Ornidazole

Ornidazole

1. Class: Nitroimidazole Antimicrobial

2. Mechanism of Action  
   Ornidazole disrupts the DNA of anaerobic bacteria and protozoa by forming free radicals that damage DNA, leading to cell death. It effectively targets anaerobic infections and protozoal infections.

3. Uses  
   - Anaerobic Bacterial Infections: Effective against pathogens such as Bacteroides species, Clostridium species, and Fusobacterium species.  
   - Protozoal Infections: Treats Trichomonas vaginalis (trichomoniasis) and Giardia lamblia (giardiasis).  
   - Gynecological Infections: Used in combination therapy for bacterial vaginosis and other gynecological infections.

4. Rationale for Use  
   - Effective Against Anaerobes and Protozoa: Targets specific pathogens not covered by many other antibiotics.  
   - Good Tissue Penetration: Effective in treating infections in various body tissues and fluids.

5. Dosage and Administration  
   - Adults: Typically 500 mg orally twice daily for 5-7 days, depending on the infection.  
   - Gynecological Infections: Often used in combination with other antibiotics or treatments.  
   - Renal Impairment: No specific dose adjustments required, but use with caution.

6. Side Effects  
   - Common: Nausea, vomiting, headache, dizziness, and dry mouth.  
   - Less Common: Allergic reactions, metallic taste, and gastrointestinal upset.  
   - Severe: Rarely, may cause peripheral neuropathy or severe allergic reactions.

7. Contraindications  
   - Allergy: Avoid in patients with known hypersensitivity to nitroimidazole derivatives.  
   - Pregnancy: Should be avoided (Category C) especially in the first trimester due to potential teratogenic effects.  
   - Lactation: Excreted in breast milk. Use with caution during breastfeeding, with close monitoring of the infant.

8. Drug Interactions  
   - Alcohol: Avoid alcohol during treatment and for 48 hours after completing the course to prevent disulfiram-like reactions (flushing, nausea, vomiting).  
   - Warfarin: May enhance the effect of warfarin, increasing the risk of bleeding. Monitor INR closely.

9. Considerations  
   - Pregnancy: Use with caution, particularly in the first trimester, if benefits outweigh risks.  
   - Lactation: Weigh risks versus benefits; monitor the infant if used during breastfeeding.  
   - Neurological Effects: Watch for signs of peripheral neuropathy or CNS effects.

10. When to Use  
    - First-Line: For anaerobic and protozoal infections where ornidazole is effective and other treatments are not suitable.  
    - Alternative: When other antibiotics are contraindicated or ineffective.

11. When Not to Use  
    - Pregnant Women (First Trimester): Due to potential risks to the developing fetus.  
    - Patients with Severe Allergic Reactions: History of severe reactions to nitroimidazoles.  
    - Patients with Active Alcohol Use: Due to risk of disulfiram-like reactions.

12. Monitoring  
    - Effectiveness: Monitor for clinical improvement of the infection.  
    - Side Effects: Watch for gastrointestinal issues, neurological symptoms, and allergic reactions.  
    - Interactions: Check for interactions with alcohol and anticoagulants.

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