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Metronidazole, the Central Nervous System, Neuropathy & the Brain

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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.

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