Breakpoints
#88 – Dosing Consult: Can we BID farewell to Q8H Metronidazole?
Dec 1, 2023
Nicholas Torney, an infectious diseases clinical pharmacist, and Sunish Shah, pharmacist at the University of Pittsburgh, delve into the evolving strategies for metronidazole dosing. They challenge the traditional Q8H schedule, exploring the benefits of switching to a Q12H regimen for better patient outcomes. Their discussion covers the drug's pharmacokinetics, the importance of tailored antibiotic therapy, and recent studies reshaping clinical practices. Plus, they touch on the fun side of metronidazole with interesting facts!
32:04
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Quick takeaways
- Metronidazole's high bioavailability and extensive tissue penetration support its effectiveness in treating various infections, which warrants reevaluation of dosing strategies.
- Emerging evidence suggests that less frequent bi-daily dosing of metronidazole yields similar clinical outcomes to the traditional every eight hours regimen, indicating the need for practice change.
Deep dives
Understanding Metronidazole Pharmacokinetics
Metronidazole is highly bioavailable, with over 90% absorption when taken orally, making it effective for various infections. Its significant distribution allows it to penetrate multiple body tissues, including the brain, which is crucial for treating serious infections. The drug is metabolized in the liver into five different metabolites, one of which retains 30% to 65% of its antimicrobial activity relative to metronidazole itself. Notably, the elimination half-life of metronidazole is approximately 6 to 10 hours, while its active hydroxy metabolite has a longer half-life of 11 to 13 hours, supporting the potential for less frequent dosing.
