Metronidazole, Indications, Dosage, Side Effects, Interactions

Last updated: February 7, 2026Reviewed date: February 7, 2026Reading time: 13 min read
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Metronidazole is a synthetic nitroimidazole derivative with antiprotozoal and antibacterial activities. Although its mechanism of action is not fully elucidated, un-ionized metronidazole is readily taken up by obligate anaerobic organisms and is subsequently reduced by low-redox potential electron-transport proteins to an active, intermediate product. Reduced metronidazole causes DNA strand breaks, thereby inhibiting...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

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Article Summary

Metronidazole is a synthetic nitroimidazole derivative with antiprotozoal and antibacterial activities. Although its mechanism of action is not fully elucidated, un-ionized metronidazole is readily taken up by obligate anaerobic organisms and is subsequently reduced by low-redox potential electron-transport proteins to an active, intermediate product. Reduced metronidazole causes DNA strand breaks, thereby inhibiting DNA synthesis and bacterial cell growth. A metroimidazole is an antibiotic and antiprotozoal medication used to treat amebiasis; vaginitis; trichomonas infections; giardiasis; anaerobic bacteria;...

Key Takeaways

  • This article explains Machanism of Action of Metronidazole in simple medical language.
  • This article explains Indications of Metronidazole in simple medical language.
  • This article explains Contra Indications of Metronidazole in simple medical language.
  • This article explains Dosage of Metronidazole in simple medical language.
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  • Any symptom that feels urgent, unusual, or unsafe for the patient.
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Metronidazole is a synthetic nitroimidazole derivative with antiprotozoal and antibacterial activities. Although its mechanism of action is not fully elucidated, un-ionized metronidazole is readily taken up by obligate anaerobic organisms and is subsequently reduced by low-redox potential electron-transport proteins to an active, intermediate product. Reduced metronidazole causes DNA strand breaks, thereby inhibiting DNA synthesis and bacterial cell growth.

A metroimidazole is an bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।" data-rx-term="antibiotic" data-rx-definition="An antibiotic is a medicine used to treat bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।">antibiotic and antiprotozoal medication used to treat amebiasis; vaginitis; trichomonas infections; giardiasis; anaerobic bacteria; and treponemal infections. It has also been proposed as a radiation sensitizer for hypoxic cells.

Machanism of Action of Metronidazole

Metronidazole, a synthetic antibacterial and antiprotozoal agent of the nitroimidazole class, is used against protozoa such as Trichomonas vaginalis, amebiasis, and giardiasis. Metronidazole is extremely effective against anaerobic bacterial infections and is also used to treat Crohn’s disease, antibiotic-associated diarrhea, and rosacea.Metronidazole is a prodrug. Unionized metronidazole is selective for anaerobic bacteria due to their ability to intracellularly reduce metronidazole to its active form. This reduced metronidazole then covalently binds to DNA, disrupt its helical structure, inhibiting bacterial nucleic acid synthesis and resulting in bacterial cell death.

or

Metronidazole is bactericidal, amebicidal, and trichomonacidal in action. The exact mechanism of action of the drug has not been fully elucidated. Metronidazole is un-ionized at physiologic pH and is readily taken up by anaerobic organisms or cells. In susceptible organisms or cells, metronidazoleis reduced by low-redox-potential electron transport proteins (e.g., nitroreductases such as ferredoxin) to unidentified polar product(s) which lack the nitro group. The reduction product(s) appears to be responsible for the cytotoxic and antimicrobial effects of the drug which include disruption of DNA and inhibition of nucleic acid synthesis. Metronidazole is equally effective against dividing and nondividing cells.
or
In in vivo studies in rats given metronidazole in dosages of 2-4 mg/100 g of body weight, the drug reportedly inhibited the development of formalin-induced edema in the rat paw. In vitro in neutrophils, metronidazole has a dose-dependent inhibitory effect on generation of hydrogen peroxide and hydroxyl radicals, oxidants that may cause tissue injury at the site of infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation. This antioxidant effect appears to be caused by a direct effect on bacterial infection. সহজ বাংলা: ব্যাকটেরিয়ার বিরুদ্ধে লড়াই করা শ্বেত রক্তকণিকা।" data-rx-term="neutrophil" data-rx-definition="Neutrophil is a white blood cell important for fighting bacterial infection. সহজ বাংলা: ব্যাকটেরিয়ার বিরুদ্ধে লড়াই করা শ্বেত রক্তকণিকা।">neutrophil function and may contribute to the drug’s anti-inflammatory effect in vivo.

Indications of Metronidazole

  • Bacterial Vaginitis
  • Bacterial Infection
  • Amebiasis
  • Aspiration Pneumonia
  • Dental Abscess
  • Clostridium difficile-associated diarrhea and colitis,
  • Helicobacter pylori infection and duodenal ulcer disease, bacterial vaginosis,
  • Giardia lamblia gastro-enteritis, amebiasis
  • STD Prophylaxis
  • Bacteremia
  • Balantidium coli
  • Bone infection
  • Clostridial Infection
  • Crohn’s Disease, 
  • Deep Neck Infection
  • Dientamoeba fragilis
  • Diverticulitis
  • Dracunculiasis
  • Endocarditis
  • Giardiasis
  • Helicobacter Pylori Infection
  • Intraabdominal Infection
  • Joint Infection
  • Lemierre’s Syndrome
  • Meningitis
  • Nongonococcal Urethritis
  • Pelvic Inflammatory Disease
  • Peritonitis
  • Pneumonia
  • Pouchitis
  • Pseudomembranous Colitis
  • Skin or Soft Tissue Infection
  • Surgical Prophylaxis
  • Trichomoniasis
  • For the treatment of anaerobic infections and mixed infections, surgical prophylaxis requiring anaerobic coverage, Clostridium difficile-associated diarrhea and colitis, Helicobacter pylori infection and duodenal ulcer disease, bacterial vaginosis, Giardia lamblia gastro-enteritis, amebiasis caused by Entamoeba histolytica, acne rosacea (topical treatment), and Trichomonas infections.

Therapeutic Indications of Metronidazole

  • Oral metronidazole (extended release formulation) is used in the treatment of bacterial vaginosis caused by Gardnerella vaginalis, Mobiluncus spp, mycoplasma hominis and anaerobes (peptostreptococcus spp and Bacteroides spp).
  • Metronidazole is used in the treatment of periodontal infections caused by Bacteroides species.
  • Oral metronidazole is used in the treatment of giardiasis caused by Giardia lamblia.
  • Some studies indicate that metronidazole may be effective, in combination with bismuth subsalicylate or colloidal bismuth subcitrate, and other oral bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।" data-rx-term="antibiotic" data-rx-definition="An antibiotic is a medicine used to treat bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।">antibiotic therapy, such as ampicillin or amoxicillin, in the treatment of Helicobacter pylori-associated gastritis and duodenal ulcer. However, metronidazole resistance may occur, especially in patients who have been previously exposed to metronidazole.
  • Metronidazole is used in the treatment of dracunculiasis (guinea worm infection) caused by Dracunculus medinensis. It decreases the inflammation around the ulcer, increasing the ease of removing the worm.
  • Metronidazole is used in the treatment of antibiotic-associated diarrhea and colitis caused by Clostridium difficile.
  • Metronidazole is used in the treatment of inflammatory bowel disease.
  • Metronidazole is used in the treatment of Balantidium coli infection.
  • Oral metronidazole is indicated in the treatment of symptomatic and asymptomatic trichomoniasis, in males and females, caused by Trichomonas vaginalis.
  • Metronidazole is indicated in the treatment of skin and soft tissue infections caused by Bacteroides species, including the Bacteroides fragilis group. Clostridium species, Fusobacterium species, Peptococcus species, and Peptostreptococcus species.
  • Metronidazole is indicated in the treatment of bacterial septicemia caused by Bacteroides species, including the Bacteroides fragilis group, and Clostridium species.
  • Metronidazole is indicated in the treatment of lower respiratory tract infections, including pneumonia, emphysema, and lung abscess, caused by Bacteroides species, including the Bacteroides fragilis group.
  • Intravenous metronidazole is indicated for the prophylaxis of perioperative infections during colorectal surgery.
  • Metronidazole is indicated in the treatment of female pelvic infections, including endometritis, endomyometritis, tubo-ovarian abscess, and postsurgical vaginal cuff infections, caused by Bacteroides species, including the Bacteroides fragilis group, Clostridium species, Peptoccus species, and Peptostreptococcus species.
  • Metronidazole is indicated in the treatment of intra-abdominal infections, including peritonitis, intra-abdominal abscess, and liver abscess, caused by Bacteroides species, including the Bacteroides fragilis group, Clostridium species, Eubacterium species, Peptococcus species, and Peptostreptococcus species
  • Metronidazole is indicated in the treatment of endocarditis caused by Bacteroides species, including the Bacteroides fragilis group.
  • Metronidazole is indicated in the treatment of CNS infections, including meningitis, caused by Bacteroides species, including the Bacteroides fragilis group.
  • Metronidazole is indicated in the treatment of brain abscess caused by Bacteroides species, including the Bacteroides fragilis group.
  • Metronidazole is indicated in the treatment of bone and joint infections caused by Bacteroides species, including the Bacteroides fragilis group (Bacteroides fragilis, Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides vulgatus).
  • Oral metronidazole is indicated in the treatment of acute intestinal amebiasis caused by Entamoeba histolytica. Metronidazole may not eradicate intestinal amebic infections, requiring treatment with a luminal amebicide.
  • Metronidazole is indicated in the treatment of extraintestinal amebiases, including amebic liver abscess, caused by Entamoeba histolytica. When used in the treatment of invasive amebiasis, metronidazole should be administered concurrently or sequentially with a luminal amebicide (eg, iodoquinol, paromomycin, tetracycline, diloxanide furoate). When used in the treatment of amebic liver abscesses, metronidazole therapy does not obviate the need for aspiration of the abscess.
  • Metronidazole is not effective against facultative anaerobes, obligate aerobes, Propionibacterium acnes, Actinomyces species, or Candida albicans.

Contra Indications of Metronidazole

Dosage of Metronidazole

Strengths:  250 mg;400 mg 375 mg; 500 mg; 750 mg; 500 mg/100 mL;

Bacterial Infection

IV

  • Loading dose: 15 mg/kg IV once infused over 1 hour
  • Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
  • Maximum dose: 4 g per day
  • Duration of therapy: 7 to 10 days

Oral ,Immediate-release Capsules and Tablets

  • 7.5 mg/kg orally every 6 hours
  • Maximum dose: 4 g per day
  • Duration of therapy: 7 to 10 days

Amebiasis

Acute Intestinal Amebiasis (Acute Amebic Dysentery)

  • Immediate-release capsules and tablets: 750 mg orally 3 times a day for 5 to 10 days

Amebic Liver Abscess

  • Immediate-release capsules and tablets: 500 to 750 mg orally 3 times a day for 5 to 10 days

Trichomoniasis

  • Immediate-release Capsules: 375 mg orally twice a day for 7 consecutive days

Immediate-release Tablets

  • One-day regimen: 2 g orally as a single dose or 1 g twice given in the same da
  • Seven-day regimen: 250 mg orally 3 times a day for 7 consecutive days

US CDC recommendations ,Immediate-release Tablets

  • Recommended regimen: 2 g orally as a single dose
  • Alternative regimen: 500 mg orally twice a day for 7 days

Trichomoniasis in HIV-infected women

  • Immediate-release tablets: 500 mg orally twice a day for 7 days

Treatment failure with single-dose therapy and reinfection is excluded

  • Immediate-release tablets: 500 mg orally twice a day for 7 days; for patients failing this regimen, 2 g orally once a day for 7 days should be considered

Helicobacter pylori Infection

Some experts recommend

  • Bismuth quadruple therapy: 250 mg orally 4 times a day
  • Clarithromycin-based triple therapy: 500 mg orally twice a day
  • Duration of therapy: 10 to 14 days

Pelvic Inflammatory Disease

US CDC recommendations
Mild to moderately severe acute pelvic inflammatory disease (PID)

  • Immediate-release tablets: 500 mg orally twice a day for 14 days

Bacterial Vaginosis

  • Extended-release Tablets: 750 mg orally once a day for 7 consecutive days

US CDC recommendations

  • Immediate-release tablets: 500 mg orally twice a day for 7 days

Intraabdominal Infection

IV

  • Loading dose: 15 mg/kg IV once infused over 1 hour
  • Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
  • Maximum dose: 4 g per day
  • Duration of therapy: 7 to 10 days

Oral

  • Immediate-release capsules and tablets: 7.5 mg/kg orally every 6 hours
  • Maximum dose: 4 g per day
  • Duration of therapy: 7 to 10 days

IDSA and SIS recommendations

  • Immediate-release tablets: 500 mg IV every 8 to 12 hours or 1500 mg IV every 24 hours

Peritonitis

IV

  • Loading dose: 15 mg/kg IV once infused over 1 hour
  • Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
  • Maximum dose: 4 g per day
  • Duration of therapy: 7 to 10 days

Oral

  • Immediate-release capsules and tablets: 7.5 mg/kg orally every 6 hours
  • Maximum dose: 4 g per day
  • Duration of therapy: 7 to 10 days

Liver Abscess

IV

  • Loading dose: 15 mg/kg IV once infused over 1 hour
  • Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
  • Maximum dose: 4 g per day
  • Duration of therapy: 7 to 10 days

Oral

  • Immediate-release capsules and tablets: 7.5 mg/kg orally every 6 hours
  • Maximum dose: 4 g per day
  • Duration of therapy: 7 to 10 days

Joint Infection

IV:
-Loading dose: 15 mg/kg IV once infused over 1 hour
-Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
-Maximum dose: 4 g per day
-Duration of therapy: 7 to 10 days

Oral

  • Immediate-release capsules and tablets: 7.5 mg/kg orally every 6 hours
  • Maximum dose: 4 g per day
  • Duration of therapy: 7 to 10 days

Osteomyelitis

IV

  • Loading dose: 15 mg/kg IV once infused over 1 hour
  • Maintenance dose: 7.5 mg/kg IV infused over 1 hour every 6 hours
  • Maximum dose: 4 g per day
  • Duration of therapy: 7 to 10 days

Oral

  • Immediate-release capsules and tablets: 7.5 mg/kg orally every 6 hours
  • Maximum dose: 4 g per day
  • Duration of therapy: 7 to 10 days

Pediatric Bacterial Infection

American Academy of Pediatrics (AAP) recommendations ,Neonates
7 days or less

  • Up to 2 kg: 7.5 mg/kg IV every 12 hours
  • Greater than 2 kg: 7.5 mg/kg IV every 8 hours

8 to 28 days

  • Up to 2 kg: 7.5 mg/kg IV every 12 hours
  • Greater than 2 kg: 7.5 mg/kg IV every 6 hours
  • Postmenstrual age less than 34 weeks: 7.5 mg/kg IV every 12 hours
  • Postmenstrual age 34 to 40 weeks: 7.5 mg/kg IV every 8 hours
  • Postmenstrual age greater than 40 weeks: 7.5 mg/kg IV every 6 hour

1 month or older

  • IV: 22.5 to 40 mg/kg/day IV in 3 divided doses
  • Maximum dose: 1.5 g/day

Oral

  • 30 to 50 mg/kg/day orally in 3 divided doses
  • Maximum dose: 2.25 g/day

Side Effects of Metronidazole

The most common side effects 

Common

Rare

Drug Interactions of Metronidazole

Metronidazole may interact with following drugs, supplements, & may change the efficacy of drugs

Pregnancy & Lactation of Metronidazole

FDA Pregnancy Category B 
Pregnancy

According to the manufacturer, oral metronidazole is contraindicated during the first trimester of pregnancy in patients with trichomoniasis. However, the CDC states that metronidazole can be used for trichomoniasis at any stage of pregnancy as studies have not demonstrated an association between metronidazole and teratogenic effects.

Lactation

Metronidazole is excreted into breast milk. Breastfeeding is not recommended during treatment with systemic products. While there is some systemic absorption from topical and vaginal products, plasma concentrations would be lower than demonstrated with systemic formulations; however, caution is still advised. Metronidazole is a mutagen in vitro and has been shown to be carcinogenic in animal studies. In general, increased oral and rectal Candida colonization and loose stools have been reported in infants exposed to metronidazole via breast milk.

 

Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Medicine doctor / pediatrician for children / qualified clinician
Tests to discuss with doctor
  • Temperature chart and hydration assessment
  • CBC with platelet count if fever persists or dengue/other infection is possible
  • Urine test, malaria/dengue tests, chest evaluation, or blood culture only when clinically indicated
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Do I need antibiotics, or is this more likely viral?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Metronidazole, Indications, Dosage, Side Effects, Interactions

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

RX Patient Help

Ask a health question safely

Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

References

Add references, clinical guidelines, textbooks, journal articles, or trusted medical sources here. You can edit this area from the RX Article Professional Blocks panel.

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