Flagyl Metronidazole Nursing Considerations & Patient Teachings

Metronidazole (Flagyl) is an antimicrobial medication used to treat various bacterial and parasitic infections. It is particularly effective against anaerobic bacteria and certain protozoal infections.

Generic name: Metronidazole

Brand names: Flagyl, Metro, Metrogel, Protostat, MetroCream

Pharmacologic class: Nitroimidazole antimicrobial

Therapeutic class: Antibiotic, antiprotozoal

Mechanism of action: Metronidazole enters microorganisms and is reduced by bacterial enzymes to form toxic compounds that disrupt DNA and protein synthesis, leading to cell death of susceptible organisms.

Indications for use: Treatment of bacterial infections including bacterial vaginosis, pelvic inflammatory disease, intra-abdominal infections, C. difficile colitis, trichomoniasis, amebiasis, and anaerobic bacterial infections.

Precautions and contraindications: Hypersensitivity to metronidazole or other nitroimidazole derivatives. First trimester of pregnancy. History of blood dyscrasias. Patients with active neurological disorders.

Drug Interactions

• Alcohol consumption must be avoided during treatment and for at least 3 days after discontinuation.
• Warfarin’s effects may be enhanced
• Lithium levels may be elevated
• Cimetidine may increase metronidazole blood levels
• Oral contraceptive effectiveness may be reduced

Adverse Effects

• Nausea, vomiting, metallic taste
• Headache, dizziness
• Peripheral neuropathy
• Dark or reddish-brown urine
• Candidiasis
• Seizures (rare)
• Stevens-Johnson syndrome (rare)

Administration Considerations

Available preparations: Oral tablets (250mg, 500mg), extended-release tablets, oral suspension, vaginal gel, IV solution.

Dosages: Adult dosing varies by indication:

• Bacterial infections: 500mg PO every 8 hours for 7-10 days
• Trichomoniasis: 2g PO as a single dose
• C. difficile: 500mg PO every 8 hours for 10-14 days
• IV dosing: 500mg every 8 hours

Nursing Considerations for Flagyl

Related Nursing Diagnoses

• Risk for infection
• Impaired skin integrity
• Risk for injury related to neurotoxicity
• Deficient knowledge related to medication regimen
• Diarrhea

Nursing Assessment

1. Assess for drug allergies and previous adverse reactions to metronidazole
2. Obtain complete health history, including neurological conditions and alcohol use
3. Assess infection symptoms before and during treatment
4. Monitor CBC, liver function tests, and kidney function
5. Assess for signs of peripheral neuropathy

Nursing Interventions

1. Administer oral doses with meals to minimize GI upset
2. For IV administration, infuse over 60 minutes
3. Monitor for signs of superinfection
4. Assess neurological status regularly
5. Monitor for signs of C. difficile-associated diarrhea

Patient Teaching Associated with Flagyl

1. Emphasize the importance of completing the full course of antibiotics
2. Avoid alcohol during treatment and for 3 days after completing therapy
3. Take medication with food to reduce stomach upset
4. Report any numbness, tingling, or unusual neurological symptoms
5. Inform about possible urine discoloration
6. Use additional birth control methods if taking oral contraceptives
7. Avoid driving or operating machinery if experiencing dizziness

Storage and Special Instructions

• Store at room temperature away from light and moisture
• Complete the prescribed course even if symptoms improve
• Take doses at evenly spaced intervals
• Do not double up on missed doses

This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult with a pharmacist for complete information.

References

1. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. 
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4. Claussen DW. Flagyl (metronidazole hydrochloride). Gastroenterol Nurs. 1993 Feb;15(4):178-80. doi: 10.1097/00001610-199302000-00007. PMID: 8443266.
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8. Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.