title: Metronidazole is still the drug of choice for treatment of anaerobic infections.
abstract: Metronidazole has been used for the treatment of infections for >45 years and is still successfully used for the treatment of trichomoniasis, amoebiasis, and giardiasis. Anaerobic bacterial infections caused by Bacteroides species, fusobacteria, and clostridia respond favorably to metronidazole therapy. Good clinical results in the treatment of vaginosis due to Gardnerella vaginalis have also been reported. Rates of resistance to metronidazole are still generally low; however, several studies have reported decreased susceptibility among Bacteroides species, as well as different mechanisms of resistance. Metronidazole-resistant Helicobacter pylori strains have been described, but combination therapy (eg, metronidazole, amoxicillin, or clarithromycin plus omeprazole) is still recommended for eradication of this pathogen in patients with gastroduodenal ulcers. Metronidazole is considered to be a cost-effective drug because of its low cost, good activity against pathogenic anaerobic bacteria, favorable pharmacokinetic and pharmacodynamic properties, and minor adverse effects. Metronidazole is still the criterion standard for therapy of anaerobic infections, as was described by Tally and colleagues 35 years ago.
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
authors.forename: Sonja
authors.initials: S
authors.lastname: Löfmark
authors.forename: Charlotta
authors.initials: C
authors.lastname: Edlund
authors.forename: Carl Erik
authors.initials: CE
authors.lastname: Nord
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D001421:Bacteria, Anaerobic / Q000187:drug effects*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D004359:Drug Therapy, Combination; D006801:Humans; D008795:Metronidazole / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D011528:Protozoan Infections / Q000188:drug therapy* / Q000469:parasitology
chemical_list: D000900:Anti-Bacterial Agents; D000981:Antiprotozoal Agents; D008795:Metronidazole