Description
Metronidazole Pharmacodynamics
Metronidazole belongs to the 5-nitroimidazoles and is a drug with a bactericidal type of action, exhibiting tropism to deoxyribo-nucleic acid.
The mechanism of action consists in the biochemical reduction of the 5-nitrogroup of metronidazole by intracellular transport proteins
of anaerobic microorganisms and protozoa. The reduced 5-nitrogroup of metronidazole interacts with the deoxyribonucleic acid
of the cells of microorganisms, inhibiting the synthesis of their nucleic acids, which leads to the death of the bacteria.
Active against protozoa: Trichomonas vaginalis, Giardia lamblia, Entamoeba histolytica, as well as facultative anaerobes Bacteroides spp.
(including Bacteroides fragilis, Bacteroides diistasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides vulgatus), Fusobacterium spp.
spp., Prevotella spp. (Prevotella bivia, Prevotella buccae, Prevotella disiens) and some gram-positive obligate (Clostridium spp.) and facultative (Eubacterium spp.
(Eubacterium spp., Peptococcus spp., Peptostreptococcus spp., Mobiluncus spp.) anaerobes and the facultative aerobe Gardnerella vaginalis.
Aerobic microorganisms are insensitive to metronidazole, but in the presence of mixed flora (aerobes and anaerobes) metronidazole acts
synergistically with antibiotics effective against common aerobes.
Indications
Topical treatment of trichomonad vaginitis, bacterial vaginosis and non-specific vaginitis caused by metronidazole-sensitive microorganisms.
Contraindications
Hypersensitivity to metronidazole or other nitroimidazole derivatives; blood diseases, leukopenia (including in anamnesis);
movement disorder, central nervous system disorders (including epilepsy); hepatic insufficiency (when administering high doses); pregnancy (I trimester), lactation, children under 18 years of age.
Caution: pregnancy (II – III trimesters).
Administration during pregnancy and lactation
The drug is contraindicated in the first trimester of pregnancy (penetrates through the placenta); thereafter, it should only be used if
potential benefit to the mother exceeds the possible risk to the fetus.
Metronidazole penetrates into the breast milk, therefore breastfeeding during the drug administration should be cancelled. Breast-feeding can be resumed not earlier than 48 hours after the end of the drug administration.
Dosage and administration method
- Intravaginal administration in adults.
- Trichomonadal vaginitis: 1 suppository a day, immediately before bedtime for 7-10 days in combination with metronidazole tablets.
- Nonspecific vaginitis, bacterial vaginosis: 1 suppository a day, immediately before bedtime for 7-10 days, if necessary, in combination with intake of metronidazole in tablets.
- The treatment should not last more than 10 days and should be repeated more than 2-3 times a year.
- Before releasing the suppository from the contour pack with scissors (cut the film along the contour of the suppository), introduce it deep into the vagina.
