This study was designed to assess the lipid lowering effects of metronidazole in patients with compelling indications for metronidazole. The study was carried out on 30 patients with clinical indications for metronidazole e.g. gastroenteritis assessed and prescribed by the physician and voluntarily agreed to participate in this trial. They were 23 males and 7 females between age limit of 23 - 45years. Only those volunteers were selected who fulfilled the inclusion and exclusion criteria. Patient meeting the selection criteria were included in the study after obtaining written informed consent. Demographic details (name, age, sex, address, and contact numbers) were obtained. Detailed history was taken and physical examination was done by the physician. Patients were allowed to continue their regular diet. A data collection form was developed to mention the effects of study designed. Patients were counseled by qualified pharmacist for the possible adverse drug effects and the adverse effects were documented. The patients meeting the inclusion criteria were started on metronidazole 1200mg per day in three divided doses for a total of 7 days.
Liver functions tests (LFTs) were performed before and after 7 days treatment at Shaukat Khanum Hospital laboratory. Blood samples for lipid profile were collected at 0 day, 4th day and 7th day treatment and 4th day post treatment. Lipid profile was measured according to enzymatic colorimetric method and compared to the reference ranges in laboratory. The information obtained was recorded in the data collection form and statistics calculated. Determination of lipid concentrations showed that therapy with 1200mg metronidazole per day in three divided doses for 7 days delivered a reproducible reduction of about 9% at 4th day and 15% (p<0.05) after 7 days in mean LDL cholesterol, about 11% (p<0.05) at 4th day and 15% (p=0.003) after 7 days in mean total cholesterol, about 3% at 4th day and 6% (p>0.05) after 7 days in mean HDL cholesterol comparing with pre treatment levels. Mean triglyceride levels showed no significant change (123+44.49mg/dL vs. 120.53+49.20mg/dL) during treatment. LFTs measured before and after treatment showed no significant change indicating lack of hepatic impairment. So while considering metronidazole for short term or long term use in patients with cardiovascular diseases, the plasma lipid levels should be monitored. It was found cost effective, safe and adverse effects experienced by the patients were minimal and resolved as soon as the treatment was stopped. However further studies are needed especially on hyperlipidemic population taking standard therapies to study the adjuvant effect of metronidazole with other hypolipidemic drugs and to answer the question of antibiotic resistance.