Metronidazole intravenous (IV) - medication shortage
Fact Sheet - for hospitals and acute care facilities
There is currently an Australia-wide shortage of intravenous (IV) metronidazole.
If your patient is currently prescribed IV metronidazole, please review and consider the following:
Is metronidazole required for the indication?
Review your local guidelines or the Therapeutic Guidelines: Antibiotic
If not indicated, CEASE metronidazole (e.g. for cholangitis add anaerobic treatment only if chronic biliary obstruction)
Can oral metronidazole be prescribed instead?
Metronidazole has excellent oral bioavailability and IV therapy offers no benefit in a patient who is tolerating and absorbing oral medications
The usual oral dose is 400mg 12-hourly (8-hourly for Clostridium difficile infection)
If IV metronidazole is still recommended for the indication, consult with infectious diseases or clinical microbiology to discuss alternatives:
The choice of antibiotic or antibiotic combination will vary depending on the location and severity of infection and patient factors including antibiotic allergies or drug interactions.
Piperacillin-tazobactam may be an appropriate alternative (e.g. for intra-abdominal or pelvic infections)
Clindamycin treats many anaerobes (with some exceptions such as Bacteroides spp., which usually resides in the lower bowel)
Clindamycin can be a useful alternative for ENT and dental infections, lung infections related to aspiration or contaminated skin and soft tissue infections
The intravenous form of amoxycillin-clavulanate is available via SAS and may be a reasonable alternative