ATC kod: J01XD01, P01AB01
En systematisk reviewartikel fann att Helicobacter pylori-resistens mot metronidazol var vanligare hos kvinnor än hos män.
En liten farmakokinetikstudie visade lägre exponering och högre clearance av metronidazol hos kvinnor efter dosjustering för kroppsvikt. Dessa farmakokinetiska skillnader bedöms dock inte kliniskt betydelsefulla.
In an open, single-dose, two-sequence, crossover randomized trial (12 men, 12 women), bioequivalence of two different formulations of metronidazole (250 mg) and sex differences in pharmacokinetics were studied. Bioequivalence analysis showed that the formulations were similar. However, differences in pharmacokinetic parameters were observed between men and women. Following dose-adjustment for body weight, AUC for metronidazole was lower (12%) and clearance was higher in women. In accordance to these findings, metronidazole half-life was shorter among women. Volume of distribution was higher in men. However, according to the authors, these findings are most likely clinically irrelevant and no dosage adjustment based on sex are not considered necessary [1].
No studies with a clinically relevant sex analysis regarding effect of metronidazole have been found.
Safety of metronidazole for Clostridioides difficile infection was analysed retrospectively in a Japanese study using electronic chart data. Nausea was more frequent in women than in men (13.6% vs 1.1%) treated with metronidazole [2].
Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).
Several studies report differences in Helicobacter pylori antibiotic resistance between men and women. A systematic review of 31 studies, published worldwide 2006-2009, found that overall, primary metronidazole resistance was more common among women than men (31.4% vs. 21.1%). Also, metronidazole resistance rate varied widely between different populations. High resistance was reported from Denmark and Korea while low resistance was observed in Sweden, the Netherlands and Japan [3].
Another study based on US-data from clinical trials between 1993 and 1999 (6087 isolates, distribution male vs. female samples unknown), described higher frequency of primary metronidazole resistant Helicobacter pylori among women than men (63% vs. 35% or 34.7% vs. 22.6%, depending on test method). The authors hypothesize that this finding is due to the use of metronidazole to treat gynecologic infections. For both men and women metronidazole resistance was more common before the age of 70 [4].
Fler kvinnor än män hämtade ut tabletter innehållande metronidazol (ATC-kod P01AB01) på recept i Sverige år 2020, totalt 44 976 kvinnor och 24 068 män. Det motsvarar 9 respektive 5 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 20-39 år hos kvinnor och i åldersgruppen 70 år och äldre hos män. I genomsnitt var läkemedel innehållande metronidazol 2,5 gånger vanligare hos kvinnor [5].
Infusionsvätska innehållande metronidazol (ATC-kod J01XD01) används huvudsakligen på sjukhus och därför saknas könsspecifika användningsdata [6].
Uppdaterat: 2021-12-21
Litteratursökningsdatum: 2021-11-18
Faktagranskat av: Diana Rydberg, Carl-Olav Stiller
Godkänt av: Karin Schenck-Gustafsson