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. 2021 Jun 15;72(12):2095-2100.
doi: 10.1093/cid/ciaa395.

Metronidazole-associated Neurologic Events: A Nested Case-control Study

Nick Daneman  1   2   3   4 , Yi Cheng  1 , Tara Gomes  1   5 , Jun Guan  1 , Muhammad M Mamdani  1   5 , Farah E Saxena  1 , David N Juurlink  1   2   3   6
Affiliations

Metronidazole-associated Neurologic Events: A Nested Case-control Study

Nick Daneman et al. Clin Infect Dis. .

Abstract

Background: Case reports have described instances of peripheral and central nervous system toxicity during treatment with metronidazole; however, no large-scale studies have examined this association.

Methods: We conducted a population-based nested case-control study of adults aged 66 years or older living in Ontario, Canada, between 1 April 2003 and 31 March 2017. Cases were individuals who attended hospital for any of cerebellar dysfunction, encephalopathy, or peripheral neuropathy within 100 days of a prescription for either metronidazole or clindamycin. We matched each case patient with up to 10 event-free control subjects who also received metronidazole or clindamycin. We used conditional logistic regression to test the association between metronidazole exposure and neurologic events, with clindamycin as the reference exposure.

Results: We identified 1212 cases with recent use of either metronidazole or clindamycin and 12 098 controls. Neurologic adverse events were associated with an increased odds of metronidazole exposure compared to clindamycin (odds ratio [OR], 1.72 [95% confidence interval {CI}, 1.53-1.94]), which persisted after accounting for patient demographics, comorbidities, and other medication exposures (adjusted odds ratio [aOR], 1.43 [95% CI, 1.26-1.63]). We found a consistent association limited to either central (aOR, 1.46 [95% CI, 1.27-1.68]) or peripheral (aOR, 1.34 [95% CI, 1.02-1.76]) nervous system events. Among metronidazole recipients, the overall incidence of neurologic events at 100 days was approximately 0.25%.

Conclusions: Metronidazole is associated with an increased risk of adverse peripheral and central nervous system events relative to clindamycin. Clinicians and patients should be aware of these rare but potentially serious adverse events.

Keywords: cerebellar syndrome; encephalopathy; metronidazole; peripheral neuropathy; pharmacoepidemiology.

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Figures

Figure 1.
Figure 1.
Study flowchart for identifying case patients.
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References

    1. Tally FP, Sutter VL, Finegold SM. Metronidazole versus anaerobes. In vitro data and initial clinical observations. Calif Med 1972; 117:22–6. - PMC - PubMed
    1. Magill SS, Edwards JR, Beldavs ZG, et al. . Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team . Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. JAMA 2014; 312:1438–46. - PMC - PubMed
    1. Baggs J, Fridkin SK, Pollack LA, Srinivasan A, Jernigan JA. Estimating national trends in inpatient antibiotic use among US hospitals from 2006 to 2012. JAMA Intern Med 2016; 176:1639–48. - PMC - PubMed
    1. Giannini AJ. Side effects of metronidazole. Am J Psychiatry 1977; 134:329–30. - PubMed
    1. Patel K, Green-Hopkins I, Lu S, Tunkel AR. Cerebellar ataxia following prolonged use of metronidazole: case report and literature review. Int J Infect Dis 2008; 12:e111–4. - PubMed

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