Intravenous metronidazole, liquid tinidazole, and intra-vaginal boric acid to cure trichomonas in a patient with gastric bypass surgery.

This study presents a case report of a female patient with symptomatic refractory Trichomonas vaginalis infection who was not able to clear her infection with high-dose oral metronidazole, oral tinidazole, intra-vaginal zinc sulfate, intra-vaginal metronidazole, intra-vaginal tinidazole, and intra-vaginal boric acid. She was unable to tolerate intra-vaginal paromomycin. A combination of intravenous metronidazole, oral tinidazole liquid suspension, and intra-vaginal boric acid for 14 days subsequently achieved a complete symptomatic and laboratory cure.

Evaluation of selected tropical seaweeds for in vitro anti-trichomonal activity.

ETHNOPHARMACOLOGICAL RELEVANCE: Human parasitic infections are a serious problem in tropical and sub-tropical developing countries. Trichomoniasis, responsible for the annual infection of 180 million people, is a common sexually transmitted disease caused by the protozoan Trichomonas vaginalis. Traditionally seaweeds have been used in folk medicine by coastal people in Asia and the Caribbean to treat parasitic infections and are a valuable source of novel anti-trichomonals. AIM OF THE STUDY: In our search for therapeutical alternatives to anti-protozoal chemotherapy, we collected a selection of 25 tropical seaweeds (12 Rhodophyta, 5 Phaeophyta and 8 Chlorophyta) from the coast of Yucatan (Mexico) in order to undertake ethnopharmacological and chemotaxonomic investigations. MATERIALS AND METHODS: Organic algal extracts were tested for their anti-trichomonal properties on the growth inhibition of Trichomonas vaginalis. The cytotoxicity of seaweed extracts on mammal cell lines was also assessed. RESULTS: The results indicated that 44% of the seaweeds studied had high to moderate anti-trichomonal activity. Lobophora variegata and Udotea conglutinata showed the maximal anti-trichomonal activity with IC(50) values of 1.39 and 1.66microg/ml, respectively, with good selectivity. CONCLUSIONS: Lobophora variegata and Udotea conglutinata demonstrated promising anti-trichomonal potential and have been selected for further bio-guided fractionation and isolation of active anti-trichomonal compounds.

Tinidazole for the treatment of vaginal infections.

Tinidazole has been used for vaginal infection worldwide but not in the US for > 40 years. Recently, tinidazole has been re-introduced and approved by the FDA for trichomoniasis and restudied as an alternative to metronidazole for bacterial vaginosis. In vitro antimicrobial activity and pharmacokinetics studies indicate that tinidazole has minor but possibly relevant antimicrobial as well as pharmacokinetic advantages when compared directly with metronidazole. Clinical comparison has been infrequent although the limited head-to-head studies indicate minimal therapeutic advantage with tinidazole. Perhaps the more relevant differences relate to the enhanced tolerance and reduced toxicity of tinidazole. Ongoing, as yet incomplete, studies directly comparing the clinical efficacy of metronidazole and tinidazole for bacterial vaginosis should clarify the status of tinidazole; however, cure rates are unlikely to be significantly different. Although uncommon, high-level trichomonal metronidazole resistance can be reliably cured by using tinidazole, which is an invaluable advantage.

A study of 4- and 7-day triple therapy with rabeprazole, high-dose levofloxacin and tinidazole rescue treatment for Helicobacter pylori eradication.

BACKGROUND: Helicobacter pylori treatment failure is becoming an emergent problem in clinical practice. Shorter treatment duration should improve compliance to therapy and keep an acceptable H. pylori eradication rate. AIMS: To evaluate the efficacy of two rabeprazole, high-dose levofloxacin and tinidazole-based regimens as 'rescue' treatment for H. pylori eradication in an open-label, randomized, pilot study carried out in a clinical practice setting. METHODS: Eighty-five consecutive patients who have previously failed at least one H. pylori eradication attempt were randomized to receive rabeprazole (20 mg, b.d.), levofloxacin (500 mg, b.d.) and tinidazole (500 mg, b.d.) either for 4 (4-day RLT, n = 42) or 7 days (7-day RLT, n = 43). Cure of H. pylori infection was assessed by means of 13C-urea breath test. RESULTS: The 7-day RLT achieved 84% (95% CI: 69-93%) and 86% (95% CI: 72-95%) eradication rates in intention-to-treat and per-protocol analyses respectively. The shorter treatment obtained an 83% (95% CI: 69-93%) eradication rate in both intention-to-treat and per-protocol analysis. Both regimens were well tolerated, although patients who received the 4-day RLT reported fewer side-effects. CONCLUSIONS: In patients who have previously failed at least one H. pylori eradication attempt, both 4- and 7-day rabeprazole, high-dose levofloxacin, tinidazole-based regimens are effective in curing the infection in more than 80% of patients.

Management of metronidazole-resistant Trichomonas vaginalis--a new approach.

Metronidazole-resistant trichomoniasis is an infrequent but challenging problem with no universally successful treatment. Since 1994, we have been using a combination regimen consisting of high-dose tinidazole plus a broad-spectrum antibiotic, i.e. doxycycline or ampicillin, and clotrimazole pessaries, for 7--14 days in this condition. A retrospective case review identified 11 cases of resistant trichomonas between 1994 and 2002. In the absence of resistance testing, resistance was defined clinically. Nine of the 11 patients were cured; one patient did not attend follow-up. In the women who attended for follow-up, the cure rate was 90%. We have found the combination of tinidazole, a broad-spectrum antibiotic, and clotrimazole pessaries to be a tolerable and effective treatment for metronidazole-resistant Trichomonas vaginalis. Although a variety of total doses of tinidazole were used in our patients, based on our findings, and those of others, we would recommend giving tinidazole 2 g twice daily for 14 days (total dose 56 g).

["Mixed" and "miscellaneous" vulvovaginitis: diagnostics and therapy of vaginal administration of nystatin and nifuratel]. / "Smísené" a "nezaraditelné" vulvovaginitidy. Diagnostika a terapie vaginální aplikací nystatinu + nifuratelu.

AIM OF THE STUDY: The evaluation of combined and miscellaneous vulvovaginal infections incidence and their treatment with combined vaginal products containing nifuratel and nystatin. DESIGN: Prospective study. SETTING: Gynecologic outpatient department LEVRET, Prague; Laboratories of Microbiology AescuLab, Prague. METHODS: 70 consecutive patients were examined with complaint of vaginal fluor and/or pruritus. We established macroscopic features of fluor, pH, amine test and mounts stained with Giemsa and Gram. We qualified the cases with more diagnostic criteria (mycosis, lactobacillosis, anaerobic vaginosis, aerobic vaginitis) as combined infection, those with no diagnostic criteria as miscellaneous. We treated all patients with vaginal tablets nystatin + nifuratel (Macmiror complex). We prescribed clotrimazol cream, if pruritus was present. We evaluated withdrawals of symptoms and relapses during 3 months after treatment. RESULTS: Combined infection was found in 21 patients from 70 (30%). The most frequent combination was that of mycosis and aerobic vaginitis (13/70, 18.6%) or mycosis and anaerobic vaginosis (4/70, 5.7%); 11 patients fulfilled criteria of no diagnosis. We concluded them as "miscelaneous". The treatment was successful in all cases, 10 women relapsed in 3 months. CONCLUSIONS: Combined vaginal infection findings are present very often (30%), likewise miscellaneous ones (15%) occur. The treatment of these women in successful with vaginal tablets with nystatin + nifuratel.

Antitrichomonas in vitro activity of Cussonia holstii Engl.

Cussonia holstii is a traditional medicinal plant used in Kenya, which has not been studied chemically up-to-date. Upon biological screening, a substantial antitrichomonas activity was found in the dichloromethane extract of the bark of Cussonia holstii. A detailed chromatographic study using centrifugal partition chromatography revealed that a pentacyclic triterpenoid, i.e., hederagenin, is the antitrichomonas constituent of the plant with a IC50 of 2.8 microM.

Wheat germ supplement reduces cyst and trophozoite passage in people with giardiasis.

The protozoan parasite Giardia lamblia is a major cause of waterborne enteric disease worldwide. Lectins are proteins that bind to carbohydrate (sugar) moieties. Potential targets for lectins are found on the surface of most single-celled organisms. Modest concentrations of wheat germ agglutinin (WGA) have been shown to inhibit G. lamblia excystation and trophozoite growth in vitro and can reduce cyst passage in mice infected with the closely related protozoan parasite, G. muris. Commercial preparations of wheat germ (WG) contain 13-53 microg of WGA per gram. We performed a double-masked, placebo-controlled study of dietary supplementation with WG in 63 subjects with giardiasis in Montreal and Lima (25 asymptomatic patients passing cysts; 38 patients with symptoms). Asymptomatic subjects received WG (2 g, 3 times a day) or placebo (cornstarch, 2 g, 3 times a day) for 10 days, followed by metronidazole (250 mg 3 times a day) for 7 days. Symptomatic subjects received metronidazole (250 mg 3 times a day) plus either WG or placebo for 7 days. Stool specimens were collected every day (Montreal) or every other day (Lima) for 10 days and on Day 35 for microscopic examination and coproantigen determination. Subjects kept a diary of symptoms for 10 days after recruitment. In asymptomatic subjects, both cyst passage and coproantigen levels were reduced by approximately 50% in those taking WG compared with the placebo group (P < 0.01 and P = 0.06, respectively). In symptomatic subjects, cyst passage and coproantigen levels fell precipitously in response to metronidazole therapy, and there were no clinically important differences between those receiving supplemental WG or placebo. However, symptoms appear to have resolved more rapidly in the subjects taking WG in addition to metronidazole. The WG supplement was well tolerated in both symptomatic and asymptomatic subjects. These data suggest that components of WG, possibly WGA, either alone or in combination with antiprotozoal agents, can influence the course of human giardiasis.

Adjunctive systemic and locally delivered metronidazole in the treatment of periodontitis: a controlled clinical study.

OBJECTIVE: To compare clinical and microbiological responses following non-surgical treatment of moderate to advanced adult periodontitis using subgingival scaling with and without adjunctive topical or systemic metronidazole. DESIGN: A single blind randomised clinical trial of 90 subjects, stratified for periodontitis disease severity and smoking status, divided into three treatment groups: 1. Subgingival scaling using ultrasonic scalers and local anaesthesia; 2. Subgingival scaling using ultrasonic scalers and local anaesthesia plus seven days of systemic metronidazole (200 mg tds); 3. Subgingival scaling using ultrasonic scalers and local anaesthesia plus two applications of 25% metronidazole gel one week apart in all sites with probing depths more than 4 mm. Evaluations were made before treatment, and 8 weeks and 24 weeks post treatment. MAIN OUTCOME MEASURES: Probing depths, probing attachment levels and bleeding on probing were measured using a Florida probe. Bacterial morphotypes were evaluated with darkfield microscopy. Results were analysed for all sites with baseline probing depths equal to or greater than Florida probe recordings of 4.6 mm using analysis of variance. RESULTS: 84 subjects completed the trial and the three treatment groups did not differ at baseline for any clinical parameter. Mean probing depths were reduced following treatment by greater than 1.6 mm (Group 1 = 1.68 mm, Group 2 = 1.62 mm, Group 3 = 1.74 mm at six months post treatment) but no significant differences were detected between treatment groups at any time point. Similarly, no significant differences were detectable between treatments for changes in mean probing attachment levels, bleeding on probing, plaque scores or proportions of bacterial morphotypes. CONCLUSIONS: This study does not support the routine use of adjunctive metronidazole in the non-surgical treatment of periodontitis.

Multicenter comparison of clotrimazole vaginal tablets, oral metronidazole, and vaginal suppositories containing sulfanilamide, aminacrine hydrochloride, and allantoin in the treatment of symptomatic trichomoniasis.

BACKGROUND AND OBJECTIVES: Trichomonas vaginalis is a common vaginal pathogen. Oral metronidazole is the drug of choice for the treatment of trichomoniasis. Oral metronidazole, however, may cause unpleasant side effects and is contraindicated during the first trimester of pregnancy. In vitro studies and preliminary clinical data have suggested that intravaginal clotrimazole may be effective against this pathogen. GOALS: To compare the efficacy of clotrimazole vaginal tablets, oral metronidazole, and vaginal suppositories containing sulfanilamide, aminacrine, and allantoin (AVC suppositories) in the treatment of women with symptomatic trichomoniasis. STUDY DESIGN: In a multicenter, open-label trial conducted in 1982 and 1983, 168 symptomatic women with microscopically evident vaginal trichomoniasis were randomized to receive any of 2 g of metronidazole as a single oral dose, two 100-mg clotrimazole vaginal tablets once a day for 7 days, or vaginal suppositories containing 1.05 g of sulfanilamide, 14 mg of aminacrine hydrochloride, and 140 mg of allantoin (AVC suppositories) twice a day for 7 days. Wet mounts and cultures were repated at 1 to 2 and 4 to 6 weeks after completion of treatment. RESULTS: The number of patients who had positive cultures after treatment were 40/45 (88.9%) in the clotrimazole group, 35/43 (81.4%) in the AVC suppository group, and 9/45 (20%) in the metronidazole group (P < 0.001). All treatments were associated with a reduction in reported symptoms. Oral metrohidazole was more effective in reducing symptoms than either of the topical preparations. Adverse events, mostly mild or moderate in severity, were reported by 7 (14.6%) of 48 patients who had received oral metronidazole and 4 (7.8%) of 51 women who used AVC suppositories. There were no adverse events reported by the 50 women who used clotrimazole vaginal tablets. CONCLUSIONS: Oral metronidazole was more effective in eradicating T. vaginalis than clotrimazole vaginal tablets or AVC vaginal suppositories. All three regimens reduced symptoms; oral metronidazole was more effective in reducing symptoms than either topical preparation.

Cephalosporin-metronidazole combinations in the management of intra-abdominal infections.

With our current understanding of antimicrobial pharmacokinetics and pharmacodynamics, optimal antimicrobial dosing strategies can be developed for a variety infectious processes. Herein, we discuss the clinical utility of a combination containing a third-generation cephalosporin plus metronidazole as compared to conventional single agents (cefoxitin and ampicillin-sulbactam) for the management intra-abdominal infections. At present, several studies have been performed that compare the bactericidal activity of such combinations to that of single agents for organisms commonly isolated from these intra-abdominal process. From these studies it appears that the use of a third-generation cephalosporin with strong activity against common aerobic organisms associated with intra-abdominal infections in combination with a potent anaerobic drug such as metronidazole provides improved antibacterial activity and optimizes the pharmacodynamic profile of the agents over the dosing interval compared to conventional single agents. As a result of the pharmacokinetic and pharmaco-dynamic superiority of the combination regimen, considerable pharmacoeconomic advantages may be realized with the clinical implementation of a third-generation cephalosporin plus metronidazole regimen. This approach should result in maximal clinical efficacy and is important not only for individual patient therapy, but also for formulary management decisions.

[Studies of compounds with potential antiparasitic action. VIII. New oxime ethers in the 1-thiochromone system]. / Badania zwiazków o potencjalnym dzialaniu przeciwpasozytniczym. VIII. Nowe etery oksymów w ukladzie 1-tiochromonu.

The 50% antitrichomonal concentration of 7 examined ethers (T. vaginalis strain N. 1/86, Roiron medium, safranine staining, 30 min.) was estimated by means of dose-response curve. The minimal mycostatic concentration (Candida albicans L-45, Geotrichum candidum; 3% Sabouraud agar, 37 degrees C, 24 hr) was calculated with the aid of regression equation. All examined ethers show in vitro a marked antitrichomonal effect comparable with activity of ornidazole or phenol. Mycostatic activity of new compounds is many times higher than activity of phenol, but considerably lower than that of clotrimazole. The strongest complex antitrichomonal and mycostatic effect-comparable to ornidazole or clotrimazole - shows the new derivative N,N-diethylaminoethyl oxime of 1-tioflavone (compound II), which is fairly toxic for mammal.