From the Guidelines
Yes, Metrogyl (metronidazole) and cefotaxime can be given together, as this combination is recommended for the management of intra-abdominal infections, according to the 2017 WSES guidelines 1. This combination is often used for mixed infections such as intra-abdominal infections, pelvic inflammatory disease, and aspiration pneumonia.
Key Points to Consider
- Cefotaxime is a third-generation cephalosporin that is effective against many aerobic and facultative gram-negative and gram-positive bacteria, while metronidazole specifically targets anaerobic bacteria and certain parasites.
- The recommended dosing for this combination is cefotaxime 2g every 8 hours and metronidazole 500mg every 6 hours, as stated in the 2017 WSES guidelines 1.
- When administering these medications together, they should be given separately (not mixed in the same IV bag or syringe) to avoid potential compatibility issues.
- This combination provides broad-spectrum coverage while the specific infection source is being identified, and therapy can be narrowed once culture results are available.
Additional Considerations
- The use of metronidazole and cefotaxime together is also supported by other guidelines, such as the 2003 Clinical Infectious Diseases guidelines 1, which recommend this combination as an option for the treatment of intra-abdominal infections.
- However, the 2017 WSES guidelines 1 are more recent and provide more specific dosing recommendations, making them the preferred reference for this combination.
From the Research
Combination of Metrogyl and Cefotaxime
- Metrogyl, also known as metronidazole, is a 5-nitroimidazole with selective activity against anaerobic microorganisms, including bacteria and protozoa 2.
- Cefotaxime is a 'third generation' semisynthetic cephalosporin with a broad spectrum of activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria 3.
- There is evidence to suggest that metronidazole can be combined with other agents, such as aminoglycosides, in the treatment of mixed infections involving anaerobic and aerobic bacteria 2.
- Cefotaxime has been given in combination with another antibiotic, such as an aminoglycoside, but the merits of such a combination have not been clearly established 3.
- In a study, metronidazole was added to ceftriaxone (a related antibiotic to cefotaxime) if anaerobic infection was suspected, and the combination was found to be safe and effective 4.
Efficacy and Safety
- Metronidazole has been shown to be efficacious in the therapy of a variety of anaerobic infections, including non-traumatic brain abscesses, intraabdominal sepsis, pelvic suppuration, and necrotizing soft tissue infections 2, 5, 6.
- Cefotaxime has been effective in treating infections due to other 'difficult' organisms, such as multidrug-resistant Enterobacteriaceae, and has been used to treat patients with complicated urinary tract and lower respiratory tract infections 3.
- The combination of metronidazole and cefotaxime may be beneficial in treating mixed aerobic/anaerobic infections, but more research is needed to establish the efficacy and safety of this combination 3, 4.