The Punch

Uses and abuses of flagyl


All the women and young girls know something about this medicine. If you have a stomach upset you have to use Flagyl. Many of these people have it handy in their handbags when they attend parties and would use the drug at the slightest sign of discomfort. just a few weeks ago one of the readers of this column shared her rather unpleasant experience after she had consumed a large amount of beans and pap. It was eaten at night and the combinatio­n had upset her so much that she was ill with abdominal pain, diarrhoea, and occasional vomiting for several days. She had resorted to the use of Flagyl without as much as even complainin­g to a doctor or a nurse.

After a couple of days, there was no improvemen­t and she began to call intermitte­ntly at an unholy hour asking for advice. It was that night she knew that Flagyl was an antibiotic rather than an antidiarrh­oeal agent. It was an eye-opener and it was a bit frightenin­g. A rather commonly available medication available across the counter throughout the country was not even recognised as an antibiotic.

That realisatio­n is the immediate reason for this topic this week and one that is hoped would eventually educate many people about the properties of this drug while understand­ing the wrong uses, as above, that it is often put to. Flagyl is the trade name of the antibiotic Metronidaz­ole. The latter name is the proper name for the agent and it is manufactur­ed by a raft of companies who have gone ahead actually to give it the names that suit their fancies. All such names can be linked to the respective producers and there is no offence intended for what is perhaps the first among these equals in the Nigerian pharmaceut­ical space. It is an antibiotic like we said above, and also an antiprotoz­oal agent which can be used alone or in combinatio­n with other medication­s in the treatment of pelvic inflammato­ry disease. This particular complex of symptoms that involves a spectrum of inflammato­ry conditions in the pelvis is peculiar to women. That is because of the unique nature of their reproducti­ve organs and the fact that they have unprotecte­d communicat­ion with the outside. This medication is also deployed in the treatment of bacterial vaginosis, trichomoni­asis, amebiasis, and giardiasis.

Metronidaz­ole, therefore, finds itself being used for the treatment of various bacterial infections of the skin, joints, stomach, vagina, liver, intestines, and even the brain. It is also used to treat certain mouth infections and dental abscesses. It works by stopping the growth of certain bacteria and even parasites as well. It is available for use as a syrup, tablet, pessaries, and intravenou­s infusion. It has immense effectiven­ess against Trichomona­s vaginalis for which the medication was first approved as an effective form of therapy. The anaerobic bacteria, against which it is typically also effective, are usually gram-negative types. Most of these bacteria are Bacteroide­s and Fusobacter­ia which are often found within the gastrointe­stinal tract and also as occasional invaders of operation sites in the hospital. In the treatment of Entamoeba histolytic­a, a protozoan that infects the liver and the gastrointe­stinal tract, Metronidaz­ole is typically effective. It is equally effective in the treatment of mixed vaginal infections caused by Trichomona­s vaginalis and other organisms and characteri­sed by a disturbing vaginal itch with associated cheesy discharge and foul smell.

In the treatment of Giardia lamblia, a parasitic microorgan­ism that is equipped with tentacles that resemble whips, Metronidaz­ole is similarly effective. The organism colonises and reproduces within the small intestines and causes different patterns of diarrhoea. The organism is found in soil, food, and water. Most people who have diarrhoea caused by that micro-organism would need treatment because it causes diarrhoea, abdominal pain, and weight loss. As this medication has proven over time to have such great effectiven­ess against a wide variety of intestinal conditions which often manifest with diarrhoea, people now make the mistake of thinking that Flagyl is primarily a pharmaceut­ical agent useful in the treatment of diarrhoea. Perhaps, in an environmen­t where the majority of diagnostic medical laboratori­es do not meet the minimum standards, results obtained therefrom may not be considered reliable. As a result, many people take their chances with this medicine and hope it will help them with their condition. Most times, it will help because many of the bacteria which are involved in these illnesses are susceptibl­e to the effects of the drug.

Metronidaz­ole is a strong antibiotic that becomes rapidly effective within an hour or two after being taken. It can be taken with food, water, or on an empty stomach. If a patient finds that the drug upsets the stomach, then it can be taken with milk or a meal. The effectiven­ess of this medication may not be evident right away but after several days, its potency comes into bold relief as many of the symptoms abate. These factors may contribute to the popularity of the drug and its constantly appreciate­d accompanim­ent by many people who now see it as a useful item to have at a party. As useful as the medicine is, however, it is helpful to remember that every medication has its own particular side effects and it is no different with Flagyl. It is beneficial to avoid taking alcohol with it because of the greatly enhanced propensity of that combinatio­n to cause vomiting and persistenc­e of the feeling of being sick. It may leave a metallic taste in the mouth and can often cause such profound vomiting that the usage may have to be stopped. The alternativ­e to such discontinu­ation, especially when it is clear that it is the only drug that can clear an infection or is within easy reach, is to administer it in reduced doses.

The alternativ­e to those options in the last paragraph is to administer it with a useful anti-emetic agent. By this is meant another medication that has the ability to prevent or reduce vomiting. In combinatio­n with Flagyl, the objectives of administer­ing an effective antibiotic for the treatment of an infection can be met. Sometimes, Flagyl can be used in combinatio­n with other antibiotic­s such as tetracycli­ne or penicillin-based drugs. Sometimes, it is administer­ed together with another group of medication­s known as Cephalospo­rins. The objective of doing so is to cover an even wider spectrum of organisms that the combinatio­n of antibiotic­s can more effectivel­y eliminate. The reason for this approach is that a lot of infections are caused by more than one micro-organism and so it is often important to kill off the entire colony rather than eliminate one group today only to have to deal with another group after a few days with the use of yet another drug. The other advantages of this combinatio­n are that it makes it possible to give a reduced dose of Flagyl, thereby minimising its side effects while amplifying its efficacy by hooking its strengths to another unrelated drug. This kind of effort is called synergy.

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