Converted to active form or nitroso free radical by
obligate anaerobes. Inhibits DNA synthesis. Causes DNA degradation

Inhibitor of bacterial 50S ribosomal subunit

Prevents protein synthesis

50% PO BA
75% Rectal BA

IV or PO

Widely distributed to all tissues

Wide distribution including bone but not CSF

10% PB

90% PB

Vd 0.75 L/kg

Hepatic Oxidation and glucuronidation

Hepatic metabolism

Renal excretion 60% unchanged

Biliary. Long post antibiotic effect leads to clostridium overgrowth

T1/2 = 6-10hrs
Renal dose adjustment not required

GIT– abdominal pain, N/V/D,
jaundice, pancreatitis
HAEM- leukopenia
CVS– T wave flattening, QT
prolongation
CNS– ataxia, seizures, insomnia, paraesthesia
HYPERSENSITIVITY– rash
OTHER– metallic taste

- Pseudomembranous colitis due to c.diff
- Contact dermatitis
- Metallic taste
- Anaphylaxis

Active against anaerobes (including clostridium, N.Gonorrhoea, N.Menigitidis, Bacterioides and Fusobacterium) and protozoa
(trichomonas, Giardia)

Aerobic G+ cocci including MRSA (except enterococci)

Anaerobic G- bacilli

Most aerobic G- bacilli are resistant including pseudomonas (except Capnocytophagia canimorus)

ANTIBIOTIC:
NITROIMIDAZOLE

ANTIBIOTIC:
LINCOSAMIDE

• Clindamycin is used to treat serious anaerobic and gram positive infection (not enterococcus) and also has MRSA and Plasmodium falciparum cover (but not p. vivax or gram negative aerobes)
• Can be used (along with primaquine) to treat PCP
• Can be used to treat toxin mediated septic syndromes including necrotizing fasciitis and toxic shock syndrome
• MOA: inhibits bacterial synthesis by disrupting the function of 50S ribosomal subunit. Can be bacteriostatic or bacteriocidal depending on concentration and microbe being treated

Nitroimidazole

Lincosamide

Level 3

Level 3

reduced rate of uptake, by efflux or by reducing the rate of metronidazole reductive activation
increased DNA repair efficiency