Metronidazole-induced encephalopathy：a review of medical literature

GOU Shuang-mei; FU Xue-tao

Abstract：Objective: To investigate the clinical characteristics, occurrence reasons and therapeutic measures of metronidazole-induced encephalopathy (MIE), and provide references for clinical rational drug use.Methods: With retrospective method, CNKI, VIP and PubMed databases were retrieved. The case reports of metronidazole-induced encephalopathy were collected from medical literature in domestic and abroad between 2005 and May 2015. The data were analyzed in respect of the distribution of patients' age, the dosage and administration of metronidazole, clinical characteristics of adverse drug reactions, imaging manifestations, onset time, consequence and prognosis.Results:A total of 25 patients developed MIE. They comprised 14 men and 11 women with the age ranging from 21 to 78 years. Among 25 patients, clinical characteristics of MIE included cerebellar dysfunction (22 cases, 64.70%), altered mental status (8 cases, 23.52%). The average onset time of MIE was 68 days, the average daily dose was 1480 mg. Most patients either improved or had complete recovery after metronidazole withdrawal. However, three patients died. The median time of recovery was 6 weeks. Nearly all patients underwent magnetic resonance imaging (MRI) examination.Conclusion:Metronidazole-induced encephalopathy does not seem to be a dose- or time-related phenomenon. While, the patients with liver damage were the high risk population of MIE. It should be paid more attention to MIE in clinical applications.