent the accumulation of metronidazole metabolites.

Patients with liver dysfunction should adjust the dose of Metrid or increase the intervals between infusions.

Adverse events:

Metride is well tolerated by patients; in some cases, the following adverse reactions may develop when using metronidazole:

From the gastrointestinal tract: stool disorders, nausea, vomiting, anorexia, metallic taste in the mouth, dry oral mucosa, pain and discomfort in the epigastric region, glossitis, stomatitis, jaundice with cholestasis, pancreatitis.

From the central and peripheral nervous system: dizziness, dysarthria, headache, coordination disorders, depression, ataxia, excessive excitability, confusion, hallucinations, tremor, nystagmus, visual impairment, encephalopathy and subacute cerebellar syndrome. When using excessive doses of metronidazole, seizures and reversible peripheral neuropathy may develop. If the patient's neurological status worsens, metronidazole therapy should be discontinued.

From the hematopoietic system: neutropenia, thrombocytopenia, pancytopenia, agranulocytosis. With long-term use, the development of reversible leukopenia is possible.

From the genitourinary system: burning in the urethra, increased risk of candidiasis, cystitis, polyuria, dysuria, enuresis, red-brown urine color, dysmenorrhea, decreased libido.

Allergic reactions: skin itching, urticaria, allergic rhinitis, hyperthermia, anaphylactoid reactions.

Others: false positive Nelson test, muscle and joint pain, ECG changes, pain, redness, swelling and thrombophlebitis at the injection site, pharyngitis.

Contraindications:

The use of the drug is contraindicated in the presence of organic lesions of the central nervous system, blood diseases, as well as severe liver dysfunction.

Metrid is not prescribed to children under 6 years of age.

Metrid should be prescribed with caution to patients with renal dysfunction with creatinine clearance less than 30 ml/min, as well as to patients whose work involves driving a car and operating potentially unsafe machinery.

Caution should also be exercised when using metronidazole to treat patients suffering from diseases of the central nervous system (the exception is brain abscess) and hepatic encephalopathy.

During pregnancy:

Metrid should not be prescribed to women during pregnancy, due to the lack of data on the effect of metronidazole on the fetus.

If you need to use Metrid during lactation, you should, after consulting with your doctor, stop breastfeeding.

Interaction with other drugs:

Metrid infusion solution is incompatible with 10% glucose solution, potassium, lactated Ringer's solution and penicillin G.

The combined use of the drug with disulfiram is prohibited due to the risk of developing neurological reactions. An interval of at least 14 days should be observed between the use of these drugs.

Metronidazole increases the effectiveness of warfarin and indirect anticoagulants (monitoring of the coagulogram is necessary when used in combination), and also increases the level of lithium and busulfan in plasma, as a result of which toxic reactions may develop.

The effectiveness of the drug Metrid increases when used in combination with other antimicrobial agents and sulfonamides.

Cimetidine increases plasma concentrations of metronidazole when used in combination, and inducers of microsomal oxidation in the liver reduce it.

Ethyl alcohol, when used in combination with metronidazole, can cause the development of a disulfiram-like reaction. The combined use of Metrid and medications containing ethyl alcohol is prohibited.

Overdose:

When metronidazole was administered at a dose that significantly exceeded the recommended dose, patients experienced the development of ataxia, nausea, disturbances in spatial orientation, as well as seizures and peripheral neuropathy.

There is no specific antidote. In case of metronidazole overdose, symptomatic therapy is indicated. In case of severe poisoning, hemodialysis is indicated.

Release form of the drug:

Solution for infusion, 100 ml in plastic bottles, 1 bottle placed in a cardboard package.

It is prohibited to use the drug if the integrity of the bottle is damaged.

Storage conditions:

The drug Metrid is stored in dry rooms at a temperature of 15 to 25 ° C.

Metrid is good for 3 years.

It is forbidden to freeze the solution.

Storage of the drug after opening the bottle is not allowed.

Synonyms:

Metrogil, Klion.

Compound:

1 bottle (100 ml) solution for infusion Metrid contains:

Metronidazole – 500 mg,

Additional substances.

Drugs with similar effects:

Gravagin Metrodent Mikogynax Ornigil Efloran

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Broad-spectrum bactericidal drug Metrogil effective against protozoa and some gram-positive bacteria. Active substance Metrogyla- metronidazole – belongs to the group of nitroimidazole derivatives. After the reduction reaction of the 5-nitro group, which occurs when interacting with intracellular proteins of bacteria, the drug is able to inhibit the synthesis of certain nucleic acids, which are the basis of bacterial DNA. Due to this effect on DNA, microbial cells die. Metrogil effective in the treatment of bacterial infections caused by anaerobic microorganisms Veillonela spp., Fusobacterium spp., Bacteroides spp., Clostridium spp., Eubacterium spp., Peptostreptococcus spp., Peptococcus spp. Strains of Trichomonas vaginalis, Gardnerella vaginalis, Entamoeba histolytica, and Giardia intestinalis are sensitive to the action of metronidazole. Metronidazole has a bactericidal effect against Helicobacter pylori, however, with monotherapy with the drug, resistance quickly develops, therefore, in the treatment of diseases caused by Helicobacter pylori, Metrogyl is used in combination with amoxicillin, which suppresses the development of resistance.

For infectious diseases caused by mixed aerobic and anaerobic flora, use Metrogyl in combination with antibiotics active against aerobes, and mutual synergism between antibiotics and metronidazole is noted.
Metronidazole increases the sensitivity of tumors to radiation. Has an effect similar to disulfiram. Stimulates repair processes in the body.

When taken orally, the drug is well absorbed from the gastrointestinal tract. Maximum plasma concentrations after oral administration are achieved within 2 hours. Metronidazole penetrates well into all biological fluids and tissues of the body. High concentrations of metronidazole are observed in organs such as lungs, kidneys, liver, brain, skin. An amount of metronidazole capable of exerting a therapeutic effect is isolated in saliva, cerebrospinal fluid, abscess cavities, amniotic fluid, vaginal secretions, seminal fluid, and breast milk.
The degree of binding to plasma proteins is low and reaches a maximum of 18-20%.

It is excreted primarily by the kidneys, however, a small amount of metronidazole is excreted in the feces. The half-life is 6-8 hours and increases with impaired liver function.

With repeated administration of the drug in patients with severe renal impairment, metronidazole may accumulate; this should be taken into account when prescribing the drug.

Indications for use

Mode of application

Usually Metrogil prescribe:
For trichomonas infections: in women they are used in combination with local therapy, while metronidazole tablets are prescribed 200 mg (1 tablet Metrogyl 200 mg) 3 times a day. Men are prescribed 200-400 mg 3 times a day. The course of treatment is usually 7 days. If necessary, a repeat course is carried out after 3-4 weeks. For severe trichomonas infections, the dose of the drug may be increased by the attending physician. An alternative to this method of administration is to prescribe 2 g of metronidazole to both partners once.
For Trichomonas infections, it is necessary to treat both sexual partners.
Children under 10 years of age are prescribed 200-400 mg per day, depending on the severity of the disease and age. Children over 10 years old are prescribed 400-500 mg per day. The daily dose is usually divided into 2 doses.
For amoebic infections: adults are usually prescribed 400 mg 3 times a day. Children are prescribed 30-40 mg/kg body weight, the resulting dose is divided into three doses. The course of treatment is usually about 7-10 days. For severe amoebic infections, such as amoebic liver abscess, the dose can be doubled for adults, then the patient takes 800 mg of metronidazole 3 times a day.
For infections caused by anaerobic microorganisms sensitive to metronidazole, adults are usually prescribed 200-400 mg 2-3 times a day. Children are usually prescribed 7 mg/kg body weight 3 times a day with an interval of 8 hours between doses. The duration of treatment is usually 7-10 days.
To prevent the development of postoperative infections caused by microorganisms sensitive to metronidazole, a single dose of 1000 mg is prescribed, after which it is switched to 200 mg 3 times a day.
The drug is taken by children under the supervision of parents and strictly as prescribed by the attending physician.
In case of impaired renal function, the dose is reduced by 2 times.

Metrogyl solution for intravenous administration:
For adults and children over the age of 12 years, the initial dose is 0.5-1 g, after which 500 mg is administered every 8 hours. The rate of administration during the first infusions should not exceed 5 ml per minute. If the drug is well tolerated by the patient, then after 2-3 infusions the speed can be increased up to a jet injection of the drug.

Typically, the duration of treatment is 6-7 days, however, if necessary, the infusion of the drug can be extended. If necessary, after the course of treatment, you can continue therapy with oral tablets.
The maximum daily dose is 4 g.
For children under 12 years of age, a single dose is calculated using the formula 7.5 mg/kg body weight.
Usually, for infectious and inflammatory diseases, a repeated course of treatment is not required.
To prevent infections after surgery, children over 12 years of age and adults are prescribed 0.5-1 g intravenously per day before surgery. Next, the drug is prescribed according to the following scheme: on the day of surgery and the next day, 1.5 g per day is prescribed, dividing the dose into 3 doses with an interval of 8 hours. After this, they switch to maintenance therapy with the drug in tablet form.
Patients with severe renal impairment should not be prescribed more than 1 g per day.

Side effects

Contraindications

Pregnancy

Interaction with other drugs

Overdose

Release form

Storage conditions

Synonyms

Compound

1 film-coated tablet Metrogyl 400 mg contains:
Metronidazole – 400 mg;
Excipients.

1 ml solution for intravenous administration Metrogil contains:
Metronidazole – 5 mg;
Excipients.

Main settings

Transparent colorless or light yellow solution

Pharmacotherapeutic group

Antibacterial drugs for systemic use. Other antibacterial drugs. Imidazole derivatives. Metronidazole

ATX code J01XD01

Pharmacological properties

Pharmacokinetics

Distribution

After intravenous administration at a dose of 500 mg for 20 minutes, the maximum concentration in the blood serum after 1 hour is 35.2 mcg/ml, after 4 hours – 33.9 mcg/ml, after 8 hours – 25.7 mcg/ml; the minimum concentration upon subsequent administration is 18 mcg/ml. With intravenous administration, the maximum concentration is reached after 30-60 minutes, the therapeutic concentration remains for 6-8 hours. With normal bile formation, the concentration of metronidazole in bile after intravenous administration can significantly exceed the concentration in plasma.

Plasma protein binding – 10-20%. The volume of distribution in adults is 0.55 l/kg, in newborns – 0.54-0.81 l/kg.

Metronidazole has high penetrating ability. Reaches bactericidal concentrations in the lungs, kidneys, liver, brain, skin, cerebrospinal fluid, bile, saliva, amniotic fluid, abscess cavities, vaginal secretions, seminal fluid, breast milk. Penetrates the blood-brain barrier and passes through the placental barrier.

Metabolism

Metabolized (about 30-60%) by hydroxylation, oxidation and glucuronidation. The main metabolite, 2 oxymetronidazole, has antiprotozoal and antimicrobial effects.

Removal

Excreted by the kidneys (60-80%), 20% - unchanged; 6-15% is excreted through the intestines. The half-life is 8 hours (6-12 hours). Renal clearance – 10.2 ml/min.

Pharmacokinetics in special clinical situations

In case of alcoholic liver damage, the half-life is 18 hours (10-29 hours), in newborns born at a gestational age of 28-30 weeks - 75 hours, at a period of 32-35 weeks - 35 hours, at a period of 36-40 weeks - 25 hours .

In patients with impaired renal function, accumulation of metronidazole in the blood serum may occur after repeated administration.

Pharmacodynamics

Antiprotozoal and antimicrobial drug, a derivative of 5-nitroimidazole. The mechanism of action is the biochemical reduction of the 5-nitro group by intracellular transport proteins of anaerobic microorganisms and protozoa. The reduced 5-nitro group interacts with DNA, inhibiting its synthesis, which leads to the death of bacteria.

The drug is active against protozoa: Trichomonas vaginalis, Entamoeba histolytica, Gardnerella vaginalis, Giardia intestinalis, Lamblia spp.; anaerobic bacteria: Bacteroides spp. (including Bacteroides fragilis, Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides vulgatus), Fusobacterium spp., Veillonella spp., Prevotella spp. (Prevotella bivia, Prevotella buccae, Prevotella disiens), Eubacterium spp., Clostridium spp., Peptococcus spp., Peptostreptococcus spp. The minimum inhibitory concentration for these strains is 0.125-6.25 μg/ml.

In combination with amoxicillin, it is active against Helicobacter pylori (amoxicillin suppresses the development of resistance to metronidazole).

Aerobic microorganisms and facultative anaerobes are resistant to the drug, but in the presence of mixed flora (aerobes and anaerobes), metronidazole acts synergistically with antibiotics effective against aerobes.

The drug increases the sensitivity of tumors to radiation, has a disulfiram-like effect, and stimulates reparative processes.

Indications for use

Treatment of infectious and inflammatory diseases caused by pathogens sensitive to the drug, including:

Severe forms of hepatic and intestinal amebiasis

Bone and joint infections, including osteomyelitis

Central nervous system infections, including meningitis, brain abscess

Bacterial endocarditis

Necrotizing pneumonia, empyema, lung abscess

Abdominal infections, including peritonitis, liver abscess

Infections of the pelvic organs (endometritis, endomyometritis, abscess of the fallopian tubes and ovaries, infections of the vaginal vault after surgery)

Skin and soft tissue infections

Sepsis, gas gangrene

As a radiosensitizing agent during radiation therapy (in cases where tumor resistance is due to hypoxia in tumor cells)

Prevention and treatment of postoperative infections (especially after operations on the colon, perirectal area, appendectomy, gynecological interventions)

Directions for use and doses

The drug is intended for intravenous infusion.

For adults and children over 12 years of age, the drug is prescribed in an initial dose of 0.5-1 g (infusion duration 30-40 minutes). Then every 8 hours, 500 mg at a rate of 5 ml/min. If well tolerated, after the first 2-3 infusions they switch to jet administration. The course of treatment is 7 days. The maximum daily dose is 4 g. According to indications, switch to maintenance oral administration at a dose of 400 mg 3 times a day.

Children under 12 years of age are prescribed according to the same regimen in a single dose of 7.5 mg/kg (1.5 ml).

For purulent-septic diseases, 1 course of treatment is usually carried out.

For preventive purposes, adults and children over 12 years of age are prescribed 0.5-1 g drops on the eve of surgery, on the day of surgery and the next day - 1.5 g per day (500 mg every 8 hours). After 1-2 days, they switch to maintenance therapy (metronidazole taken orally).

For patients with chronic renal failure (with CC less than 30 ml/min) and/or with liver failure, the maximum daily dose is 1 g (with a frequency of administration 2 times a day).

As a radiosensitizing agent, the drug is administered intravenously at a rate of 160 mg/kg or 4-6 g/m2 of body surface 0.5-1 hour before the start of irradiation. Apply before each irradiation session for 1-2 weeks. During the remaining period of radiotherapy, metronidazole is not used. The maximum single dose is 10 g, course dose is 60 g.

Side effects

Very common(≥1/10)

Headache

Nausea

Often(≥1/100 to<1/10)

Abdominal pain, abdominal cramps

Uncommon(≥1/1000 to<1/100)

Anorexia, vomiting, coated tongue

Peripheral neuropathy (numbness of the extremities), dizziness, incoordination, drowsiness, dysgeusia (metallic taste)

Increased temperature, fever

Skin hyperemia

Nasal congestion

Arthralgia

Flattening of the T wave on the ECG

Dysuria, cystitis, polyuria, urinary incontinence, candidiasis

Quincke's edema, itching, rash, urticaria

Rarely(≥1/10000 to<1/1000)

Confusion, ataxia, irritability, depression, increased excitability, weakness, insomnia, convulsions, hallucinations, peripheral neuropathy

Decreased appetite, constipation

Dry mucous membrane, glossitis, stomatitis

Pancreatitis

Darkening of urine

Very rarely(<1/10000)

Neutropenia (leukopenia)

Anaphylactic reactions

Thrombophlebitis

Cholestasis, jaundice

Erythema multiforme

Increased liver enzyme activity

These phenomena usually disappear with a reduction in the administered dose or after completion of the course of therapy.

Contraindications

Hypersensitivity to the components of the drug and other nitroimidazole derivatives

Leukopenia (including history)

Organic lesions of the central nervous system, including epilepsy

Liver failure (when using the drug in high doses)

Pregnancy (I trimester)

Lactation period

Severe renal failure

Drug interactions

With simultaneous use of Metrid:

With indirect anticoagulants, an increase in prothrombin time is observed;

With preparations of lithium salts, it is possible to increase the concentration of lithium in the blood plasma and develop symptoms of intoxication;

With prednisolone – the excretion of metronidazole from the body increases due to the acceleration of its metabolism in the liver under the influence of prednisolone;

With cimetidine - inhibition of the metabolism of metronidazole is noted, which can lead to an increase in the concentration of metronidazole in the blood plasma and an increased risk of adverse reactions;

With drugs that stimulate microsomal liver enzymes (phenytoin, phenobarbital), the elimination of metronidazole may be accelerated, resulting in a decrease in its concentration in the blood plasma;

With rifampicin - the clearance of metronidazole from the body increases,

With phenytoin - a slight increase in the concentration of phenytoin in the blood plasma is possible; a case of toxic effects has been described;

With fluorouracil - the toxic effect is enhanced, but not the effect of fluorouracil;

With ethanol, disulfiram-like reactions develop;

With disulfiram - can lead to the development of neurological reactions (the interval between prescriptions should be at least 2 weeks).

Sulfonamides and antibiotics enhance the antimicrobial effect of metronidazole.

Pharmaceutical interactions

Metronidazole for intravenous administration is not recommended to be mixed with other drugs.

special instructions

It should be taken into account that during the period of use of the drug, alcohol intake is contraindicated, since the development of a disulfiram-like reaction (cramping abdominal pain, nausea, vomiting, headache, sudden rush of blood to the face) is possible.

When treating a disease such as metritis, a dropper with Metrid solution is used. One of the serious gynecological problems, which is accompanied by the progression of the inflammatory process in the muscle fibers of the vagina, is metritis. This disease can be diagnosed in patients of different age categories and occurs in various forms. The occurrence of metritis is preceded by a female disease such as endometritis. It is important to contact a specialist immediately when signs of illness appear, as this will prevent the development of many complications.

Metritis is treated with various methods and often this process can drag on for several months or even years. It is important to remember that before starting any therapy, it is important to study the features of a particular drug and the instructions for its use usually help to understand this.

Causes and symptoms of pathology

Metritis can develop as a result of a woman using contraceptives that are placed inside the reproductive organ. In addition, the symptoms of the pathology can develop if the patient underwent surgery to remove appendicitis, during which an infection entered the woman’s body.

Often the disease begins to progress after bruises and injuries to the uterus of various types, as well as when pathogenic microorganisms and bacteria enter the body. In the event that microbes enter the cavity of the reproductive organ, the result is metritis.

Infection can enter the patient’s body as a result of:

• Difficult childbirth;
• When performing abortions;
• During menstruation.

In some cases, the development of pathology occurs:

• With severe hypothermia of the female body;
• With weak contractions during childbirth;

Metritis is considered a rather complex and dangerous disease, because the lack of effective therapy can cause the inflammatory process to spread to adjacent organs and tissues. The uterus itself is located in the central part of the pelvis, and it is attached to the pelvic floor thanks to muscles, ligaments and peritoneum. When the inflammatory process moves to the abdominal area, an acute form of the disease develops, which gradually turns into chronic perimetritis.

Experts identify several forms of the disease metritis.

In the acute form of the disease, the myometrium loosens, and it also becomes very thick and swollen. This pathological condition of the reproductive organ is complemented by the fact that pus begins to form on the endometrium. If the pathology develops after an abortion, the location of the fetal remains becomes the site of occurrence of the pathological process.

Medical practice shows that approximately 3-4 days after artificial termination of pregnancy, the development of postpartum metritis is observed.
It is accompanied by the appearance of the following symptoms:

• Temperature rise;
• The occurrence of pain in the lower abdomen;
• Deterioration of the woman’s general condition;
• Increasing the size of the reproductive organ.

The initial stage of the disease is complemented by the appearance of the following signs of the disease:

• Severe bloating;
• Rapid pulse;
• The appearance of sharp pain;
• Problems with stool;
• Problems with urination.

Typically, perimetritis causes severe symptoms, and the lack of effective treatment can not only worsen the patient’s health, but also cause death.

Features of pathology treatment

When diagnosing acute metritis, treatment is carried out using the following methods:

1. Compliance with complete bed rest.
2. Applying cold to the lower abdomen.
3. Taking drugs that cause contraction of the reproductive organ: Oxytocin, Pregnanthol, Pituitrin.
4. Painkillers.

In addition, metritis is treated with antibacterial drugs, which are considered highly effective in the fight against pathogenic microorganisms

If symptoms appear indicating the presence of remnants of the fertilized egg in the cavity of the reproductive organ, removal is carried out by curettage of the uterus.

• Development of bleeding;
• The appearance of cramping pain;
• Ultrasound results.

If a woman is diagnosed with chronic metritis, treatment is carried out using:

• Mud therapy;
• Diathermy;
• Ultrasound;
• Ozocerite therapy;

If menstruation is disrupted, the patient is prescribed hormonal medications. Some women resort to traditional medicine recipes, however, often such treatment does not give a positive result. It is for this reason that when characteristic symptoms of metritis appear, you should seek help from specialists and not self-medicate.

Treatment of pathology with Metrid

Metritis is a complex and quite dangerous disease that requires mandatory treatment. Drug therapy involves taking medications, among which Metrid can be distinguished. This medicine is widely used to treat various inflammatory pathologies, including metritis.

Metrid is a drug that is used for infusion into the body. It has an antimicrobial effect, therefore it gives good results in the treatment of various infectious and inflammatory diseases. The instructions for use of such a medicine indicate that the main component of the drug is metronidazole, which, when it enters a pathological cell, is metabolized and changes the composition of bacteria.

Droppers with Metrid for infectious diseases help to completely get rid of anaerobic microorganisms.

The introduction of the drug into the patient’s body leads to its penetration into the cerebrospinal fluid and its high concentration is observed in the tissues of the lungs and brain, as well as in the bile ducts. The attached instructions for use indicate that Metrid is excreted in the form of metabolites by the kidneys or intestines.

Metrid is widely used in the treatment of patients with infectious diseases that are severe. Typically, the development of such pathologies occurs under the influence of pathogenic microorganisms that are hypersensitive to the drug.

Metrid is prescribed in the following cases:

• For gynecological pathologies of an infectious nature;
• After surgery;
• For preventive purposes and to eliminate infections that entered the body during surgery.

The attached instructions for use of the drug recommend prescribing it in the form of droppers to those patients who have difficulty taking metronidazole orally.

Before starting treatment for any type of disease, the patient or specialist should carefully study the attached instructions for use of the drug. This is due to the fact that Metrid may be poorly tolerated by patients and this results in the development of some side effects:

The functioning of the gastrointestinal tract is disrupted and this manifests itself in the following:

• Abnormal stool;
• Attacks of vomiting;
• Rapid weight loss;
• The appearance of a metallic taste in the oral cavity;
• Increased dryness of the oral cavity;
• The appearance of discomfort in the epigastric region;
• Progression of stomatitis;
• Diagnosing jaundice with cholestasis.

Deviations in the functioning of the genitourinary system may occur in the form of:

• Severe burning sensation in the urethra;
• In the development of cystitis,
• Giving urine a brownish tint;
• In violation of libido.

Droppers with Metrid can cause an allergic reaction, which causes increased itching of the skin and the appearance of rhinitis of allergic origin.

Malfunctions in the functioning of various parts of the nervous system occur, and this is accompanied by the appearance of the following symptoms:

• Frequent dizziness;
• Constant headache;
• Problems with coordination;
• Persistent depression;
• Increased excitability;
• Problems with the visual organs.

Instructions for use indicate the use of certain doses of the drug and if they are exceeded, the development of seizures and peripheral neuropathy is observed.

Treatment with a medicine such as Metrid is not recommended for patients who are hypersensitive to its individual components.

In addition, the instructions for use prohibit the use of droppers with this product in the following groups of patients::

• With damage to the central nervous system of an organic nature;
• With blood pathologies;
• With pronounced abnormalities in liver function.

In addition, Metrid is not prescribed to pediatric patients. This drug should be used with caution in those patients whose work is closely related to driving a car.

The instructions for use of the drug prohibit its use during pregnancy, since it has not yet been possible to obtain accurate data on the effect of metronidazole on the condition of the fetus. If there is a need to treat an inflammatory disease during breastfeeding with Metrid, you should consult a specialist. Usually in such a situation, breastfeeding is canceled and the patient undergoes a course of treatment.

It is possible to achieve a positive result in the treatment of disease in women with the help of Metrid due to the combination of taking this drug with other antimicrobial drugs.

Antiprotozoal and antimicrobial drug, a derivative of 5-nitroimidazole. The mechanism of action is the biochemical reduction of the 5-nitro group of metronidazole by intracellular transport proteins of anaerobic microorganisms and protozoa. The reduced 5-nitro group of metronidazole interacts with the DNA of microbial cells, inhibiting the synthesis of their nucleic acids, which leads to the death of bacteria.

Active against Trichomonas vaginalis, Entamoeba histolytica, Gardnerella vaginalis, Giardia intestinalis, Lamblia spp., as well as obligate anaerobes Bacteroides spp. (including Bacteroides fragilis, Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides vulgatus), Fusobacterium spp., Veillonella spp., Prevotella (Prevotella bivia, Prevotella buccae, Prevotella disiens) and some gram-positive microorganisms (Eubacterium spp., Clostridium spp., Peptococcus spp., Peptostreptococcus spp.). The MIC for these strains is 0.125 - 6.25 μg/ml.

In combination with amoxicillin, it is active against Helicobacter pylori (amoxicillin suppresses the development of resistance to metronidazole).

Aerobic microorganisms and facultative anaerobes are insensitive to metronidazole, but in the presence of mixed flora (aerobes and anaerobes), metronidazole acts synergistically with antibiotics effective against common aerobes. Increases the sensitivity of tumors to radiation, causes disulfiram-like reactions, and stimulates reparative processes.

Pharmacokinetics

Absorption - high (bioavailability of at least 80%). It has high penetrating ability, reaching bactericidal concentrations in most tissues and body fluids, including lungs, kidneys, liver, skin, cerebrospinal fluid, brain, bile, fluid, breast milk, and penetrates hematomas and placental barriers. Volume of distribution: adults - approximately 0.55 l/kg, newborns - 0.54-0.81 l/kg. The maximum concentration ranges from 6 to 40 mcg/ml, depending on the dose. Time to reach maximum concentration is 1-3 hours. Communication with plasma proteins is 10-20%. With intravenous administration of 500 mg of Metronidazole over 20 minutes, the maximum concentration of the drug in the blood serum is after 1 hour - 35.2 mcg/ml, after 4 hours - 33.9 mcg/ml, after 8 hours - 25.7 mcg/ml; the minimum concentration upon subsequent administration is 18 mcg/ml. The time to reach maximum concentration is 30-60 minutes, the therapeutic concentration is maintained for 6-8 hours. With normal bile formation, the concentration of metronidazole in bile after intravenous administration may significantly exceed the concentration in plasma. About 30-60% of metronidazole is metabolized in the body by hydroxylation, oxidation and glucuronidation. The main metabolite (2-oxymetronidazole) also has antiprotozoal and antimicrobial effects.

The half-life for normal liver function is 8 hours (from 6 to 12 hours), for alcoholic liver damage - 18 hours (from 10 to 29 hours), in newborns: those born during pregnancy - 28 - 30 weeks - about 75 hours, 32 - 35 weeks - 35 hours, 36-40 weeks - 25 hours. 60 - 80% is excreted by the kidneys (20% unchanged), through the intestines - 6 - 15%. Renal clearance - 10.2 ml/min. In patients with impaired renal function, accumulation of metronidazole in the blood serum may occur after repeated administration (therefore, in patients with severe renal impairment, the frequency of dosing should be reduced). Metronidazole and its main metabolites are quickly removed from the blood during hemodialysis (the half-life is reduced to 2.6 hours). During peritoneal dialysis, it is excreted in small quantities.

Indications for use

Protozoal infections: extraintestinal amebiasis, including amoebic liver abscess, intestinal amebiasis (amebic dysentery), trichomoniasis, giardiasis, balantidiasis, giardiasis, cutaneous leishmaniasis, trichomonas vaginitis, trichomonas urethritis. Infections caused by Bacteroides spp. (including Bacteroides fragilis, Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides vulgatus): infections of bones and joints, infections of the central nervous system, including meningitis, brain abscess, bacterial endocarditis, pneumonia, empyema pleura and lung abscess, sepsis. Infections caused by Clostridium spp., Peptococcus and Peptostreptococcus: infections of the abdominal cavity (peritonitis, liver abscess), infections of the pelvic organs (endometritis, endomyometritis, abscess of the fallopian tubes and ovaries, infections of the vaginal vault).

Prevention of postoperative complications (especially interventions on the colon, peri-rectal area, appendectomy, gynecological operations).

Radiation therapy for patients with tumors - as a radiosensitizing drug in cases where tumor resistance is due to hypoxia in tumor cells.

Contraindications

Hypersensitivity to metronidazole or components included in the drug, as well as to other nitroimidazole derivatives; I trimester of pregnancy, lactation period, organic lesions of the central nervous system (including epilepsy), blood diseases (including prescription of large doses).

Pregnancy and lactation

1st trimester of pregnancy - contraindicated; II and III trimesters of pregnancy - only for health reasons;

For nursing mothers - according to indications with simultaneous cessation of breastfeeding.

Directions for use and doses

Intravenous administration of the drug is indicated for severe infections, as well as in the absence of the possibility of taking the drug orally.

For adults and children over 12 years of age, the initial dose is 0.5 - 1 g intravenously (infusion duration is 30 - 40 minutes), and then every 8 hours, 500 mg at a rate of 5 ml/min. If well tolerated, after the first 2-3 infusions they switch to jet administration. The course of treatment is 7 days. If necessary, intravenous administration is continued for a longer time. The maximum daily dose is 4 g. If the patient's condition improves, according to indications, a transition to maintenance administration of the drug orally at a dose of 400 mg 3-5 times a day is carried out.

Children under 12 years of age are prescribed according to the same regimen in a single dose - 7.5 mg/kg.

For purulent-septic diseases, 1 course of treatment is usually carried out.

For preventive purposes, adults and children over 12 years of age are prescribed intravenous drips of 0.5 - 1 g on the eve of surgery, on the day of surgery and the next day - 1.5 g / day (500 mg every 8 hours). After 1 - 2 days, they switch to maintenance therapy orally. For patients with chronic renal failure and creatinine clearance less than 30 ml/min and/or liver failure, the maximum daily dose is no more than 1 g, the frequency of administration is 2 times a day.

As a radiosensitizing drug, the drug is administered intravenously at a rate of 160 mg/kg or 4-6 g/sq.m of body surface 0.5-1.0 hour before the start of irradiation. Apply before each irradiation session for 1-2 weeks. During the remaining period of radiation treatment, metronidazole is not used. The maximum single dose should not exceed 10 g, course dose 60 g. To relieve intoxication caused by radiation, drip administration of a 5% dextrose solution, hemodez or 0.9% sodium chloride solution is used.

Side effect

From the digestive system: diarrhea, anorexia, nausea, vomiting, intestinal colic, constipation, “metallic” taste in the mouth, dry mouth, glossitis, stomatitis, pancreatitis.

From the nervous system: dizziness, impaired coordination of movements, ataxia, confusion, irritability, depression, increased excitability, weakness, insomnia, headache, convulsions, hallucinations, peripheral neuropathy.

Allergic reactions: urticaria, skin rash, skin hyperemia, nasal congestion, fever, arthralgia.

From the urinary system: dysuria, cystitis, polyuria, urinary incontinence, candidiasis, red-brown coloration of urine.

Local reactions: thrombophlebitis (pain, hyperemia or Other: neutropenia, leukopenia, flattening of the T wave on the ECG.

Interaction with other drugs

Metronidazole for intravenous administration is not recommended to be mixed with other drugs.

Strengthens the effect of indirect anticoagulants, which leads to an increase in prothrombin time.

Similar to disulfiram, it causes ethanol intolerance.

Concomitant use with disulfiram can lead to the development of various neurological symptoms (the interval between prescriptions is at least 2 weeks). Cimetidine inhibits the metabolism of metronidazole, which may lead to an increase in its concentration in the blood serum and an increased risk of side effects. The simultaneous administration of drugs that stimulate microsomal oxidation enzymes in the liver (phenobarbital, phenytoin) can accelerate the elimination of metronidazole, resulting in a decrease in its plasma concentration.