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metronidazole
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Wed Jul 06 2005 at 23:55:17
Metronidazole
(C
6
H
9
N
3
O
3
) is an antibacterial and antiprotozoal agent that has gained widespread use as a
drug
. It is classified as a
nitroimidazole
, and it is a synthetic derivative of
azomycin
. It is sold in the
United States
as
Flagyl
.
History
Metronidazole
was first used against
parasites
such as
Trichomonas vaginalis
and
Entamoeba histolytica
. The antibacterial activity of
metronidazole
was discovered purely by
accident
in
1962
when a patient was cured of both
trichomoniasis
and bacterial
gingivitis
, and since then, the use of
metronidazole
has skyrocketed.
Metronidazole
has remained popular because it is
inexpensive
, has good tissue penetration, and has relatively mild side effects.
Metronidazole
is also effective against a wide variety of
pathogenic
critters, such as
Trichomonas vaginalis
,
Entamoeba histolytica
,
Giardia lamblia
,
Clostridium difficile
, and
Helicobacter pylori
.
1
However, the
mechanism
by which
metronidazole
works has until recently been poorly understood, and even today some questions linger. This is probably because, in the past,
noone really cared as long as it worked
, but as concerns about
resistance
to
metronidazole
are beginning to surface in the scientific community, a need for research into the matter has been recognized.*
Trends
Metronidazole
-sensitive organisms all live under
anaerobic
conditions, and the more complex
parasites
all lack
mitochondria
,
centrioles
, and
introns
. This implies that
metronidazole
is activated by
enzymes
specific to
anaerobic
organisms, and this notion has been upheld by various findings. For instance, researchers have shown that
metronidazole
acts against
Trichomonas vaginalis
by binding to a
protein
called
Trichomonas vaginalis
ferredoxin
(hereafter referred to as TvFd), a protein that is found in the
hydrogenosome
of the
protozoan
and is a component of the creature's
electron
transport pathway.
Mechanism
It was originally thought that
metronidazole
was a
protein
inhibitor
and disrupted essential
metabolic pathway
s, but experiments have
squashed
this idea. Research shows that
metronidazole
is
activated
when it
gains an electron
from the
molecule
that activates it. In the case of
Trichomonas vaginalis
, that
molecule
is TvFd.
It has been proven experimentally that upon gaining an
electron
,
metronidazole
becomes extremely reactive and destroys cellular
DNA
. However, the exact mechanism by which
metronidazole
is
reduced
has not yet been
elucidate
d.**
Risks
, or Possible Causes for
Concern
Metronidazole
has been shown to cause
cancer
in lab animals, probably a result of its
reaction with DNA
. However, it has not been proven to cause
cancer
in
humans
.
It is a bad idea to take
metronidazole
if you are allergic to it, are in the
first trimester
of your
pregnancy
, are
breast-feeding
, or if you have a
blood
disorder,
epilepsy
,
heart disease
, or
liver
disease.
It is also a bad idea to take
metronidazole
while drinking
alcoholic beverages
. In general,
just don't do anything stupid
.
Side Effects
Metronidazole
will often cause stomach cramps, dizziness, headache,
diarrhea
,
nausea
or vomiting. If it causes numbness, tingling, or
convulsions
, you should check with your doctor immediately.
1
The use of
metronidazole
against
gastritis
caused by
Helicobacter pylori
is a component of
combination therapy
used to treat the condition.
*The issue of resistance to metronidazole is currently a fairly minor concern, but some scientists worry that the widespread use of treatments which use only metronidazole will eventually lead to problems.
**I have recently been using computer simulations to research the mechanism by which metronidazole is reduced by TvFd. Much of the information I put in this writeup was taught me by my supervisor at the beginning of the project. I have not included specific details of this project because it would require a long explanation of some of the characteristics of TvFd, and that is not the subject of this writeup.
References
, or just more reading:
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202365.html
Petrin, D., K. Delgaty, R. Bhatt, and G. Garber. 1998. Clinical and microbiological aspects of Trichomonas vaginals. Clin. Microbol. Rev. 11:300-317.
or online at
http://cmr.asm.org/cgi/content/full/11/2/300
Sameuelson, John. 1999. Why Metronidazole Is Active against both Bacteria and Parasites. Antimicrob. Agents Chemother. 43: 1533-1541.
or online at
http://aac.asm.org/cgi/content/full/43/7/1533
These papers have their own references as well.
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