Clinical relevance of metronidazole and peripheral neuropathy: a systematic review of the literature

•Metronidazole is well tolerated, but prolonged use of this drug is associated with peripheral neuropathy.•The overall incidence of metronidazole–associated peripheral neuropathy is unknown.•Most cases of metronidazole–associated peripheral neuropathy are seen with >42 g of total drug or >4 weeks of treatment.•Symptoms resolve after discontinuation of therapy in most patients.•Antimicrobial stewardship programs may use metronidazole in antibiotic combinations when treating with ≤42 g or ≤4 weeks.