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Metronidazole is a nitroimidazole antimicrobial used in children for anaerobic bacterial and protozoal infections when targeted therapy is needed.
Dosing varies by indication: 15 mg/kg/day in divided doses for giardiasis vs higher doses for anaerobic infections.
Food reduces GI upset; metallic taste is common and manageable.
Alcohol causes disulfiram-like reactions—strict avoidance is essential.
Monitor for neuropathy or seizures with prolonged high-dose therapy.
Adjust dosing in severe hepatic impairment and consider therapeutic drug monitoring for long courses.
Metronidazole offers targeted anaerobic and protozoal coverage across several organ systems.
It is guideline-supported for giardiasis, bacterial vaginosis, trichomoniasis, and adjunctive therapy in anaerobic abscesses and C. difficile infection.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Giardiasis | Children and adolescents | Yes | Administer 15 mg/kg/day divided in three doses for 5 days or 20 mg/kg/day divided twice daily for 3 days per CDC recommendations. |
| Clostridioides difficile infection | Children | No | Reserve for mild disease when vancomycin or fidaxomicin are unavailable or for use in combination with oral vancomycin in fulminant colitis. |
| Anaerobic intra-abdominal or pelvic infections | Children and adolescents | Yes | Combine with cephalosporins or other broad-spectrum agents to cover gram-negative aerobes and anaerobes after perforated appendicitis or pelvic abscess. |
| Bacterial vaginosis | Adolescents | Yes | Use oral 500 mg twice daily for 7 days or topical gel per CDC STI guidelines; treat sexual partners if recurrent. |
| Trichomoniasis | Adolescents | Yes | Administer 2 g orally in a single dose or 500 mg twice daily for 7 days and ensure partner treatment. |
| Topical therapy for inflammatory rosacea | Adolescents | No | Metronidazole 0.75–1% gel or cream reduces papules and pustules through anti-inflammatory effects. |
FDA-approved primary uses with Level A evidence
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Quick selection guides and diagnostic pearls
When to consider other medications
How to explain treatment to families
Metronidazole side effects are usually mild and include GI upset and metallic taste.
Serious reactions like neuropathy or encephalopathy are rare and typically linked to high doses or long courses.
Nausea
Common • mild
Metallic taste
Common • mild
Headache
Common • mild
Peripheral neuropathy
Rare • serious
Rash/Urticaria
Uncommon • moderate
Disulfiram-like reaction with alcohol
Rare • moderate
Organized by affected organ systems
How to discuss side effects with families
Management protocols and monitoring
Common concerns and practical guidance
Practical administration guidance for pediatric metronidazole courses.
Give with food or milk if stomach upset occurs. Liquid formulations should be shaken well. If using tablets, swallow them whole; they can be crushed and mixed with flavored syrup if needed.
Because the medicine has a bitter taste, coat the tongue with chocolate syrup or follow with juice. Set alarms to keep every-6-to-8-hour dosing on schedule.
Emergency contact: Seek urgent care for trouble breathing, swelling of the face, severe abdominal pain, persistent vomiting, or neurologic changes like numbness or seizures.
Stay the course even if symptoms improve early and avoid any alcohol-containing products while on therapy and for 72 hours after the last dose.
Different formulations and concentrations
Safe preparation and measuring techniques
Tailored approaches for different ages
Solutions for common challenges
Storage guidelines and safety tips
Expert pearls and evidence-based tips
Anaerobic protozoa and bacteria reduce metronidazole to reactive metabolites that damage DNA and inhibit nucleic acid synthesis.
Metronidazole becomes activated in anaerobic environments to disrupt microbial DNA.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
Clinical pearls to maximize safe metronidazole use.
Focus on adherence, taste-masking, and safety monitoring.
Avoid alcohol or products containing propylene glycol during therapy and for 72 hours after the last dose.
Mix the dose with syrup or follow with cold juice to reduce metallic aftertaste.
Prolonged courses warrant checking for numbness or tingling and reviewing concurrent neurotoxic agents.
Core insights every provider should know
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Recent updates that change how we practice
Organized by dosing, administration, and safety
How to explain treatments to families
Real-world cases with evidence-based approaches
Key numbers, algorithms, and decision tools
Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Metronidazole and monitor your child's response to treatment.
Yes. Milk or food can lessen stomach upset and does not reduce effectiveness.
Metronidazole naturally has a metallic taste. Chilling the dose or mixing with syrup helps mask it.
Some protocols use a single daily dose for 5 days or a single large dose. Follow your clinician’s instructions exactly.
Short courses rarely need labs. Prolonged therapy may require liver and blood count monitoring.