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!
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Metronidazole Pharmacokinetics Insight
- Metronidazole has nearly 100% oral bioavailability and distributes widely including into the CNS and bile.
- Its active hydroxy metabolite with a half-life of ~12 hours supports consideration of twice daily dosing.
Dosing Frequency Controversy
- Metronidazole exhibits concentration-dependent killing against anaerobes.
- Despite this, traditional dosing often favors thrice daily, highlighting a dosing controversy.
Sunish Shah's Early BID Experience
- Sunish Shah learned metronidazole 500 mg twice daily dosing as a student at UPenn.
- He continued this practice into his PGY2 residency and career despite it being less common elsewhere.