Shortage of IV metronidazole antibiotic prompts indication-specific alternatives

May 16, 2014

There has been a recent national backorder of iv Metronidazole (Flagyl) due to manufacturing delays with Hospira. As a result of this delay Hospira has not been able to provide a tentative timeline or estimate date of when IV metronidazole will be available to purchasers/buyers once again. While this situation plays out, there are general management strategies that might be implemented based on the facility.

There has been a recent national backorder of IV metronidazole (Flagyl) due to manufacturing delays with Hospira.

As a result of this delay, Hospira has not been able to provide a tentative timeline or estimate date of when IV metronidazole will be available to purchasers/buyers. While this situation plays out, there are general management strategies that might be implemented based on the facility.

The use of IV metronidazole should only be reserved for use in those situations where there is a clear need for the antibiotic over other available therapies. The therapy should be discontinued as soon as possible based on clinical indication and status of the patient with ongoing monitoring of therapy on a daily basis. The use of IV metronidazole should be based on a prioritization criteria that can include severe complicated clostridium difficile or severe infections that require anaerobic coverage when combined with a fluroquinoline, aminogloycosides, or azetronam as a result of a beta-lactam allergy. If a patient is considered to meet the criteria for intravenous to oral therapy the conversion should be performed or provide the first dose of IV metronidazole and then switch to oral metronidazole.

Here are indication-specific alternatives to IV metronidazole during the shortage period:

IndicationAlternatives
Clostridium difficile-Mild to moderate: oral metronidazole
Anaerobic infections (ie, intra-abdominal, diverticulitis, cholangitis, or abscess, etc.)- Consider oral metronidazole if appropriate (Oral metronidazole is bioequivalent to IV metronidazole )
Surgical prophylaxis (ie, biliary tract, appendectomy, small intestine, colorectal, hysterectomy)-Clindamycin IV plus aminoglycoside or fluoroquinolone