Metronidazole Dosing Guidelines for Pediatric Patients

Indication-Specific Dosing

The Infectious Diseases Society of America recommends oral metronidazole at 7.5 mg/kg per dose given 3-4 times daily for 10 days for initial episodes of non-severe Clostridium difficile infection in children 1, 2
The maximum dose of metronidazole should not exceed 500 mg per dose, regardless of the frequency of administration, for the treatment of Clostridium difficile infection in children 1, 2
For severe or fulminant Clostridium difficile infection, intravenous metronidazole at 10 mg/kg per dose three times daily (maximum 500 mg per dose) may be added to oral vancomycin in critically ill patients 1, 2

Oral metronidazole is preferred over intravenous administration for the treatment of Clostridium difficile infection, as it achieves high intraluminal concentrations 1, 2
Vancomycin is the preferred treatment over metronidazole for severe Clostridium difficile infection in children, and for recurrent Clostridium difficile infection, vancomycin in tapered/pulsed regimens is recommended 1, 2
The maximum dose of metronidazole should not be exceeded, even if weight-based calculations suggest higher doses, to minimize the risk of side effects 1, 2

The typical duration of metronidazole therapy for most infections is 7-10 days 1, 2