Metronidazole, the Central Nervous System, Neuropathy & the Brain

[Guide]

The papers below are discussing ORAL metronidazole, however, you should be aware of these studies with regard to the Central Nervous System, the brain, neuropathy and treatment with metronidazole (considered one of the Anti-parasitic Prescription Agents).  

"This microdialysis study describes the steady-state brain distribution of metronidazole in patients and confirms its extensive distribution....These findings demonstrate that the extensive distribution of metronidazole within brain ECF contributes to the CNS toxicity observed occasionally during treatments with this antibiotic. " [1]

"Metronidazole is a potential cause of reversible autonomic neuropathy." [2]

"Cerebellar toxicity is a rare adverse event in patients treated with metronidazole." [3]

"Metronidazole is a commonly used antimicrobial drug. When used excessively, it can cause encephalopathy." [4]

"Nevertheless, six cases of peripheral neuropathy with metronidazole have been reported, and we describe here a further patient with peripheral neuropathy due to metronidazole." [5]

"Metronidazole is distributed extensively within CSF, with a mean CSF to unbound plasma AUC0-τ ratio of 86% ± 16%." [6]

End Notes

[1] Frasca D, Dahyot-Fizelier C, Adier C, et al. Metronidazole and hydroxymetronidazole central nervous system distribution: 1. microdialysis assessment of brain extracellular fluid concentrations in patients with acute brain injury. Antimicrob Agents Chemother. 2014;58(2):1019–1023. doi:10.1128/AAC.01760-13

[2] J Child Neurol, 21 (5), 429-31  May 2006
Metronidazole: Newly Recognized Cause of Autonomic Neuropathy
Lisa D Hobson-Webb, E Steve Roach, Peter D Donofrio
PMID: 16901452  DOI: 10.1177/08830738060210051201

[3] Int J Infect Dis. 2008 Nov;12(6):e111-4. doi: 10.1016/j.ijid.2008.03.006. Epub 2008 Jun 3.
Cerebellar ataxia following prolonged use of metronidazole: case report and literature review.
Patel K, Green-Hopkins I, Lu S, Tunkel AR.

[4] Kalia V, Vibhuti, Saggar K. Case report: MRI of the brain in metronidazole toxicity. Indian J Radiol Imaging. 2010;20(3):195–197. doi:10.4103/0971-3026.69355

[5] Br Med J. 1977 Sep 3; 2(6087): 610–611. doi: 10.1136/bmj.2.6087.610 PMCID: PMC1631560, PMID: 198056
Metronidazole neuropathy.
W G Bradley, I J Karlsson, and C G Rassol

[6] Antimicrob Agents Chemother. 2014;58(2):1024-7. doi: 10.1128/AAC.01762-13. Epub 2013 Nov 25.
Metronidazole and hydroxymetronidazole central nervous system distribution: 2. cerebrospinal fluid concentration measurements in patients with external ventricular drain.
Frasca D, Dahyot-Fizelier C, Adier C, Mimoz O, Debaene B, Couet W, Marchand S.

[ElaineA]

Lets put things in perspective here.

Oral Metronidazole was first introduced in 1960.   Oral Metronidazole is a highly effective drug against certain types of bacteria and parasites. Hundreds of millions of doses of this drug have been given over the last 61 years.  Oral Metronidazole is on the WHO's list of 100 essential medications. In general, Oral Metronidazole has a good safety record.   

In the papers mentioned above,  6 people out of tens of millions are reported as having a RARE, serious reaction to Oral Metronidazole, most after prolonged use.  While this was certainly a serious situation for the people that it happened to, it doesn't mean that everyone is in danger of this complication.   Taking any antibiotic for a prolonged period of time is generally not advisable.   Almost every medication out there has serious side effects for some people.

I was given the antibiotic Minocin (minocycline) for 6-8 years by 4 different dermatologists who all misdiagnosed Rosacea Subtype 2 as bacterial acne.  My Rosacea Subtype 3 was misdiagnosed as allergic conjunctivitis.  Eventually, the Minocin triggered Guillain-Barre Syndrome (GBS) that didn't stop until I stopped taking the drug.  Decades later my Rosacea Subtype 2 and 3 became severe.   2 weeks on the Oral Ivermectin + Oral Metronidazole treatment cured it.  I had zero bad side effects to either the Oral Ivermectin or the Oral Metronidazole.  It became obvious after the fact that I also had had the symptoms of Small Intestine Bacterial Overgrowth (SIBO) since I was a teenager.   The Oral Ivermectin killed the demodex skin mites that SIBO had allowed to become severely over-populated.  The Oral Metronidazole cured the SIBO which fixed the Rosacea.  3.5 years later I'm still clear after decades of fighting skin, eye and abdominal issues. 

 

 

[Guide]

35 minutes ago, ElaineA said:

Lets put things in perspective here.

Oral Metronidazole was first introduced in 1960.   Oral Metronidazole is a highly effective drug against certain types of bacteria and parasites. Hundreds of millions of doses of this drug have been given over the last 61 years.  Oral Metronidazole is on the WHO's list of 100 essential medications. In general, Oral Metronidazole has a good safety record.   

In the papers mentioned above,  6 people out of tens of millions are reported as having a RARE, serious reaction to Oral Metronidazole, most after prolonged use.  While this was certainly a serious situation for the people that it happened to, it doesn't mean that everyone is in danger of this complication.   Taking any antibiotic for a prolonged period of time is generally not advisable.   Almost every medication out there has serious side effects for some people.

I was given the antibiotic Minocin (minocycline) for 6-8 years by 4 different dermatologists who all misdiagnosed Rosacea Subtype 2 as bacterial acne.  My Rosacea Subtype 3 was misdiagnosed as allergic conjunctivitis.  Eventually, the Minocin triggered Guillain-Barre Syndrome (GBS) that didn't stop until I stopped taking the drug.  Decades later my Rosacea Subtype 2 and 3 became severe.   2 weeks on the Oral Ivermectin + Oral Metronidazole treatment cured it.  I had zero bad side effects to either the Oral Ivermectin or the Oral Metronidazole.  It became obvious after the fact that I also had had the symptoms of Small Intestine Bacterial Overgrowth (SIBO) since I was a teenager.   The Oral Ivermectin killed the demodex skin mites that SIBO had allowed to become severely over-populated.  The Oral Metronidazole cured the SIBO which fixed the Rosacea.  3.5 years later I'm still clear after decades of fighting skin, eye and abdominal issues. 

 

 

Thanks Elaine for putting all this in perspective. As with all treatments there are risks, but the risks associated with taking oral metronidazole are indeed very small. Appreciate your investigation and personal experience into this since you are quite knowledgeable in this area of expertise. 

We do have a post on oral ivermectin for rosacea and a post on Oral Ivermectin Compared with Ivermectin–Metronidazole Combined Therapy. 

[Apurva Tathe]

On 7/3/2021 at 12:13 PM, ElaineA said:

Lets put things in perspective here.

Oral Metronidazole was first introduced in 1960.   Oral Metronidazole is a highly effective drug against certain types of bacteria and parasites. Hundreds of millions of doses of this drug have been given over the last 61 years.  Oral Metronidazole is on the WHO's list of 100 essential medications. In general, Oral Metronidazole has a good safety record.   

In the papers mentioned above,  6 people out of tens of millions are reported as having a RARE, serious reaction to Oral Metronidazole, most after prolonged use.  While this was certainly a serious situation for the people that it happened to, it doesn't mean that everyone is in danger of this complication.   Taking any antibiotic for a prolonged period of time is generally not advisable.   Almost every medication out there has serious side effects for some people.

I was given the antibiotic Minocin (minocycline) for 6-8 years by 4 different dermatologists who all misdiagnosed Rosacea Subtype 2 as bacterial acne.  My Rosacea Subtype 3 was misdiagnosed as allergic conjunctivitis.  Eventually, the Minocin triggered Guillain-Barre Syndrome (GBS) that didn't stop until I stopped taking the drug.  Decades later my Rosacea Subtype 2 and 3 became severe.   2 weeks on the Oral Ivermectin + Oral Metronidazole treatment cured it.  I had zero bad side effects to either the Oral Ivermectin or the Oral Metronidazole.  It became obvious after the fact that I also had had the symptoms of Small Intestine Bacterial Overgrowth (SIBO) since I was a teenager.   The Oral Ivermectin killed the demodex skin mites that SIBO had allowed to become severely over-populated.  The Oral Metronidazole cured the SIBO which fixed the Rosacea.  3.5 years later I'm still clear after decades of fighting skin, eye and abdominal issues. 

 

 

Yes Elaine we sometimes take antibiotics on our own and due to the misdiagnosis of physician and taking antibiotics for a longer period of time (you mentioned years) would adversely affect our overall system because we live with so many microorganisms inside as well as outside on our skin. Most of the microbes are friendly and live with commensalism but taking wrong antibiotics or unnecessarily when you do not have any issue or taking steadily for a longer period of time not only cause side effects but will make your microbes resistant to antibiotics whether they are friendly and when they become resistant they cause serious problems and I guess because of this, you get these issues and your rosacea also became worse.