The use of metronidazole in management of methylmalonic and propionic acidaemias

Eur J Pediatr. 1990 Aug;149(11):792-6. doi: 10.1007/BF01957284.


Gut bacteria have been implicated as an important source of propionate in children with inborn errors of propionate metabolism. We have investigated the value of oral metronidazole (10-20 mg/kg per day) in five children with methylmalonic acidaemia (MMA) and four with propionic acidaemia (PA). Urinary excretion of propionate metabolites fell significantly during the treatment in all subjects, the mean decrease being 41% (range 12-76, P less than 0.01), while mean plasma propionate was reduced from 45.0 mumol/l to 25.1 mumol/l (P less than 0.05). Substantial reduction of the gut bacterial population was confirmed by lactulose breath hydrogen tests and by stool culture, and stool propionate concentration was reduced in most subjects. Clinical improvement was noted in three children. These results suggest that long-term antimicrobial therapy may offer significant clinical benefit to children with inborn errors of propionate metabolism.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amino Acid Metabolism, Inborn Errors / drug therapy*
  • Breath Tests
  • Child, Preschool
  • Feces / chemistry
  • Feces / microbiology
  • Humans
  • Hydrogen / analysis
  • Infant
  • Infant, Newborn
  • Intestines / microbiology
  • Methylmalonic Acid / blood*
  • Metronidazole / therapeutic use*
  • Propionates / analysis
  • Propionates / blood*


  • Propionates
  • Metronidazole
  • Hydrogen
  • Methylmalonic Acid