The main representative of nitromidazole is metromidazole.
This substance belongs to the group of nitroimidazoles. In addition to metronidazole, the drugs tinidazole and nimorazole belong to this rather small group of substances. Metronidazole is also known under the trade name Clont R. It is a standard drug and co-medication in the treatment of anaerobic infections. Metronidazole is well-drained and can be administered as a short infusion (via the venous blood system), in tablet form (orally), as a suppository (vaginal) and vaginally.
Metronidazole inhibits the nucleic biosynthesis of anaerobically growing bacteria and protozoa (protozoa). Compared to the antibiotics of other groups of substances, nitroimidazoles are the only ones acting on this pathway. Due to the inhibition, the drug has a bactericidal effect.
Metronidazole and the other drugs of the substance group nitroimidazoles act primarily against anaerobically growing germs and protozoa (protozoa). Apart from actinomycetes and propionibacteria, metronidazole acts on all anaerobically growing bacteria. In the protozoa Entamoeba histolytika, Trichomonas vaginalis and Gardia lamblia should be mentioned. Furthermore, metronidazole acts against the germ Gardenella vaginalis, which causes mainly gynecological infections.
Operational areas include gastrointestinal and vaginal infections and abscesses caused by anaerobic bacteria as well as prophylactic before gastrointestinal interventions and gynecological surgeries. Metronidazole is also used in non-infectious gastrointestinal diseases, such as the chronic inflammatory bowel disease Crohn's disease and ulcerative colitis.
Especially complaints on the gastrointestinal tract, especially stomatitis and glossitis, need to be feared. Also, taste irritations and, above all, metallic taste have been described when taking metronidazole. Furthermore, these drugs interact with alcohol and cause alcohol intolerance. Also, neurological complaints have been observed, including headache, dizziness, inactivity (ataxia) and emotional disorders (neuropathy). In animal experiments, a carcinogenic effect could be detected. Since the drug is metabolized in the liver and excreted in the urine, a urine staining during use is expected.
As mentioned above, metronidazole should not be combined with alcohol because of intolerance. If the medication barbiturates and phenytoin are given concomitantly, a faster decomposition of metronidazole and the resulting reduction of the effect must be expected due to an enzyme acceleration. If blood thinners (anticoagulants) are combined with metronidazole, an interaction and an increased tendency to bleed must be expected. In the treatment of depression with lithium, there is a risk that the lithium level increases dangerously high in combination with nitroimidazoles and causes corresponding side effects.
In diseases of the central nervous system or the hematopoietic system, as well as in severe liver diseases, pregnancy and lactation, metronidazole and similar preparations from the same substance group should not be administered.