Treatment of Anaerobic Infections: The recommended dosage schedule for adults is: Loading Dose: 15 mg/kg infused over one hour (approximately 1 g for a 70-kg adult).
Maintenance Dose: 7.5 mg/kg infused over one hour every six hours (approximately 500 mg for a 70-kg adult). The first maintenance dose should be instituted six hours following the initiation of the loading dose.
IV to oral conversion: Parenteral therapy may be changed to oral metronidazole when conditions warrant, based upon the severity of the disease and the response of the patient to Nirmet treatment. The usual adult oral dosage is 7.5 mg/kg every six hours.
A maximum adult IV or oral dose recommended is 4 g during a 24-hour period.
Hepatic function impairment: Patients with severe hepatic disease metabolize metronidazole slowly, with resultant accumulation of metronidazole and its metabolites in the plasma. Accordingly, for such patients, doses and/or frequency of administration of metronidazole should be modified in response to the degree of hepatic impairment. Close monitoring of plasma metronidazole levels and toxicity is recommended.
Perioperative Prophylaxis: For surgical prophylactic use, to prevent postoperative infection in contaminated or potentially contaminated colorectal surgery, the recommended dosage schedule for adults is 15 mg/kg infused over 30 to 60 minutes and completed approximately one hour before surgery followed by 7.5 mg/kg infused over 30-60 minutes at 6 and 12 hours after initial dose.
It is important that administration of the initial preoperative dose be completed approximately one hour before surgery so that adequate drug levels are present in the serum and tissues at the time of initial incision. Nirmet is administered, if necessary, at 6-hour intervals to maintain effective drug levels. Prophylactic use of Nirmet should be limited to the day of surgery only, following the previous guidelines.
Nirmet is to be administered by slow intravenous drip infusion only, either as a continuous or intermittent infusion. Additives should not be introduced into Nirmet. If used with a primary intravenous fluid system, the primary solution should be discontinued during metronidazole infusion. Do not use equipment containing aluminum (e.g. needles, cannulae) that would come in contact with the drug solution.