Fact Sheet - for hospitals and acute care facilities

‚ÄčThere 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
    Piperacillin-tazobactam may be an appropriate alternative (e.g. for intra-abdominal or pelvic infections)
  • Clindamycin
    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
  • Amoxycillin-clavulanate
    The intravenous form of amoxycillin-clavulanate is available via SAS and may be a reasonable alternative

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