Drug use evaluation of metronidazole in clinical practice: Insights from a prospective observational study

Background: Drug Use Evaluation (DUE) is a structured approach to ensure rational prescribing and optimize therapeutic outcomes. Metronidazole is widely used in hospital practice for infectious and inflammatory conditions; however, inappropriate prescribing and drug–drug interactions (DDIs) remain important concerns.
Aim: This study aimed to assess the prescribing and utilization patterns of metronidazole and to evaluate the potential DDIs among inpatients of Singareni Collieries Company Limited (SCCL) Main Hospital, Kothagudem.
Methods: A six-month prospective observational study was conducted in a 300-bedded multispecialty hospital. Data were collected using a structured proforma based on WHO DUE guidelines. Patient demographics, clinical indications, dosage forms, routes of administration, and DDIs were recorded. Statistical analysis was performed using descriptive statistics, chi-square test, and ANOVA where applicable, with p < 0.05 considered statistically significant.
Results: A total of 323 patients were included. The majority were aged 51–60 years (30.95%), with males (71.83%) significantly more than females (p < 0.01). Inflammation was the leading indication (48.60%), and intravenous route was predominantly used (96.28%). DDIs were detected in 86.69% of patients (n = 280), amounting to 723 interactions. Among these, 77.60% were of major severity, 20.33% moderate, and 2.07% minor, with age and polypharmacy showing a significant association with higher DDI prevalence (p < 0.05).
Conclusion: The study revealed a high prevalence of clinically significant DDIs with metronidazole, underscoring the need for vigilant monitoring, adherence to prescribing guidelines, and pharmacist-led interventions to promote rational use and improve patient safety.