Flagyl 200mg/5ml Suspension (Metronidazole)

Drug Class: Nitroimidazole Antibiotic & Antiprotozoal | Form: Oral Suspension (120ml) | Prescription Status: Prescription Only (Rx) — DRAP Registered

What is Flagyl 200mg/5ml Suspension?

Flagyl Suspension is an oral liquid antibiotic and antiprotozoal medicine containing Metronidazole 200mg per 5ml — the same powerful active ingredient as Flagyl 400mg Tablet, formulated as a suspension specifically designed for children who cannot swallow tablets, as well as adults who prefer or require a liquid form of this medicine.

Each 5ml measured dose delivers 200mg of Metronidazole — half the strength of one Flagyl 400mg tablet — making it straightforward for doctors to prescribe accurate, weight-based doses for children of different ages and sizes. The liquid form also allows flexible dose adjustment as the child grows or as the clinical situation changes during treatment.

Flagyl Suspension treats a wide range of serious infections caused by anaerobic bacteria — bacteria that survive and multiply in low-oxygen environments — and by protozoan parasites such as amoeba and Giardia, which are among the most common causes of childhood gut infections (آنتوں کا انفیکشن) in Pakistan. Because Metronidazole penetrates deeply into tissues throughout the entire body, it effectively treats infections not only in the gut but also in the genital tract, skin, joints, mouth, and other organs.

As with all antibiotics, the full prescribed course must always be completed without stopping early, even when the child or patient feels better before the course ends.

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What is Flagyl Suspension Used For?

Flagyl 200mg/5ml Suspension is approved for the treatment of the following bacterial and parasitic infections:

• Stomach and intestinal infections:
  • Amoebiasis — intestinal infection caused by the Entamoeba histolytica parasite causing severe diarrhoea, bloody stools, and stomach cramps — very common in children in Pakistan (پیچش / آنتوں کا پرجیوی انفیکشن)
  • Giardiasis — intestinal infection caused by Giardia lamblia parasite causing persistent watery diarrhoea, bloating, and stomach discomfort (گیارڈیا انفیکشن)
  • Amoebic liver abscess — serious complication of amoebiasis where the parasite spreads to the liver
  • Pseudomembranous colitis — serious gut infection caused by Clostridioides difficile bacteria
• Gynaecological infections (adolescent and adult females):
  • Bacterial vaginosis — bacterial imbalance in the vagina causing abnormal discharge and odour
  • Trichomoniasis — sexually transmitted parasitic infection of the genital tract
• Dental and oral infections:
  • Severe gum infections (periodontitis), tooth abscesses, and acute necrotising ulcerative gingivitis (مسوڑھوں اور دانتوں کا شدید انفیکشن)
• Skin and soft tissue infections:
  • Anaerobic bacterial skin and soft tissue infections not responding to standard antibiotics
  • Infected wounds with anaerobic bacterial involvement
• Joint infections:
  • Anaerobic bacterial joint infections where Metronidazole is required as part of combination therapy
• Anaerobic bacterial infections:
  • Infections caused by anaerobic bacteria in the blood, abdominal cavity, lungs, and other body tissues
• Helicobacter pylori eradication:
  • Used as part of combination therapy to eradicate H. pylori bacteria responsible for stomach ulcers and gastritis (معدے کے السر کا علاج)

How Does Flagyl Suspension Work?

Metronidazole works through a unique mechanism that makes it selectively deadly to anaerobic bacteria and protozoan parasites while leaving the body's own cells unharmed:

Once swallowed and absorbed into the bloodstream, Metronidazole enters the cells of anaerobic bacteria and protozoan parasites. Inside these organisms — which survive in low-oxygen environments — Metronidazole undergoes a chemical activation process, converting it into a highly toxic reactive form. This activated form directly attacks and breaks apart the DNA of the bacteria or parasite. Without intact DNA, the organism cannot reproduce, repair cellular damage, or survive — and it rapidly dies.

Why this mechanism is so effective:

Selective targeting: The chemical activation of Metronidazole only occurs inside anaerobic organisms — meaning it specifically targets the harmful anaerobic bacteria and parasites causing the infection while having minimal effect on the aerobic bacteria that form part of the body's normal healthy flora.

Exceptional tissue penetration: Metronidazole is a small molecule with outstanding ability to cross biological barriers — including the blood-brain barrier, bone tissue, placental barrier, and peritoneal fluid. This allows it to reach and effectively treat infections in deep organs and tissues where many other antibiotics cannot achieve adequate concentrations. After oral administration, the suspension is rapidly and nearly completely absorbed — reaching effective blood levels within 1 to 2 hours.

Dosage and Administration

⚠️ Always follow your doctor's prescribed dose exactly. For children, the dose is always calculated based on body weight — never estimate or use a household spoon. Use only the measuring spoon or oral syringe provided with the bottle.

Each 5ml of Flagyl Suspension contains 200mg of Metronidazole.

Paediatric Dosing (Weight-Based):

Practical Dosing Guide by Weight (at 7.5mg/kg per dose):

Adult Dosing (Liquid Form):

How to Give or Take the Suspension:

• Shake the bottle thoroughly before every single dose — Metronidazole particles settle at the bottom between uses and must be evenly mixed before measuring
• Measure the exact prescribed volume using the oral dosing syringe or measuring spoon provided — never use a kitchen teaspoon or tablespoon as household spoon sizes vary considerably
• Always give with food or immediately after a meal — this significantly reduces the nausea and stomach upset that Metronidazole commonly causes, particularly in children
• Give doses at evenly spaced intervals throughout the day — for a three-times-daily schedule, aim for every 8 hours to maintain consistent blood levels
• If a dose is missed, give it as soon as remembered — but if it is nearly time for the next dose, skip the missed dose and continue normally; never double the dose
• Always complete the full prescribed course — do not stop early even when the child appears completely well before the course finishes

Active Ingredient

Who Should NOT Take Flagyl Suspension?

Do not give this suspension if the patient:

• Is allergic to Metronidazole or any other nitroimidazole medicine such as Tinidazole or Ornidazole
• Has a history of blood disorders or bone marrow suppression
• Is an infant in the first trimester of pregnancy — relevant for adolescent patients
• Is currently taking Disulfiram or has taken it within the last 2 weeks

Always inform your doctor before starting treatment if the patient has any of the following:

• Liver disease — Metronidazole is metabolised by the liver; severe liver disease requires careful dose reduction and monitoring as the drug can accumulate to harmful levels
• Kidney disease — monitoring is recommended during prolonged courses
• Neurological conditions — history of seizures, epilepsy, or any other nervous system disorder; Metronidazole can lower the seizure threshold
• Existing peripheral neuropathy — numbness or tingling in hands or feet; Metronidazole can worsen this with prolonged use
• Is breastfeeding — Metronidazole passes into breast milk and gives it a bitter taste; breastfeeding should be paused during treatment and for 24 to 48 hours after the last dose
• Is pregnant (second or third trimester) — use only when clearly indicated and prescribed by a doctor
• Is taking blood-thinning medicines such as Warfarin

Side Effects

Flagyl Suspension is generally well tolerated in children and adults at the prescribed dose and duration. Side effects are more likely with higher doses or longer courses.

Common Side Effects:

• Nausea, stomach discomfort, or vomiting — the most common side effect; significantly reduced by always giving with food
• Metallic or bitter taste in the mouth (منہ میں کڑوا ذائقہ) — very characteristic of Metronidazole; harmless and disappears after completing the course
• Loss of appetite — common in children; ensure adequate fluid and food intake during treatment
• Diarrhoea (دست) or stomach cramping
• Mild headache or dizziness
• Dark or reddish-brown urine — harmless discolouration caused by Metronidazole metabolites; not a sign of kidney problems; reassure parents if noticed in children
• Dry mouth or unpleasant breath

Serious Side Effects — Stop Immediately and Seek Emergency Medical Attention:

• Neurological effects — numbness, tingling, or burning in hands or feet; confusion; unsteady walking; difficulty speaking or seeing — stop immediately and contact your doctor
• Seizures or fits — particularly at higher doses or in children with pre-existing neurological conditions — seek emergency help immediately (یہ طبی ہنگامی صورتحال ہے)
• Severe allergic reaction — sudden widespread rash, hives, swelling of the face, lips, tongue or throat, difficulty breathing
• Severe skin reaction — widespread blistering or peeling skin — rare but requires immediate emergency attention
• Signs of liver damage — yellowing of skin or eyes (یرقان / jaundice), very dark urine, severe upper abdominal pain, extreme fatigue
• Signs of blood disorder — unusual bruising, persistent unexplained sore throat, severe fatigue, or fever — possible with prolonged use

If any serious side effect occurs in your child or yourself, stop Flagyl Suspension immediately and go to the nearest hospital emergency department without delay.

Drug, Food, and Alcohol Interactions

Always inform your doctor and pharmacist about all medicines your child or you are currently taking before starting Flagyl Suspension.

🚨 Critical Alcohol Warning for Parents and Caregivers: Many children's cough syrups, cold medicines, and herbal preparations contain alcohol as a preservative or solvent. Always check the ingredient list of every liquid medicine your child is taking alongside Flagyl Suspension to ensure no alcohol-containing product is being given simultaneously.

Preparation and Storage Instructions

Before First Use:

• Flagyl Suspension is supplied ready to use as a pre-mixed liquid — no reconstitution with water is required, unlike some antibiotic syrups
• Check that the seal is intact before opening for the first time

Shake Before Every Use:

• Always shake the bottle thoroughly before measuring each dose — the active ingredient settles at the bottom between uses and must be evenly distributed before administration

Storage:

• Store below 25°C in a cool, dry place — do not refrigerate unless specifically stated on the label; refrigeration can cause the suspension to thicken and make accurate measuring more difficult
• Protect from direct sunlight and heat
• Keep the cap tightly closed between doses to prevent contamination and evaporation
• Keep out of reach of children (بچوں کی پہنچ سے دور رکھیں) — despite being a children's medicine, the bottle contains multiple doses and accidental ingestion of a large volume is harmful
• Do not use after the expiry date printed on the bottle or outer carton
• Discard any remaining suspension 4 weeks after first opening — do not save leftover medicine for a future illness

Frequently Asked Questions

How do I calculate the correct dose of Flagyl Suspension for my child? 

The dose is always based on your child's body weight — your doctor will prescribe the exact number of millilitres per dose. The standard dose is 7.5mg of Metronidazole per kg of body weight per dose, given three times daily. Since each 5ml of Flagyl Suspension contains 200mg, this converts to approximately 0.19ml per kg per dose. However, never attempt to calculate this yourself — always follow the exact volume your doctor has written on the prescription, and use the oral syringe provided for accurate measurement.

My child's urine has turned dark brown — should I be worried? 

No — dark or reddish-brown urine is a well-known and completely harmless side effect of Metronidazole. It is caused by the way Metronidazole and its breakdown products are excreted in the urine. It does not indicate kidney damage or any other serious problem. The urine returns to its normal colour within 24 to 48 hours of completing the course. However, if dark urine is accompanied by yellowing of the skin or eyes, severe abdominal pain, or extreme fatigue, contact your doctor as these could indicate a liver-related issue.

Q: My child seems better after 3 days — can I stop the suspension? No — stopping Flagyl Suspension early is one of the most common mistakes in antibiotic and antiprotozoal treatment. When symptoms improve, it means the medicine is working and the number of bacteria or parasites has reduced — but they may not be fully eliminated yet. Stopping early allows the remaining organisms to survive, multiply again, and cause the infection to return — sometimes in a harder-to-treat form. Always give every single dose of the complete prescribed course exactly as instructed, regardless of how well the child appears.

Q: Can alcohol-containing children's syrups be given alongside Flagyl Suspension? This is a very important safety question for Pakistani parents, as many commonly available children's cough syrups and cold medicines contain small amounts of alcohol as a preservative or solvent. Even small amounts of alcohol can trigger a disulfiram-like reaction in a child taking Metronidazole — causing flushing, rapid heartbeat, nausea, and distress. Always carefully read the ingredient list of every other liquid medicine your child is taking and consult your pharmacist before combining any syrup with Flagyl Suspension.

Q: Is Flagyl Suspension safe for very young babies and infants? Metronidazole can be used in young children and infants when clearly needed, but requires extra care with dosing. The dose must be precisely calculated by a paediatrician based on the infant's exact weight. Very young infants have immature liver function and may process Metronidazole more slowly, requiring adjusted doses and careful monitoring. The treating paediatrician will assess whether Flagyl Suspension is the most appropriate treatment for a very young infant or whether an alternative approach is safer.

Q: Can Flagyl Suspension be given to treat both amoebiasis and giardiasis at the same time? Yes — both amoebiasis and giardiasis are very common parasitic gut infections in Pakistani children, and Metronidazole is a first-line treatment for both. In some cases, a child may be co-infected with both parasites simultaneously — particularly in areas with poor sanitation or contaminated water supply. Your doctor will confirm the diagnosis through stool examination before prescribing, as the dose and duration differ slightly for each condition. Never self-diagnose or self-prescribe based on symptoms alone — watery or bloody diarrhoea in children can have multiple causes requiring different treatments.

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⚕️ Medical Disclaimer: This product description is provided for general informational purposes only and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified and licensed doctor or pharmacist before giving any prescription medicine to a child. Follow the prescribed dose exactly, shake well before every dose, and complete the full course. If the child shows signs of allergic reaction, seizures, or worsening symptoms, seek emergency medical attention immediately.

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DRAP Registered | Prescription Required (Rx) | Shake well before every dose — always give with food — avoid all alcohol-containing products during treatment — complete the full course