What is the role of metronidazole in intravenous-to-oral switch therapy?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Metronidazole can be part of regimens for switching patients from intravenous to oral therapy. Treatment between prolonged intravenous therapy and intravenous therapy followed by conversion to oral antibiotic therapy is equivalent in children with perforated appendicitis. Similarly, a study noted 8 patients with brain abscesses who refused prolonged hospitalization and were treated with a short course (6-12 d) of intravenous antibiotics followed by prolonged treatment (15-19 wk) with an oral antibiotic regimen consisting of metronidazole, ciprofloxacin, and amoxicillin. All patients responded favorably based on clinical findings and imaging studies.

In 2003, Starakis et al compared the efficacy and safety of sequential intravenous/oral ciprofloxacin plus intravenous/oral metronidazole with that of intravenous ceftriaxone plus intravenous/oral metronidazole in the treatment of complicated intra-abdominal infections in 135 patients. Conversion to oral therapy with ciprofloxacin/metronidazole was as effective as continued intravenous therapy with ceftriaxone and oral metronidazole in patients who were able to tolerate oral feeding. [40]

Similarly, in 1996, Solomkin et al reported a study in which patients were randomized to either (1) ciprofloxacin plus metronidazole intravenously or imipenem intravenously throughout their treatment course or (2) ciprofloxacin plus metronidazole intravenously and treatment with oral ciprofloxacin plus metronidazole when oral feeding was resumed, with equal outcomes. [29]

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