Metronidazole + Tetracycline Pharmacology

Metronidazole + Tetracycline

About Metronidazole + Tetracycline
Mechanism of Action of Metronidazole + Tetracycline
Pharmacokinets of Metronidazole + Tetracycline
Onset of Action for Metronidazole + Tetracycline
Duration of Action for Metronidazole + Tetracycline
Half Life of Metronidazole + Tetracycline
Side Effects of Metronidazole + Tetracycline
Contra-indications of Metronidazole + Tetracycline
Special Precautions while taking Metronidazole + Tetracycline
Pregnancy Related Information
Old Age Related Information
Breast Feeding Related Information
Children Related Information
Indications for Metronidazole + Tetracycline
Interactions for Metronidazole + Tetracycline
Typical Dosage for Metronidazole + Tetracycline
Schedule of Metronidazole + Tetracycline
Storage Requirements for Metronidazole + Tetracycline
Effects of Missed Dosage of Metronidazole + Tetracycline
Effects of Overdose of Metronidazole + Tetracycline


About Metronidazole
A nitroimidazole antibiotic, Anti-infective, Antiprotozoal,amebicide.
Mechanism of Action of Metronidazole
Metronidazole is nitro imidazoles which have broad spectrum cidal activity against Protozoa and some anaerobic bacteria. Its selective toxicity to anaerobic microbes involves 1. Drug enters the cell by diffusion, 2. Nitro group of drug is reduced by redox proteins present only in anaerobic organisms to reactive nitro radical which exerts cytotoxic action by damaging DNA and other critical biomolecules. 3. DNA helix destabilization & strand breakage has been observed.
Pharmacokinets of Metronidazole
Absorption: Well absorbed orally, Distribution: Widely distributed,
Metabolism: Metabolized in liver by oxidation & glucuronide conjugation, Excretion: Excreted in urine.
Onset of Action for Metronidazole
1 to 2 days
Duration of Action for Metronidazole
Half Life of Metronidazole
8 hours.
Side Effects of Metronidazole
2.Metallic taste
7.Looseness of stool.
8.Peripheral neuropathy &CNS effects.
11.Transient leucopenia
12.Dry mouth
13.Abdominal distress
16.Thrombophlebitis at site of injection
Contra-indications of Metronidazole
1.Hypersensitivity to the drug
2.Blood dyscrasias
3.CNS disorders
Special Precautions while taking Metronidazole
1.Renal impairment
2.Hepatic impairment
3.Alcoholic cirrhosis
4.Use cautiously along with other hepatotoxic drugs & In visual field changes
Pregnancy Related Information
Use with caution
First trimester:contra indicated
Old Age Related Information
May be used.
Breast Feeding Related Information
Children Related Information
Use with caution
Neonates: Contraindicated
Indications for Metronidazole
3.Trichomonas vaginitis
4.Pseudo membranous enterocolitis
5.Anaerobic bacterial infections after surgery, Brain abscess, & Endocarditis
6.Helicobacter pylori infections
7.Ulcerative gingivitis
Interactions for Metronidazole
Warfarin & other coumarin anticoagulants: Potentiates the anticoagulant effect resulting in increased prothrombin time.
Alcohol: A disulfiram-like reaction. Abdominal cramps, nausea, vomiting, headache & flushing.
Disulfiram: Acute psychotic reaction or confusional state.
Phenobarbital & Phenytoin: Increased metabolism of metronidazole resulting in decreased efficacy.
Lithium: Increased lithium levels and toxicity.
Flurouracil: Increased toxicity of flurouracil.
Lab tests: May interfere with chemical analysis for AST,SGOT, ALT, SGPT, LDH, triglycerides and hexokinase glucose. Zero values may occur.
Typical Dosage for Metronidazole
Amoebiasis:400 to 800 mg 8hourly for 5 to 10days depending up on the severity of infection
In severe infections and liver abscess: 1gm as slow I.V. infusion followed by 0.5 gm twice daily till oral therapy is started
Giardiasis:200mg 8hourly for 1week or 2gm/day for 3days or I.V.500mg thrice daily
Trichomonas vaginitis: 400mg 8 hourly for a week or 2gm once daily for a week.
Male partner should be concurrently treated with the drug
Pseudo membranous enterocolitis:800 mg 8hourly
Anaerobic bacterial infections after surgery, Brain abscess, & Endocarditis:400 to 800 mg 8hourly
In severe cases: 15mg/kg I.V. infusion for 1hour followed by 7.5mg/kg 4 times daily till oral therapy is substituted
Helicobacter pylori infections:400mg 8hourly along with amoxicillin/clarithromycin and a proton pump inhibitor
Ulcerative gingivitis:200 to 800mg 8hourly
Amoebiasis: 30 to 50mg/kg/day for 5to10 days.
Giardiasis:10 to 15mg/kg/day thrice daily
Children (below 12years): 7.5mg/kg I.V.
Schedule of Metronidazole
Storage Requirements for Metronidazole
Store in a well closed container in a cool dark place. Keep out of the reach of children.
Effects of Missed Dosage of Metronidazole
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Metronidazole
Treatment is supportive & symptomatic. Drug is removed by induced emesis, gastric lavage, and administration of activated charcoal & use of cathartics. For controlling seizures diazepam & phenytoin may be used.


About Tetracycline
A broad-spectrum polyketide antibiotic,Tetracycline Derivative.
Mechanism of Action of Tetracycline
Tetracycline is a broad spectrum antibiotic which has more specific action against gram positive organisms than gram negative organisms. It exerts its bacteriostatic action by accumulating inside the bacteria through specific transporter protein & inhibits bacterial protein synthesis by attaching to 30 S subunit of bacterial ribosome (which are absent in mammals). It chelates cations like Ca &Mg and inhibits functioning of various enzymes & ribosome. It is used in some areas for the treatment of Chloroquine-resistant falciparum malaria
Pharmacokinets of Tetracycline
Absorption: Orally well absorbed, Distribution: widely distributed; shows protein- binding, Metabolism: metabolized by liver, Excretion: excreted through urine
Onset of Action for Tetracycline
3 hours
Duration of Action for Tetracycline
12 hours
Half Life of Tetracycline
8 hours
Side Effects of Tetracycline
1.Headache, dizziness, intracranial hypertension
2.Aggravates renal & hepatic impairment
5.Epigastric distress
6.Super infection
7.Skin rashes
8.Arrhythmia, Cardiac arrest
9.Neutropenia, Thrombocytopenia
10.Elevated liver enzymes
11.Discoloration of teeth & Retardation of bone growth
12.Esophageal ulceration
Contra-indications of Tetracycline
Hypersensitive individuals
Special Precautions while taking Tetracycline
Renal impairment:
1.Tetracycline aggravates renal impairment & leads to negative nitrogen balance. So avoid use of drug in renal impairment.
Hepatic impairment:
High dose causes hepato toxicity, so dose adjustments is required & avoid
Other precautions:
1.Avoid use together with milk & milk products, Antacids, Cations, Vitamins, Products which contain divalent or trivalent cations
2.Potentiation of action of anticoagulants; so avoid use together
3.Diabetes mellitus, Hyperthyroidism, & Hypertensions
Pregnancy Related Information
Old Age Related Information
May be used
Breast Feeding Related Information
Children Related Information
Children: Contraindicated
Neonates: Contraindicated

Indications for Tetracycline
1. Pneumonia
2. Chlamydia infections
3. Rickettsial infections
4. Cholera
5. Brucellosis
6. Sexually transmitted diseases like syphilis, gonorrhea, Chancroid
7. Urinary tract infections
8. H-pylori infection
9. Acne
10. Lyme disease
11. Malaria
Interactions for Tetracycline
Antacids (aluminium, calcium, zinc, magnesium), Iron salts, Bismuth salts: Impair absorption of tetracyclines thus reducing its efficacy.
Anticoagulants: Increase the hypothrombinemic effects of anti-coagulants.
Cimetidine: Decreases GI absorption leading to decreased efficacy of tetracyclines.
Digoxin: Increased serum levels leading to digoxin toxicity.
Methoxyflurane: Nephrotoxic effects of both increased.
Oral contraceptives: Breakthrough bleeding, pregnancy due to decreased efficacy.
Penicillins: Efficacy reduced.
Food: Dairy products decrease efficacy of tetracyclines.
Lab tests: Bacterio-suppressive levels of Demeclocycline persist in both urine and blood for several days after cessation of therapy interfering with culture studies.
Typical Dosage for Tetracycline
Adults: Oral administration of 500mg tablets 6 hourly or 12 hourly as required.
Children: 15 to 25mg/kg bodyweight. Maximum dose 50mg/kg. Administer 6hourly or 12 hourly as required
Infections of cervix, urethra&rectum caused by Chlamydia trachomatis:2gm daily; orally; in four divided doses for a week.
Gonorrhea: Starts with 1.5gm oral administration & then administer 500mg tablets four times daily for four days
Syphilis: oral administration of 1-2 gm daily in four divided doses for two weeks
Brucellosis: 2gm daily in four divided doses for 28 days (along with streptomycin 1gm for first 21 days)
Ulcer caused by H-pylori infection: 2gm daily in four divided doses for 10 - 14 days.
Lyme disease: 0.25-0.5gm; orally four times daily for 10 days to One month.
Acne: Initial dose-0.5gm to 1gm orally four times daily; maintenance dose 0.12 to 0.5mg daily
Malaria: 1 g daily in 2 - 4 divided doses
Schedule of Tetracycline
Storage Requirements for Tetracycline
Store in a cool place
Effects of Missed Dosage of Tetracycline
Take the missed dose whenever remember. If it is the time of next dose avoid that dose; because over dosage leads to toxicity.
Effects of Overdose of Tetracycline
Treatment is supportive & symptomatic. Drug can be removed by gastric lavage

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