Metrogyl dose in pediatrics
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I now have comprehensive data from multiple authoritative sources. Here is the complete pediatric dosing for Metrogyl (Metronidazole):
Metrogyl (Metronidazole) - Pediatric Dosing
By Indication
1. Amebiasis (Intestinal & Amebic Liver Abscess)
| Route | Dose | Frequency | Duration |
|---|---|---|---|
| Oral / IV | 35-50 mg/kg/day | Divided in 3 doses (TDS) | 7-10 days |
- Maximum: Does not exceed adult dose of 500-750 mg per dose TDS
(Goodman & Gilman's Pharmacological Basis of Therapeutics)
2. Giardiasis
| Route | Dose | Frequency | Duration |
|---|---|---|---|
| Oral | 15 mg/kg/day | Divided TDS (3 times per day) | 5-7 days |
- Maximum per dose: 250 mg
(Yamada's Textbook of Gastroenterology)
3. Anaerobic Infections / Intra-abdominal Infections (Surgical / Bowel Flora)
| Route | Dose | Frequency | Duration |
|---|---|---|---|
| IV | 7.5 mg/kg/dose | Every 6 hours (QID) | As clinically indicated |
- Typically combined with a 2nd agent (e.g., ceftriaxone 50 mg/kg/day once daily, or gentamicin 2.5 mg/kg q8h) for bowel flora coverage
- Severe/complicated infections: same dose 7.5 mg/kg q6h IV + cefepime 50 mg/kg q12h
(Rosen's Emergency Medicine)
4. Bacterial Vaginosis / Trichomoniasis
| Age | Dose | Frequency | Duration |
|---|---|---|---|
| Children | 30 mg/kg/day | Divided every 6 hours (QID) | 7 days |
- Maximum: Does not exceed adult dose (500 mg BID or 2 g single dose)
(Dermatology, 5e)
Quick Reference Summary Table
| Indication | Dose | Route | Frequency | Duration |
|---|---|---|---|---|
| Amebiasis | 35-50 mg/kg/day | Oral/IV | TDS (÷3) | 7-10 days |
| Giardiasis | 15 mg/kg/day (max 250 mg/dose) | Oral | TDS (÷3) | 5-7 days |
| Anaerobic/intra-abdominal infections | 7.5 mg/kg/dose | IV | q6h (QID) | Per clinical course |
| Bacterial vaginosis / Trichomoniasis | 30 mg/kg/day | Oral | q6h (÷4) | 7 days |
Key Points
- Maximum dose: Should not exceed the standard adult dose in any indication
- Neonates/infants: Use with caution - immature hepatic metabolism prolongs half-life; dose adjustments needed (typically longer dosing intervals)
- Hepatic impairment: Dose reduction required as metronidazole is hepatically cleared
- Palatability: The liquid formulation is intensely bitter and often refused by pediatric patients - masking with sweetened vehicles may be needed
- Avoid alcohol during therapy and for 48 hours after (disulfiram-like reaction)
- Tinidazole is often preferred over metronidazole in children >3 years for giardiasis due to single-dose efficacy (50 mg/kg, max 2 g) and better tolerability
Sources: Goodman & Gilman's Pharmacological Basis of Therapeutics; Yamada's Textbook of Gastroenterology; Rosen's Emergency Medicine; Red Book 2021 (AAP); Dermatology 5e
For dysentery
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I have all the data needed. Here is the focused answer:
Metrogyl (Metronidazole) for Dysentery in Pediatrics
Metronidazole is used specifically for amoebic dysentery (caused by Entamoeba histolytica). It is not the drug of choice for bacillary (Shigella) dysentery.
Amoebic Dysentery / Amebic Colitis
| Parameter | Details |
|---|---|
| Dose | 35-50 mg/kg/day |
| Division | 3 divided doses (every 8 hours) |
| Max per dose | 750 mg |
| Route | Oral (or IV if unable to take orally) |
| Duration | 7-10 days |
- For mild-moderate amebic colitis: 35 mg/kg/day in 3 divided doses x 7 days
- For severe/invasive disease or amebic liver abscess: 50 mg/kg/day in 3 divided doses x 10 days
(Rosen's Emergency Medicine; Goodman & Gilman's; Dermatology 5e)
Important: Always Follow With a Luminal Amebicide
Metronidazole kills tissue trophozoites but NOT luminal cysts. After completing the metronidazole course, always add a luminal agent to ensure eradication:
| Luminal Agent | Pediatric Dose |
|---|---|
| Paromomycin (preferred) | 25-35 mg/kg/day in 3 divided doses x 5-10 days |
| Iodoquinol | 30-40 mg/kg/day in 3 divided doses x 20 days |
| Diloxanide furoate | 20 mg/kg/day in 3 divided doses x 10 days |
Alternative: Tinidazole (for children >3 years)
If available, tinidazole is preferred over metronidazole - better tolerated, simpler dosing:
- 50 mg/kg/day once daily (max 2 g/day)
- Duration: 3 days (intestinal) / 5 days (severe/liver abscess)
- Also requires a luminal amebicide after
(Rosen's Emergency Medicine - Table 167.6)
Bacillary Dysentery (Shigella) - Note
Metronidazole has no role here. Drugs of choice:
- Azithromycin 12 mg/kg on day 1, then 6 mg/kg/day for 4 days (preferred in children)
- Ciprofloxacin or ceftriaxone depending on sensitivities
Key Points
- Dysentery context = amoebic -> Metronidazole is first-line
- Always pair with a luminal amebicide after completing metronidazole
- Take with food to reduce GI side effects (nausea, metallic taste)
- Avoid alcohol during treatment and for 48 hours after (disulfiram-like reaction)
- Adjust dose in severe hepatic impairment (metronidazole is hepatically cleared)
Sources: Rosen's Emergency Medicine; Goodman & Gilman's Pharmacological Basis of Therapeutics; Katzung's Basic & Clinical Pharmacology 16e; Dermatology 5e
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