Metronidazole-induced central nervous system toxicity: a systematic review. Clin Neuropharmacol 2011;34(6):241-7
Date
10/15/2011Pubmed ID
21996645DOI
10.1097/WNF.0b013e3182334b35Scopus ID
2-s2.0-81955161936 (requires institutional sign-in at Scopus site) 182 CitationsAbstract
OBJECTIVE: To assess patient and medication factors that contribute to metronidazole toxicity.
DATA SOURCES: We searched PUBMED from 1965 through April 7, 2011, and performed a hand search of bibliographies.
STUDY SELECTION: Case reports or case series reporting metronidazole-induced central nervous toxicity.
DATA EXTRACTION: Two authors independently abstracted demographics, metronidazole indication, dose and duration, neurological manifestations, and outcomes as well as brain imaging findings.
DATA SYNTHESIS: Among 64 patients, 48 (77%) had cerebellar dysfunction, 21 (33%) had altered mental status, and 8 (15%) had seizures. Patients' ages averaged 53.3 years (range, 12-87 years), and 64% were male. The median duration of metronidazole was 54 days, although 26% had taken it less than a week and 11% had taken it less than 72 hours. Among cases with outcome data, most patients either improved (n = 18 [29%]) or had complete resolution of their symptoms with discontinuation of metronidazole (n = 41 [65%]). There was no difference in resolution of symptom by age (P = 0.71) or sex (P = 0.34). The patients with cerebellar dysfunction were less likely to experience complete resolution than those with mental status changes or seizures (relative risk, 0.67; 95% confidence interval (CI), 0.49-0.92). Nearly all patients (n = 55 [86%]) underwent imaging of the brain: 44 (69%) underwent magnetic resonance imaging (MRI) and 12 (19%) underwent computed tomographic studies. All patients with cerebellar dysfunction had abnormalities on imaging: 93% (n = 39) had a cerebellar lesion, although numerous areas in the brain were affected. On follow-up MRIs, 25 patients (83%) had complete resolution of abnormalities.
CONCLUSIONS: Metronidazole can rarely cause central nervous system toxicity; it does not seem to be a dose- or duration-related phenomenon. Most patients will have MRI abnormalities. Prognosis is excellent with metronidazole cessation.
Author List
Kuriyama A, Jackson JL, Doi A, Kamiya TAuthor
Jeffrey L. Jackson MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Brain
Central Nervous System
Child
Female
Humans
Magnetic Resonance Imaging
Male
Mental Disorders
Metronidazole
Middle Aged
Nervous System Diseases
Young Adult
