Successful treatment of Bacteroides bacteraemia with metronidazole, after failure with clindamycin and lincomycin

Intravenous metronidazole for treatment of infections involving anaerobic bacteria

Intravenous metronidazole was administered, either by continuous or intermittent infusion, to 20 patients with infections involving anaerobic bacteria; 14 of the 20 patients were changed to oral administration of metronidazole for completion of therapy. Six of eight patients with infections derived from oropharyngeal bacterial flora were cured; the addition of ampicillin was required in one patient, however, because of an incomplete response to metronidazole. Eight of eleven evaluable patients with infections derived from bowel flora were also cured by metronidazole or metronidazole plus an aminoglycoside. Of 93 anaerobic bacteria isolated before therapy, 89 were susceptible to 16 micrograms or less of metronidazole per ml. Mean plasma levels of metronidazole were 27.6 +/- 11.4 micrograms/ml in patients receiving continuous infusions of drug and 19.9 +/- 10.7 micrograms/ml (trough) in patients receiving intermittent infusions. Two patients developed peripheral neuropathy during therapy. Metronidazole is an effective agent for the treatment of anaerobic infections. Because metronidazole is not active against facultative and aerobic bacteria, the addition of a second antimicrobial agent may be required for the treatment of mixed anaerobic-aerobic infections.

The prevention of post-appendicectomy sepsis by metronidazole and cefazolin: a controlled double blind trial

A double blind, randomized, controlled trial was carried out at two hospitals to try the effect of metronidazole, which is effective against most anaerobes, and cefazolin, which is effective against many aerobic organisms, singly and in combination, on the incidence of wound sepsis following appendicectomy. Patients were placed at random into one of four groups; to receive metronidazole and placebo, cefazolin and placebo, metronidazole and cefazolin, or double placebo. Patients with generalized peritonitis were excluded for ethical reasons. Treatment was started before operation and continued eight-hourly for twenty-four hours. All patients in the trial were followed up at about two weeks after discharge from hospital and their wounds inspected. Two hundred and seventy-one patients were assessed. Sepsis rates at the two hospitals were similar. On the untreated controls, 30% discharged pus from their wounds, and in the groups receiving one drug only, about 20%. In those receiving both drugs the infection rate was 3%, a highly significant difference from that in the other three groups.

Pre- and postoperative rectal metronidazole for the prevention of wound infection in childhood appendicitis

Children suspected of having appendicitis were treated with preoperative metronidazole per rectum and then postoperative metronidazole per rectum until the drug could be administered orally. This series shows that even when administered after anesthetic induction, an adequate blood level of metronidazole was achieved at surgery. Other antibiotics were not used even when there was peritonitis. The wound infection rate in this small series was low, when compared to other series and our own comparison group.

Treatment of anaerobic infections with metronidazole

Metronidazole (Flagl), a compound widely used in man with minimal side-effects, has been used in the treatment of anaerobic infections caused by Bacteroides fragilis and other Bacteroides species. Seven patients were treated and all were restored to full health. Four of them did not respond to lincomycin or clindamycin which so far have been the drugs of choice against anaerobic infections. The reasons for the good results during metronidazole therapy such as the good penetration through the blood/brain barrier and into abscess cavities are discussed.