Side Effects of metronidazole: A Synthesis of Findings from 17 Studies

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Original Abstract of the Article

Main Research Findings

Metronidazole (MTZ) is an antibiotic widely used to treat bacterial and parasitic infections. However, long-term use of MTZ can lead to side effects such as neurotoxicity and infertility, and the mechanisms have been attracting attention in recent years. 5 showed that long-term use of MTZ caused neurotoxicity and infertility in rats. This side effect was suggested to be caused by thiamine deficiency and increased oxidative stress induced by MTZ. Additionally, it was found that co-administration of grapefruit (GP) aggravated the side effects of MTZ. 12 showed that ronidazole (RNZ) was more effective in destroying liver cells in zebrafish than MTZ. RNZ showed effectiveness at lower concentrations than MTZ and had fewer side effects. 4 reported nausea, vomiting, headache, and abdominal pain as common side effects of MTZ. 15 reported urine discoloration as a side effect of MTZ. 6 reported neurotoxicity, gastrointestinal symptoms, and skin symptoms as side effects of MTZ. 13 reported that long-term use of MTZ caused cerebral infarction. 3 reported peripheral neuropathy as a side effect of MTZ. reported nausea, vomiting, headache, abdominal pain, and rash as side effects of MTZ. 1 reported gastrointestinal symptoms as side effects of MTZ. 16 reported abnormal findings in brain MRI images as a side effect of MTZ. 11 showed that a new type of NTR (nitroreductase) with higher effectiveness than MTZ has been developed, which increases cell destruction effects. 7 showed that vaginal administration of MTZ was more effective and had fewer side effects compared to oral administration. 9 showed that single-dose MTZ was effective in treating giardiasis. 8 showed that triple therapy containing MTZ was effective in treating Helicobacter pylori infection. 10 showed that MTZ was effective in treating prurigo nodularis. reported serious side effects of MTZ. 17 reported cerebellar toxicity as a side effect of MTZ. 14 reported encephalitis as a side effect of MTZ.

Reasons for Side Effects

MTZ-induced neurotoxicity and infertility may be caused by thiamine deficiency and increased oxidative stress. 5 showed that long-term use of MTZ caused decreased thiamine levels in blood and increased oxidative stress levels in the brain and testes of rats. Thiamine plays a crucial role in the synthesis of neurotransmitters and energy metabolism, and its deficiency can lead to neurological disorders and impaired sperm production. Oxidative stress is known to cause cell damage and aging. MTZ can increase oxidative stress by inhibiting redox reactions within cells.

Common Side Effects

Neurotoxicity

Neurotoxicity of MTZ can lead to neurological disorders and mental problems. 5 , 13 , 17 , 14 reported neurotoxic symptoms such as encephalitis, peripheral neuropathy, and cerebellar toxicity after long-term use of MTZ. Symptoms such as headache, dizziness, lightheadedness, visual impairment, speech impairment, altered consciousness, numbness, and paralysis may occur.

Gastrointestinal Symptoms

Gastrointestinal symptoms of MTZ can cause digestive problems and inflammation of the gastrointestinal tract. 6 , 1 reported gastrointestinal symptoms such as nausea, vomiting, abdominal pain, and diarrhea as side effects of MTZ. MTZ can also alter the gut microbiota, which can lead to digestive problems and gastrointestinal inflammation.

Skin Symptoms

Skin symptoms of MTZ can lead to skin inflammation and pigmentation problems. 6 reported rash, itching, and skin dryness as side effects of MTZ. MTZ can also cause photosensitivity.

Other

Urine discoloration and metallic taste have been reported as side effects of MTZ. 15 reported urine discoloration as a side effect of MTZ. reported metallic taste as a side effect of MTZ.

Countermeasures for Side Effects

Countermeasures for Neurotoxicity

To prevent neurotoxicity, it is important to minimize the use of MTZ. 13 , 17 , 14 reported that neurotoxic symptoms improved after discontinuation of MTZ. If neurotoxic symptoms occur, discontinue MTZ and follow your doctor's instructions.

Countermeasures for Gastrointestinal Symptoms

Taking MTZ with meals can be effective in preventing gastrointestinal symptoms. 1 showed that taking MTZ with meals can reduce gastrointestinal symptoms. Consult your doctor if gastrointestinal symptoms occur.

Countermeasures for Skin Symptoms

Using sunscreen and limiting sun exposure can be effective in preventing skin symptoms. 6 suggests that avoiding sun exposure is effective in preventing skin symptoms caused by MTZ. Consult your doctor if skin symptoms occur.

Comparison between Studies

Commonalities between Studies

Multiple studies have shown that MTZ can cause side effects such as neurotoxicity, gastrointestinal symptoms, and skin symptoms. Additionally, it is confirmed that MTZ side effects are influenced by long-term use, high doses, and individual differences.

Differences between Studies

MTZ side effects have shown different aspects in different studies. 5 suggests that MTZ side effects may be caused by thiamine deficiency and increased oxidative stress. On the other hand, 12 showed that ronidazole was more effective in destroying cells than MTZ. This suggests that ronidazole has fewer side effects than MTZ. Furthermore, 7 showed that vaginal administration of MTZ had fewer side effects compared to oral administration. These research results indicate that MTZ side effects vary greatly depending on administration method, dosage, and individual constitution.

Points to Note for Application in Daily Life

MTZ is an effective drug for treating bacterial and parasitic infections, but it is important to understand the risks of side effects such as neurotoxicity and infertility. If taking MTZ, follow your doctor's instructions and do not stop taking it on your own or combine it with other medications. If you are concerned about the side effects of MTZ, consult your doctor.

Limitations of Current Research

Research on the side effects of MTZ is still insufficient. Further research is needed, especially on side effects from long-term use and differences in side effects due to individual differences.

Future Research Directions

The following research is needed to better understand the side effects of MTZ and develop preventative and therapeutic methods:

  • Research to elucidate the mechanisms of MTZ side effects
  • Research to develop drugs or methods to suppress MTZ side effects
  • Research to evaluate the individual susceptibility to MTZ side effects

Conclusion

MTZ is an effective drug for treating bacterial and parasitic infections, but it carries the risk of side effects such as neurotoxicity and infertility. When taking MTZ, it is important to follow your doctor's instructions and understand the side effects. It is hoped that future research on the side effects of MTZ will lead to safer use of this drug.

Literature analysis of 17 papers
Positive Content
12
Neutral Content
1
Negative Content
4
Article Type
3
0
0
2
15
1.

The frequency and duration of side-effects associated with the use of oral metronidazole; A prospective study of VITA trial participants.

Author: AyindeOluseyi, RossJonathan Dc

Bacterial vaginosis treatment
Gastrointestinal side effects

Metronidazole is commonly used to treat bacterial vaginosis but is often thought to cause gastrointestinal side effects. This study assessed the frequency and type of adverse effects associated with metronidazole in women with bacterial vaginosis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

2.

The frequency and duration of side-effects associated with the use of oral metronidazole; A prospective study of VITA trial participants.

Author: AyindeOluseyi, RossJonathan Dc

Bacterial vaginosis treatment
Gastrointestinal side effects

Metronidazole is commonly used to treat bacterial vaginosis but is often thought to cause gastrointestinal side effects. This study assessed the frequency and type of adverse effects associated with metronidazole in women with bacterial vaginosis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

Metronidazole and Peripheral Neuropathy: A Report of Two Cases of (Unusual) Side Effects.

Author: GussagoStefano, Poroli BastoneCristiana, CelioDiana, ArigoniMichele, QuarenghiMassimo C

Anaerobic infection treatment
Protozoan infection treatment
Peripheral neuropathy

Metronidazole, a commonly prescribed antibiotic, can cause peripheral neuropathy. This report describes two cases of peripheral neuropathy attributed to metronidazole treatment. Prolonged therapy regimens (>4 weeks of treatment and/or 42 g cumulative dose) may increase the risk of neurological complications, particularly peripheral polyneuropathy.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

6.

Therapeutic uses of metronidazole and its side effects: an update.

Author: Hernández CeruelosA, Romero-QuezadaL C, Ruvalcaba LedezmaJ C, López ContrerasL

Treats amoebiasis
Treats giardiasis
Treats trichomoniasis
Toxicity

This review discusses the therapeutic uses of metronidazole and its associated toxicity.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

7.

Intravaginally applied metronidazole is as effective as orally applied in the treatment of bacterial vaginosis, but exhibits significantly less side effects.

Author: BrandtM, AbelsC, MayT, LohmannK, Schmidts-WinklerI, HoymeU B

Effective treatment for BV
Improved patient satisfaction

Intravaginal application of metronidazole was as effective as oral administration in treating bacterial vaginosis (BV) but with significantly less adverse events and likely better patient compliance.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

8.

Experience with 'triple' anti-Helicobacter pylori eradication therapy: side effects and the importance of testing the pre-treatment bacterial isolate for metronidazole resistance.

Author: BellG D, PowellK, BurridgeS M, PallecarosA, JonesP H, GantP W, HarrisonG, TrowellJ E

Effective for H. pylori eradication
Diarrhea
Vomiting/nausea

Triple therapy with bismuth, tetracycline, and metronidazole was effective in eradicating Helicobacter pylori infection in patients with metronidazole-sensitive organisms, but less effective in patients with metronidazole-resistant organisms. Side effects, particularly diarrhea and nausea, were common.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

10.

Systemic Medication for the Treatment of Prurigo Nodularis-A Systematic Review.

Author: McCampbellLillian E, ZainoMallory L, RanpariyaManas, PatelTejesh, FeldmanSteven R

Prurigo nodularis treatment
Pruritus reduction
Muscle and nerve pain
Side effects

This review examined the efficacy of systemic treatments for prurigo nodularis. Dupilumab was found to be most effective with the fewest side effects. Thalidomide and pregabalin were also effective, but long-term use was limited by side effects. Janus kinase inhibitors may also be beneficial, but further research is needed.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

12.

Ronidazole Is a Superior Prodrug to Metronidazole for Nitroreductase-Mediated Hepatocytes Ablation in Zebrafish Larvae.

Author: ChenYuhang, LiPeipei, ChenTing, LiuHanjie, WangPeijian, DaiXiaozhen, ZouQingliang

Liver regeneration
Reduced toxicity

Metronidazole is a drug that is often used to ablate cells in the liver. However, it has several side effects. This study screened five metronidazole analogs, including ronidazole, to determine if any were less toxic and more effective in ablating liver cells in zebrafish. Ronidazole was found to be less toxic and equally effective in ablating liver cells compared to metronidazole.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

13.

Metronidazole-induced encephalopathy delayed diagnosis due to cerebellar infarction: A case report.

Author: ChaSangha, LeeByung Chan, MoonChang-Won, ChoKang Hee

Metronidazole encephalopathy

This case report highlights the importance of considering metronidazole-induced encephalopathy in patients with long-term disability, even in the presence of other neurological deficits.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

14.

Metronidazole-Induced Encephalopathy (MIE).

Author: ChaudhariDinesh M, RenjenPushpendra Nath, HasanUrusa, GoyalNidhi, AhmadKamal

Infections treatment
Neurologic side effects

This case report describes a gentleman in his early 60s with a liver abscess who presented with altered sensorium, abnormal gait, and slurring of speech after three weeks of metronidazole therapy. MRI brain revealed bilateral symmetrical hyperintensities suggestive of metronidazole-induced encephalopathy (MIE).

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

15.

Urine Discoloration Associated with Metronidazole: A Case Report.

Author: AnjumMohammad Firoz, TwanabasuSajal, ShresthaKipa

Urine discoloration

Metronidazole is an antibiotic with rare side effects, one of which is urine discoloration. This case report describes a 4-year-old boy with nephrotic syndrome who developed reddish urine after starting metronidazole. The discoloration resolved after stopping the drug.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

17.

Metronidazole Induced Cerebellar Toxicity: A Case Report.

Author: SapkotaShova, NiroulaAliska, PrajapatiRina, SharmaSubhani, DhunganaKrishna

Cerebellar toxicity
Neurotoxicity

Metronidazole-induced cerebellar toxicity can occur following prolonged metronidazole therapy.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

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