Prescribing or administering IV metronidazole? Think tabs before jags
Improving Antimicrobial Stewardship and Sustainability by Promoting Oral Metronidazole When Appropriate
Key Messages
- Metronidazole has excellent oral bioavailability reaching 95-100%.
- NHSGGC Adult Infection Management Guidelines were updated to include the option of oral metronidazole in the management of intra-abdominal sepsis (IAS) and diabetic foot infection.
Actions for clinical staff:
- Think before you initiate IV metronidazole - could my patient have oral therapy?
- In patients meeting the following criteria, consider starting oral rather than IV therapy:
- Oral route reliably available
- No issue with gut absorption
- No clinical deterioration/systemic sepsis
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In patients already prescribed IV metronidazole, review daily to ensure timely switch from IV to oral metronidazole when appropriate (even if still on other IV antibiotics).
Background
- The IV route is often overused in the hospital environment when managing patients with infection.
- In NHSGGC, IV metronidazole is commonly prescribed as a component of triple empirical antimicrobial treatment in the management of IAS.
- Promotion of the oral route, particularly for antimicrobials with high oral bioavailability (> 90%) and timely IV to oral switch (NHSGGC IVOST Policy) are key antimicrobial stewardship initiatives in the acute hospital setting to encourage prudent and appropriate antimicrobial prescribing.
- In addition to improved antimicrobial stewardship, appropriate use of the oral route provides a number of advantages including:
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Reduced patient risk of IV line infections (e.g. Staphylococcus aureus bacteraemia) and complications (e.g. thrombophlebitis).
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Improved patient comfort and mobility
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Reduced staff workload
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Reduced costs - IV route (of metronidazole) 27 times more expensive than oral tablets
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Improved sustainability and reduced plastic waste
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A recent multidisciplinary quality improvement approach to promote oral metronidazole when appropriate in surgical wards at the Royal Alexandra Hospital (RAH) has resulted in a median 45% reduction in IV metronidazole use and a 30% median reduction in metronidazole drug costs. This equates to 320 less IV administrations per month in these wards. Link to further information here.
Remember
Small changes in metronidazole prescribing to promote the oral route where appropriate can make a significant difference over time in terms of benefits for patients, healthcare system and the environment.
Click here for a poster to help promote oral metronidazole in your clinical area.
Published: 03/08/2022. Medicines Update blogs are correct at the time of publishing