Metronidazole Syrup Dosing for Children Based on Weight
The recommended dose of metronidazole syrup for children with non-severe infections is 7.5 mg/kg/dose given three or four times daily, with a maximum dose of 500 mg per dose. 1
Dosing Guidelines by Indication
For Clostridium difficile Infection (CDI)
- Initial episode, non-severe CDI: 7.5 mg/kg/dose three or four times daily for 10 days 1
- Maximum dose: 500 mg per dose
- Total daily dose: 22.5-30 mg/kg/day divided into 3-4 doses
For Other Common Pediatric Indications
- Anaerobic infections: 7.5 mg/kg/dose given 3-4 times daily 1, 2
- SIBO (Small Intestinal Bacterial Overgrowth): Similar dosing as for non-severe infections 3
- Parasitic infections: Dosing may vary based on the specific parasite
Dosing Considerations
Age and Weight Adjustments
- The dose should always be calculated based on the child's weight
- For very young infants, consult with a pediatric infectious disease specialist
- For children ≥35 kg, adult dosing may be appropriate
Duration of Treatment
- CDI: 10 days 1
- Anaerobic infections: 10-14 days (may be longer for severe infections) 2
- SIBO: 10-14 days 3
Special Considerations
Malnourished Children
- Malnourished children may require dose reduction due to altered drug metabolism
- Consider reducing the dose to approximately 12 mg/kg/day in severely malnourished children 4
- More frequent monitoring for adverse effects is recommended
Alternative Dosing Approaches
- Some centers have explored once-daily dosing (30 mg/kg/day) for certain indications like appendicitis, but this is not standard practice for most infections 5
Important Precautions
- Avoid prolonged or repeated courses due to risk of cumulative and potentially irreversible neurotoxicity 1, 3
- Advise caregivers that children should avoid products containing alcohol during treatment
- Monitor for common side effects: nausea, metallic taste, darkened urine
- For severe infections, consider IV formulation initially (30 mg/kg/day divided into 3 doses) 2
Administration Tips
- Metronidazole syrup can be given with or without food
- If gastrointestinal upset occurs, administer with food
- Shake the bottle well before measuring the dose
- Use a calibrated measuring device for accurate dosing
Remember that metronidazole is a valuable antibiotic for anaerobic infections, but should be used judiciously to minimize the risk of adverse effects and antimicrobial resistance.