The therapeutic use of metronidazole in anaerobic infection: six years' experience in a London hospital.

For the past 6 years at St. Thomas' Hospital, metronidazole has been used to treat proven anaerobic infection at a wide variety of sites and of varying clinical severity. Throughout this period, intravenous, oral, and rectal preparations of the drug have been available. Initial experience was predominantly in abdominal sepsis where excellent therapeutic results were obtained and treated patients included many with mixed aerobic/anaerobic infection in whom metronidazole was used alone. Metronidazole also has been used either alone or in combination, most frequently with amoxicillin, to treat many other anaerobic infections: head and neck, pleuropulmonary, genital tract, bone and joint, skin and soft tissue, and cases of fusobacterial septicemia (necrobacillosis). Although, as in pyogenic infection of any etiology, surgical intervention often is required in anaerobic sepsis, there is little doubt of the useful therapeutic role of metronidazole in these patients. Increasing awareness of the wide clinical spectrum of human anaerobic infections has led to increasing therapeutic dependence on metronidazole with as yet little evidence of bacterial resistance.