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149
31

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Pharmacology

Infections

Question 6 of 180

Which of the following antibiotics is used first line to treat tetanus:

Answer:

Intravenous metronidazole is used first line to treat established tetanus infection, together with tetanus immunoglobulin, and supportive measures.

Metronidazole

Pharmacology / Infections

Last Updated: 26th March 2019

Mechanism of Action

Metronidazole, of the nitroimidazole class, is a bacterial nucleic acid synthesis inhibitor. It has high activity against anaerobic bacteria and protozoa. Metronidazole is well absorbed orally and the intravenous route is normally reserved for severe infections.

Indications

Indications include:

  • Clostridium difficile colitis
  • Helicobacter pylori eradication (with clarithromycin/amoxicillin and PPI)
  • Bacterial vaginosis
  • Pelvic inflammatory disease (with doxycycline and ceftriaxone or ofloxacin)
  • Peritonitis (with cephalosporin or gentamicin)
  • Acute oral infections
  • Tetanus
  • Rosacea and acne (topical)
  • Surgical prophylaxis
  • Protozoal infections
    • Amoebic dysentery
    • Giardiasis
    • Trichomoniasis

Interactions

Metronidazole can cause a disulfiram-like reaction with alcohol causing symptoms such as flushing, headaches, dizziness, nausea/vomiting, tachypnoea and tachycardia.

Metronidazole enhances the anticoagulant effect of warfarin. If concurrent use cannot be avoided, consider reducing the warfarin dosage appropriately.

Side Effects

Common adverse effects include a metallic taste and gastrointestinal irritation (in particular nausea and vomiting). These are more common at higher doses. Patients should be advised that metronidazole should be taken with or after food.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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