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Metronidazole – systemic use

Classification: A

Drug products: Flagyl, Flagyl®, Metronidazol Actavis, Metronidazol Baxter, Metronidazole Braun

ATC code: J01XD01, P01AB01

Summary

A systematic review found the resistance of Helicobacter pylori to metronidazol to be higher in women.

A small pharmacokinetic study showed lower exposure and higher clearance of metronidazole in women after adjusting for body weight. These pharmacokinetic differences are not considered clinically important.

Additional information

Pharmacokinetics and dosing

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].

Effects

No studies with a clinically relevant sex analysis regarding effect of metronidazole have been found.

Adverse effects

No studies with a clinically relevant sex analysis regarding adverse effects of metronidazole have been found.

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Other information

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 [2].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 [3].

Updated: 2019-02-26

Date of litterature search: 2015-01-28

References

  1. Carcas AJ, Guerra P, Frias J, Soto A, Fernandez-Aijón A, Montuenga C et al. Gender differences in the disposition of metronidazole. Int J Clin Pharmacol Ther. 2001;39:213-8. PubMed
  2. De Francesco V, Giorgio F, Hassan C, Manes G, Vannella L, Panella C et al. Worldwide H pylori antibiotic resistance: a systematic review. J Gastrointestin Liver Dis. 2010;19:409-14. PubMed
  3. Osato MS, Reddy R, Reddy SG, Penland RL, Malaty HM, Graham DY. Pattern of primary resistance of Helicobacter pylori to metronidazole or clarithromycin in the United States. Arch Intern Med. 2001;161:1217-20. PubMed
  4. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-04-05.] länk

Authors: Anna Garmén, Desirée Loikas

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson