METRONIDAZOLE
Strength500 mg
Formoral.solid
Women: 500 mg orally twice daily for 7 days. Men: 2 g orally as a single dose. Treat the index case and the sexual partner together. x 7 days in women; single dose in men
15-30 mg/kg/day [child max 1000 mg]
(The formulary gives no trichomoniasis-specific paediatric dose. Its only paediatric metronidazole line is general dosing for susceptible infection: 15 to 50 mg/kg/day orally in three divided doses, maximum 2,250 mg/day — a daily total and a ceiling, not a per-dose figure. Trichomoniasis in a child needs evaluation for sexual abuse and specialist input before treatment.)
| 3kg | 45-90 mg/day |
|---|---|
| 4kg | 60-120 mg/day |
| 5kg | 75-150 mg/day |
| 6kg | 90-180 mg/day |
| 7kg | 105-210 mg/day |
| 8kg | 120-240 mg/day |
| 9kg | 135-270 mg/day |
| 10kg | 150-300 mg/day |
| 11kg | 165-330 mg/day |
| 12kg | 180-360 mg/day |
| 13kg | 195-390 mg/day |
| 14kg | 210-420 mg/day |
| 15kg | 225-450 mg/day |
| 16kg | 240-480 mg/day |
| 17kg | 255-510 mg/day |
| 18kg | 270-540 mg/day |
| 19kg | 285-570 mg/day |
| 20kg | 300-600 mg/day |
| 21kg | 315-630 mg/day |
| 22kg | 330-660 mg/day |
| 23kg | 345-690 mg/day |
| 24kg | 360-720 mg/day |
| 25kg | 375-750 mg/day |
| 26kg | 390-780 mg/day |
| 27kg | 405-810 mg/day |
| 28kg | 420-840 mg/day |
| 29kg | 435-870 mg/day |
| 30kg | 450-900 mg/day |
| 31kg | 465-930 mg/day |
| 32kg | 480-960 mg/day |
| 33kg | 495-990 mg/day |
| 34kg | 510-1000 mg/day (upper capped) |
| 35kg | 525-1000 mg/day (upper capped) |
| 36kg | 540-1000 mg/day (upper capped) |
| 37kg | 555-1000 mg/day (upper capped) |
| 38kg | 570-1000 mg/day (upper capped) |
| 39kg | 585-1000 mg/day (upper capped) |
| 40kg | 600-1000 mg/day (upper capped) |
| 41kg | 615-1000 mg/day (upper capped) |
| 42kg | 630-1000 mg/day (upper capped) |
| 43kg | 645-1000 mg/day (upper capped) |
| 44kg | 660-1000 mg/day (upper capped) |
| 45kg | 675-1000 mg/day (upper capped) |
| 46kg | 690-1000 mg/day (upper capped) |
| 47kg | 705-1000 mg/day (upper capped) |
| 48kg | 720-1000 mg/day (upper capped) |
| 49kg | 735-1000 mg/day (upper capped) |
| 50kg | 750-1000 mg/day (upper capped) |
Trichomoniasis - disease-level clinical article (trichomoniasis-clinical.txt)
The disease article states both regimens and the card carried only one of them: for women it recommends metronidazole 500 mg by mouth twice a day for 7 days, on the grounds that it usually costs less and is easier to obtain than the other 5-nitroimidazoles, tinidazole and secnidazole; for men it recommends a single oral 2 g dose of metronidazole. The Egyptian formulary carries only the 7-day course, so the international figure leads for men and the formulary's is noted on the row.
- FIRST TRIMESTER: the Egyptian formulary contraindicates metronidazole in the first trimester, and that is the position taken here. BASHH 2021 takes the opposite view and says so plainly - metronidazole is usable at every stage of pregnancy and while breast-feeding. It does add that a single high-dose regimen is not recommended in pregnancy, so the 7-day course is the one it means. Both are current guidance; the disagreement is real and is stated here rather than hidden, so that deferring treatment is a choice and not an oversight.
- In the first trimester, treat symptoms with clotrimazole pessaries and defer metronidazole to the second, or take the BASHH position deliberately.
- If a single-dose regimen is needed, the formulary's single-dose trichomoniasis option is secnidazole 2 g orally once, with sexual partners treated at the same time (antimicrobial-2023.pdf page index 316, printed p307).
- ALCOHOL - the CDC 2021 guideline reviewed the evidence and found abstinence unnecessary. It found "no in vitro studies, animal models, reports of adverse effects, or clinical studies providing convincing evidence of a disulfiram-like interaction between alcohol and metronidazole", notes that "Metronidazole does not inhibit acetaldehyde dehydrogenase, as occurs with disulfiram", and concludes: "Thus, refraining from alcohol use while taking metronidazole (or tinidazole) is unnecessary." The review is in that guideline's Bacterial Vaginosis chapter; its Trichomoniasis chapter does not mention alcohol.
- Treat all sexual partners concurrently; abstain from intercourse until both partners complete therapy.
- May cause metallic taste, nausea, dark urine, and peripheral neuropathy with prolonged use.
- 1,000 mg/day is the paediatric ceiling used here, against the formulary's 15-50 mg/kg/day band. The lower figure is the safer read for trichomoniasis.
- Do not give metronidazole to anyone who has taken disulfiram within the past 2 weeks. This is a contraindication in its own right and is not affected by the alcohol position above - Egyptian National Drug Formulary, Antimicrobial 2023, metronidazole contraindications.
- The Egyptian formulary states only one metronidazole regimen for this infection - oral, 500 mg twice a day over 7 days, for the index case and the sexual partner alike - and no single-dose option. The 2 g single dose for men is the disease article's figure.
- The 7-day course, not the single dose, is what the article recommends for women: it does not offer the 2 g single dose to women, and cure rates are lower with it.
| Egyptian brand | Manufacturer | Indicative price |
|---|---|---|
| DUMOZOL 500MG 20 F.C. TABS. | MINA PHARM > ALPHARMA-DENMARK | 7.00 EGP (0.35/unit) |
| ZOLGUARD 500MG 20 TAB. | UNIPHARMA CO. > UNIPHARMA | 9.00 EGP (0.45/unit) |
| NITROFECTAZOLE 500 MG 20 F.C. TABS. | GYPTO PHARMA | 10.50 EGP (0.53/unit) |
| FLAGICURE FORTE 500 MG 20 F.C. TAB | KAHIRA | 23.00 EGP (1.15/unit) |
| TRICHOGYL 500MG 12 F.C.TAB. | EL NASR | 15.00 EGP (1.25/unit) |
| FLAGELLAT FORTE 500MG 20 F.C.TABS. | MUP | 30.00 EGP (1.50/unit) |
| GEDAZOLE 500MG 20 TAB. | JEDCO INT. CO. FOR PHARMACEUTICALS | 34.00 EGP (1.70/unit) |
| METROGYPTON 500 MG 20 F.C. TABS. | GYPTO PHARMA | 34.00 EGP (1.70/unit) |
| DUMOZOL 125MG/5ML SUSP. 125ML? strength differs? different route - not oral solid | MINA PHARM > ALPHARMA-DENMARK | 5.75 EGP |
| METROZOLE 125MG/5ML SUSP. 120 ML? strength differs? different route - not oral solid | MEMPHIS | 19.50 EGP |