Metronidazole 目前廣泛用於治療厭氧菌感染，耐受性佳，但當長期使用或累積劑量大時，發生神經病變副作用的機率較高。本案例報告為一名54 歲女性因肝膿瘍使用metronidazole 治療，但在治療2 週後（metronidazole 累積劑量28 g），開始主訴四肢麻木刺痛等神經症狀。在住院後第21 天，因感染症狀改善，病人出院並繼續服用口服劑型的metronidazole。期間神經症狀持續惡化，出院後回診，醫師懷疑其神經症狀是metronidazole 造成的副作用而予以停藥，此時metronidazole 累積劑量已達49 g。停藥後3 年，追蹤其神經病變的症狀仍未完全恢復，持續需要藥物緩解其症狀。因此，應該特別留意使用metronidazole 病人的神經症狀，像是感覺異常、麻木刺痛、灼熱感等表現，謹慎評估續用metronidazole 的利弊，以期避免造成永久性的神經損傷。

 

Metronidazole has been widely used to treat various anaerobic infections without producing major side effects. However, neuropathy is one of the complications of prolonged administration or relatively high cumulative doses of metronidazole. We report the case of a 54-year-old woman who was treated with metronidazole for a liver abscess. She complained of numbness and tingling in her limbs after 2 weeks treatment (the cumulative dose of metronidazole was 28 g). On the 18th day of the course of metronidazole, the patient was discharged from the hospital and continued to take metronidazole orally due to the improvement of infection symptoms. During this period, her neurological symptoms continued worsening. On the 25th day, the physician suspected that the neurological symptoms were side effects of metronidazole and discontinued the drug (the cumulative dose of metronidazole had reached 49 g). However, her symptoms of peripheral neuropathy did not resolve after cessation of metronidazole. She still needs medication to relieve her neurological symptoms after 3 years of follow-up. On the basis of this case, patients being treated with metronidazole should be closely monitored for neurotoxicity such as paresthesia, numbness, tingling, and burning sensation. The pros and cons of metronidazole treatment should be carefully evaluated to avoid permanent nerve damage.

 

 

Summited for publication: 2021.7.1; Accepted for publication: 2021.8.30