# 一位35歲的個案因細菌性陰道炎出院，醫囑給予metronidazole 500 mg口服一天三次。哪一項衛教最重要？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375248&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位35歲的個案因細菌性陰道炎出院，醫囑給予metronidazole 500 mg口服一天三次。哪一項衛教最重要？

## 選項

1. 若尿液變深就停藥。
2. 為改善味道將藥磨碎與伏特加混合。
3. 治療期間及最後一劑後至少48小時內避免所有酒精(包括啤酒、紅酒、漱口水、含酒精的咳嗽糖漿、用酒料理的食物)；metronidazole會產生disulfiram-like反應導致潮紅、嚴重噁心嘔吐、頭痛、心悸、低血壓；金屬味與深色尿可為正常，但神經症狀仍須回報；完成療程，第一孕期避免。 **✔ 正確答案**
4. 與此藥同時飲酒沒問題。

**正確答案: 3**

## 解析

Metronidazole 用於厭氧菌感染、細菌性陰道炎、滴蟲病、困難梭狀桿菌（C. difficile）感染（目前口服萬古黴素或fidaxomicin為困難梭狀桿菌感染的首選）、幽門螺旋桿菌、腹腔內及骨盆腔感染、以及梨形鞭毛蟲病。重要衛教：(1) 與酒精產生戒酒樣反應（disulfiram-like reaction）——即使少量酒精，如漱口水、咳嗽糖漿或含酒烹調的食物都可能引起潮紅、嚴重噁心嘔吐、頭痛、心悸、低血壓、呼吸困難，罕見致命性心律不整；治療期間及最後一次服藥後至少48小時（有些資料延至72小時）內避免飲酒；徹底教導病人及家屬；(2) 常見副作用——金屬味、噁心、腸胃不適、口乾、深色或紅棕色尿液（因藥物代謝產物所致，無害，但若有任何變化仍應通報以排除其他原因）；(3) 中樞神經——頭暈、頭痛、長期使用可能引起周邊神經病變，罕見癲癇或無菌性腦膜炎；(4) 藥物交互作用——warfarin（INR上升）、鋰鹽（中毒）、phenytoin、busulfan；(5) 可能時懷孕第一期避免使用；(6) 按時完成全程療程。喝酒、與伏特加混用、及因尿液顏色深而停藥都是不安全的。

## 深入解析

metronidazole禁酒並涵蓋最後一劑後48小時。disulfiram-like反應為NCLEX高頻答案。深色尿無害。

## 重要概念

- **metronidazole** — Flagyl，厭氧菌/BV/滴蟲/H. pylori，disulfiram-like，金屬味，周邊神經病變
- **disulfiram-like reaction** — 乙醛累積，潮紅、噁心嘔吐、頭痛、心悸、低血壓，需避酒48-72小時
- **hidden alcohol sources** — 漱口水、咳嗽糖漿、料酒、部分藥品，需仔細閱讀標示

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