Minicase 2

Boys Zone

1. As Ronans attending physician,

how would you explain what
happened to him? What is your basis?
Do you need other laboratory data to
support diagnosis?

The physician should explain to her what happened

in a way that she would understand. She probably
forgot that the drug should not be taken with alcohol
or the physician who gave her the medication could
have not told her about it. Laboratory data is not
necessary since this is a known reaction of the drug
when there is alcohol intake. Laboratory data may,
however, be necessary to confirm amoebiasis is
present before the treatment or if it is eradicated
after treatment is done.

2. What is metronidazole? What are the indications for

metronidazole? Was it a safe drug to give to Ronan?

Metronidazole is a nitroimidazole antiprotozoal drug. It is the drug of choice in the treatment of amoebiasis. It kills
trophozoites but not cysts of E. histolytica and effectively eradicates intestinal and extraintestinal tissue infections.
The typical dosage is 500 mg three times daily orally or intravenously (30 mg/kg/d). (Katzung and Trevor 2015).

It was safe to give the drug to Belle since she developed amoebiasis and metronidazole is the
drug of choice for its treatment. She did not have any active or chronic peripheral or CNS
diseases and is not stated to be an alcoholic or had any before the start of the treatment.

3. What is an ADR? Did Ronan have an ADR? If your answer is yes, what is
the probable mechanism, of his drug reaction and what type of ADR did he
incur?

An adverse drug reaction (ADR) is a harmful or unintended response to an administered drug. The reaction may
be life threatening, cause persistent incapacity, birth defects or may even be fatal. For a reaction to be
considered as an ADR it must be undesirable, unintentional, suspected, but not necessarily proven, and a
consequence of therapy or other products.

In this case, Ronan did have an adverse reaction to metronidazole. Since the drug is
already known to cause Disulfiram-like effects when there is alcohol intake, the ADR is
classified as a secondary type A reaction. The classification is said to be secondary
because the reaction is different from the drugs known therapeutic action.

In the liver, alcohol dehydrogenase oxidizes ethanol into acetaldehyde, which is further converted
into the harmless acetic acid by acetaldehyde dehydrogenase. Acetaldehyde is responsible for
hangovers. Metronidazole, like Disulfiram, prevents the oxidation of acetaldehyde to acetic acid.
The accumulation of acetaldehyde is what causes the adverse reaction in the patient.

4. What are your responsibilities as Ronans physician, if

you are considering his case to be that of an ADR?

The physician should take the responsibility of advising the patient to not drink alcoholic drinks for the next few
days of taking the medication and resume drinking for until 2-3 days after treatment.
The patient should be advised to take in oral rehydration solutions (ORS) in order for the patient to stay hydrated
and not cause further damage.