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Question answered:10/09/07 Warning! this question is over two years old.
The NLH Q&A Service is unable to say that iv metronidazole can be mixed with all antibiotics. We found a number of examples in the literature describing the use of iv metronidazole mixed with an individual antibiotic. For instance a document on the British Society for Antimicrobial Chemotherapy have a document on the management of Clostridium difficile colitis [1], this includes the following passage:
“Oral therapy is preferred, but if the patient cannot tolerate oral medication, then antibiotics can be given by nasogastric tube. Neither metronidazole nor vancomycin achieves reliable levels in the gut when administered parenterally, so if IV administration is required, both should be used.
Appropriate regimens are:
Oral metronidazole for 7–10 days
Oral vancomycin (if no response) for up to 10 days
Nasogastric administration can be used if the patient cannot tolerate oral medication
IV metronidazole plus vancomycin can alternatively be used in patients unable to tolerate oral agents..”
Another example is taken from a document produced by the Queen’s Medical Centre in Nottingham. The document, a guide to antibiotic use in adults [2] reports the following (see webpage, URL below, for the context of this quote:
“Penicillin allergy:
Levofloxacin 500mg od 7/7 (or IV Cefuroxime 1.5g tds if nonanaphylactic penicillin allergy) plus, if aspiration of concern, IV Metronidazole 500mg tds”
However, as mentioned above we are unable to say that all antibiotics are acceptable to be mixed with iv metronidazole. Even more than that we cannot comment on the context of the above quotes and the applicability to your own practice. As such we recommend you allow us to forward your question to a specialist medicines information unit who will be better placed to advise. If you are happy for us to do this can you let us know via ‘Contact us’ (http://www.clinicalanswers.nhs.uk/index.cfm?action=contact)
References
1) http://www.bsac.org.uk/pyxis/Gastrointestinal%20infections/Clostridium%20difficile%20colitis/Clostridium%20difficile%20colitis.htm
2) http://www.nuh.nhs.uk/qmc/antibiotics/Full%20Guidelines/QMC%20guide%20to%20antibiotics%20use%20finalmar%2005.pdf
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