Metronidazole
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Various toxicities: case report A 43-year old woman developed hives, whole body pruritus, shortness of breath, vomiting, feeling of warmth in calves, increased salivation and burning sensation under skin during treatment with metronidazole. The woman had been diagnosed with trichomoniasis. Therefore, she started receiving oral metronidazole 500mg twice daily for 7 days. However, shortly after administration of first dose, she developed hives, pruritus, shortness of breath and vomiting. Therefore, she was admitted to the hospital to undergo metronidazole desensitisation. During the procedure, metronidazole doses were prepared from an IV solution with an initial concentration of 5 mg/mL and was serially diluted 10 fold in sodium-chloride as necessary. Subsequently, during the desensitisation procedure, she received IV metronidazole 0.005mg (step 1) and 0.015mg (step 2). However, following administration of the third IV metronidazole dose of 0.05 mg, she developed warmth in her calves, increased salivation and pruritus. The woman therefore received treatment with diphenhydramine and methylprednisolone. After approximately 90 minutes of last metronidazole dose, the desensitisation protocol was restarted at a lower starting dose of 0.15mg and at a reduced infusion rate. Subsequently, she received IV metronidazole 0.5mg (step 5), 1.5mg (step 6), 5mg (step 7) and 15mg (step 8). However, after the ninth IV metronidazole dose of 30mg, she developed whole body pruritus accompanied by a burning sensation under her skin. Hence, desensitisation was discontinued and she was discharged on next day with instructions to use boric-acid. Her partner was also treated with metronidazole 2g orally for one dose. Following boric-acid therapy, she had an improvement in odour; however, vaginal discharge was persisting. Then, she started receiving second course of boric-acid without the consent of provider. Later, she stopped on her own due to vaginal bleeding. As she exhibited symptom recurrence, she was prescribed nitazoxanide; however, she was not able to obtain the medication due to the cost. Approximately after 6 weeks, her symptoms persisted. At that time, a repeat nucleic acid amplification testing returned positive for T. vaginalis. Reinfection was ruled out. Thereafter, she underwent a successful tinidazole desensitisation procedure without experiencing any adverse effects. Subsequently, she reported resolution of her symptoms. She remained asymptomatic for 6 months following tinidazole therapy. Biagi M, et al. Successful treatment of trichomoniasis with tinidazole following desensitization in a patient allergic to metronidazole. International Journal of STD and AIDS : 803517605 Jan 2020. Available from: URL: http://doi.org/10.1177/0956462420963912
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Reactions 28 Nov 2020 No. 1832
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