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For amebiasis there is still discussion about the use of a single high dose versus repeated lower doses, both as regards efficacy and adverse effects. The use of metronidazole against infections with anerobic bacteria has increased over the years, and with this indication the use of metronidazole in combination with many other drugs used by patients with conditions likely to develop secondary anaerobic bacterial infections. With increased use there is also a widespread and increasing incidence of resistance of various strains of bacteria. The use of metronidazole as an added medication merely “to make assurance double sure” is to be discouraged.

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Metronidazole has a disulfiram-like effect in users of alcohol, sufficient to justify a warning. An unusual Antabuse-type reaction reported on one occasion seems to have been due to an interaction of metronidazole with the alcohol present in X-Prep. An interaction with metronidazole and ciclosporin, in which ciclosporin blood concentrations rise, has been suggested, though only in isolated case histories. It has been confirmed that metronidazole can produce a two-fold increase in blood concentrations of ciclosporin and tacrolimus, with a subsequent increase in serum crea-tinine in both cases.

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Central nervous system symptoms can occur with standard doses of metronidazole, but they are mainly seen with high doses and especially when such doses are given for a long time. Under the latter conditions, there was a 25% incidence of such symptoms as headaches, dizziness, tremor, ataxia, and confusion.

Common Cold

Inflammation of the nasal passages due to any number of respiratory viruses. Usually not serious; vast majority are self-treated. Incidence/Prevalence in USA: Preschool children 6-10 colds/yr; kindergarten 12/yr; schoolchildren 7/yr; adolescents/adults 2-4/yr. National Ambulatory Survey: 31 episodes/100 persons/year (counting only colds that lead to medical attention or at least one day of restricted activity).

Coccidioidomycosis

Pulmonary fungal infection endemic to the Southwest USA. Can become progressive and involve extrapulmonary sites, including bone, CNS, and skin. Known as the “great imitator.” Incubation period is 1 to 4 weeks after exposure.

Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is characterized primarily by profound fatigue, in association with multiple systemic and neuropsychiatric symptoms, lasting at least 6 months. The fatigue must have a new or definite onset (i.e., not lifelong), is not relieved by rest, and results in a substantial reduction in previous activities (occupation, education, social, and personal).

Chronic Cough

Chronic cough is defined as cough of >3 weeks duration. Patients present for fear of underlying pathology (eg, cancer), annoyance, self-consciousness, hoarseness. Patients with stress urinary incontinence may find cough particularly troubling. COPD and smoking-related cough are most common etiologies at the primary care level.