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1.
Int J STD AIDS ; 31(3): 221-229, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31996095
2.
Am J Obstet Gynecol ; 222(2): 114-122, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31513780

RESUMO

Vaginitis is one of the most common causes of patient visits to gynecologists, primary care providers, and urgent care centers. However, many women leave without a clear diagnosis or experience recurrent symptoms despite treatment. The 3 most common etiologies of vaginitis are trichomonas, bacterial vaginosis, and vulvovaginal candidiasis, which account for an estimated 70% of cases. The remaining 30% may be related to other causes of vaginitis, including atrophic vaginitis, desquamative inflammatory vaginitis, and vaginal erosive disease. The purpose of this review is to describe the noncandidal causes of acute and recurrent vaginitis, with the goal of improving the likelihood of accurate diagnosis as well as efficient and effective therapy. We excluded candidal vaginitis from our review because there was a recently published review on this topic in the Journal. The clinical presentation and evaluation of patients with symptoms of vaginitis can be triaged into 1 of 2 diagnostic pathways: noninflammatory and inflammatory vaginitis. The most common noninflammatory cause is bacterial vaginosis. Features such as irritation, purulent discharge, and the presence of polymorphonuclear neutrophils are more suggestive of an inflammatory process. Trichomoniasis is the most common cause of inflammatory vaginitis. Other well-described forms of inflammatory vaginitis include atrophic vaginitis, desquamative inflammatory vaginitis, and erosive disease. We present a review of the pathogenesis, symptoms, examination findings, diagnostic testing, and treatment for each of these causes of noncandidal vaginitis.


Assuntos
Anti-Infecciosos/uso terapêutico , Vaginite Atrófica/diagnóstico , Candidíase Vulvovaginal/diagnóstico , Vaginite por Trichomonas/diagnóstico , Vaginose Bacteriana/diagnóstico , Administração Intravaginal , Administração Oral , Anti-Inflamatórios/uso terapêutico , Vaginite Atrófica/terapia , Clindamicina/uso terapêutico , Desidroepiandrosterona/uso terapêutico , Diagnóstico Diferencial , Terapia de Reposição de Estrogênios , Estrogênios/uso terapêutico , Feminino , Humanos , Hidrocortisona/uso terapêutico , Inflamação , Líquen Plano/diagnóstico , Líquen Plano/terapia , Metronidazol/análogos & derivados , Metronidazol/uso terapêutico , Penfigoide Mucomembranoso Benigno/diagnóstico , Penfigoide Mucomembranoso Benigno/terapia , Penfigoide Bolhoso/diagnóstico , Penfigoide Bolhoso/terapia , Pênfigo/diagnóstico , Pênfigo/terapia , Tamoxifeno/análogos & derivados , Tamoxifeno/uso terapêutico , Tinidazol/uso terapêutico , Vaginite por Trichomonas/terapia , Vaginite/diagnóstico , Vaginite/terapia , Vaginose Bacteriana/terapia
3.
Gac Med Mex ; 155(Suppl 1): S22-S27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31638607

RESUMO

Introduction: In Mexico, seroprevalence of Entamoeba histolytica is 8.4%. The intestinal amebiasis in patients with acute leukemia of novo, after the start of chemotherapy (CT) in the Hematology Service of the CMN 20 de Noviembre is 12%, even if patients show a negative baseline coprological test. Objective: To find out if the administration of tinidazole, in patients with acute leukemia and negative coprological test, at the beginning of the CT, decreases the incidence of amoebic colitis during the induction to remission. Method: Prospective and not comparative study. Patients with de novo diagnosis of acute leukemia who initiate induction and initial coprological CT. Tinidazole was indicated, 2 g/day for 5 days in the first week of CT started. They were monitored until the induction was concluded and hematopoietic recovery started. Results: 38 patients, 15 women and 23 men with a mean age of 44 years (16-72), with acute lymphoblastic leukemia 19, myeloblastic 16 and promyelocytic 3. Cases without and with intestinal amebiasis were 35 and 3, respectively. Patients with amebiasis only received tinidazole for 3 days and it was given 2 days after the CT started. Conclusion: Tinidazole, in patients with acute de novo leukemia who initiate induction CT, is effective in the prevention of intestinal amebiasis, during the induction stage, if administered at 2 g/day, for five days, starting on day 1 of the CT.


Assuntos
Amebicidas/uso terapêutico , Disenteria Amebiana/prevenção & controle , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Promielocítica Aguda/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Tinidazol/uso terapêutico , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Disenteria Amebiana/parasitologia , Feminino , Humanos , Quimioterapia de Indução/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
4.
Mater Sci Eng C Mater Biol Appl ; 105: 110017, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31546382

RESUMO

Hydroxyapatite (HAp) is a highly promising material as a drug carrier. The solubility, osteoinductivity, antibacterial properties and drug loading efficiency of HAp can be further enhanced by Zn doping. In this study, we carried out first-principles and molecular dynamics (MD) simulations to investigate the influence of Zn doping on the crystal structure and adsorption capacity of macromolecular drugs on HAp. Our results showed that the binding energy of doxorubicin (DOX) on HAp is significantly increased in consequence of Zn-doping. Moreover, the interaction between surface Ca ions and carbonyl-O mostly contributed to the adsorption. The binding energy of tinidazole on HAp was much lower than that observed for DOX. The number of active "O" atoms in the drug and binding stability were positively correlated. These simulations provide important insight into the understanding of drug adsorption on HAp or ion-doped HAp.


Assuntos
Doxorrubicina/química , Durapatita/química , Simulação de Dinâmica Molecular , Tinidazol/química , Zinco/química , Adsorção , Doxorrubicina/farmacologia , Conformação Molecular , Eletricidade Estática , Termodinâmica , Tinidazol/farmacologia
5.
Infez Med ; 27(3): 336-339, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31545780

RESUMO

Caused by the protozoan Giardia lamblia, giardiasis is one of the most common parasitic diarrheal infections affecting humans. Although a variety of antigiardial drugs are available to treat infections in humans, failure of conventional treatment with nitroimidazoles for giardiasis has been increasingly reported. We describe the follow-up of a patient with recurrent giardiasis refractory to nitroimidazoles. Despite the different therapies received, the symptomatology and parasitic forms of G. lamblia persisted in the patient. There is no standard treatment regimen for giardiasis refractory to nitroimidazoles. When treatment failure is confirmed, it is necessary to switch to second-line regimens.


Assuntos
Antiprotozoários/uso terapêutico , Giardia lamblia , Giardíase/tratamento farmacológico , Nitroimidazóis/uso terapêutico , Adulto , Albendazol/uso terapêutico , Antiprotozoários/administração & dosagem , Furazolidona/uso terapêutico , Giardia lamblia/efeitos dos fármacos , Humanos , Masculino , Metronidazol/administração & dosagem , Metronidazol/análogos & derivados , Metronidazol/uso terapêutico , Tiazóis/uso terapêutico , Tinidazol/uso terapêutico , Falha de Tratamento
6.
Orv Hetil ; 160(34): 1340-1345, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31423829

RESUMO

Introduction and aim: As the efficacy of the first-line traditional treatment used to eradicate Helicobacter pylori (H. p.) decreased below 75% in Hungary, a new protocol had to be created. Method: Supposing the success rate of the traditional therapy (14-day double dose of proton pump inhibitor [PPI], 1000 mg amoxicillin b.i.d., 500 mg clarithromycin b.i.d. [PAC]) to be 75% and the efficacy of the new protocol (10-day 120 mg bismuth dicitrate q.i.d., double dose PPI b.i.d., 500 mg tetracycline q.i.d. and 500 mg tinidazole b.i.d. [BQT]) to be 90%, we calculated 109 patients on each arm. Patients were recruited after upper gastrointestinal endoscopy from 5 endoscopic units in Vas county. The heterogeneity of groups, success rate and side effects of both therapies were evaluated by Fisher exact test; p<0.05 was considered significant. Results: 110 patients were included in the BQT and 109 patients in the PAC group. There was no heterogeneity between the two groups in age, gender and indication of eradication. H. p. eradication was successful in 103/110 (93.6%) in the BQT and 81/109 (74.3%) in the PAC group (p<0.001). The odds ratio in the BQT group for successful eradication was 5.05 (95% confidence interval: 2.02-14.42) as compared to the PAC group (p<0.001). The side effects of the two groups were similar, in the BQT group the frequency was 34.5%. Conclusion: 10 day-long BQT containing double dose PPI with 120 mg bismuth dicitrate q.i.d., 500 mg tetracycline q.i.d. and 500 mg tinidazole b.i.d. is recommended as the first-line treatment for the eradication of H. p. because of its high efficacy and tolerable side effects. Orv Hetil. 2019; 160(34): 1340-1345.


Assuntos
Antiácidos/administração & dosagem , Antibacterianos/administração & dosagem , Bismuto/administração & dosagem , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Inibidores da Bomba de Prótons/administração & dosagem , Adulto , Idoso , Amoxicilina/administração & dosagem , Amoxicilina/uso terapêutico , Antiácidos/uso terapêutico , Antibacterianos/uso terapêutico , Bismuto/uso terapêutico , Claritromicina/administração & dosagem , Claritromicina/uso terapêutico , Esquema de Medicação , Farmacorresistência Bacteriana , Quimioterapia Combinada , Endoscopia Gastrointestinal , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/isolamento & purificação , Humanos , Hungria , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico , Tetraciclina/administração & dosagem , Tetraciclina/uso terapêutico , Tinidazol/administração & dosagem , Tinidazol/uso terapêutico , Resultado do Tratamento
7.
Chem Pharm Bull (Tokyo) ; 67(8): 810-815, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31366830

RESUMO

Helicobacter pylori (H. pylori) infection is common and can result in gastric and duodenal ulcers, and in some cases, gastric lymphoma and cancer. Omeprazole (OMP)-in combination with clarithromycin (CLR), amoxicillin (AMX), tinidazole (TND), or metronidazole (MET)-is used in double or triple combination therapy for eradication of H. pylori. However, the roles of the drugs other than OMP are not clearly understood. Therefore, in the present study, we aimed to investigate any effects of these drugs on OMP metabolism by wild-type CYP2C19 using spectroscopy and enzyme kinetics. The dissociation constants (Kd) for CYP2C19 with OMP, CLR, AMX, TND, and MET were 8.6, 126, 156, 174, and 249 µM, respectively. The intrinsic clearance of OMP was determined to be 355 mL/min/µmol of CYP2C19. Metabolism of OMP was significantly inhibited by 69, 66, 28, and 40% in the presence of CLR, TND, AMX, and MET, respectively. Moreover, the combination of CLR and TND resulted in 76% inhibition of OMP metabolism, while the combination of AMX and MET resulted in 48% inhibition of OMP metabolism. Both combinations of drugs not only have antibacterial effects, but also enhance the effect of OMP by inhibiting its metabolism by CYP2C19. These results indicate that drug-drug interactions of co-administered drugs can cause complex effects, providing a basis for OMP dose adjustment when used in combination therapy for H. pylori eradication.


Assuntos
Antibacterianos/farmacologia , Citocromo P-450 CYP2C19/metabolismo , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Omeprazol/farmacologia , Amoxicilina/química , Amoxicilina/farmacologia , Antibacterianos/química , Antibacterianos/metabolismo , Cromatografia Líquida de Alta Pressão , Claritromicina/química , Claritromicina/farmacologia , Citocromo P-450 CYP2C19/química , Combinação de Medicamentos , Humanos , Metronidazol/química , Metronidazol/farmacologia , Testes de Sensibilidade Microbiana , Estrutura Molecular , Omeprazol/antagonistas & inibidores , Omeprazol/metabolismo , Tinidazol/química , Tinidazol/farmacologia
8.
Trials ; 20(1): 443, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324206

RESUMO

BACKGROUND: The foreskin is the main site of HIV acquisition in a heterosexual uncircumcised man, but many men in endemic countries are reluctant to undergo penile circumcision (PC). Observational studies suggest that proinflammatory anaerobic bacteria are enriched on the uncircumcised penis, where they may enhance HIV susceptibility through increased foreskin inflammatory cytokines and the recruitment of HIV-susceptible CD4+ target cells. This trial will examine the impact of systemic and topical antimicrobials on ex vivo foreskin HIV susceptibility. METHODS/DESIGN: This randomized, open-label clinical trial will randomize 125 HIV-negative Ugandan men requesting voluntary PC to one of five arms (n = 25 each). The control group will receive immediate PC, while the four intervention groups will defer PC for 1 month and be provided in the interim with either oral tinidazole, penile topical metronidazole, topical clindamycin, or topical hydrogen peroxide. The impact of these interventions on HIV entry into foreskin-derived CD4+ T cells will be quantified ex vivo at the time of PC using a clade A, R5 tropic HIV pseudovirus assay (primary endpoint); secondary endpoints include the impact of antimicrobials on immune parameters and the microbiota of the participant's penis and of the vagina of their female partner (if applicable), assessed by multiplex enzyme-linked immunosorbent assay and 16S rRNA sequencing. DISCUSSION: There is a critical need to develop acceptable, simple, and effective means of HIV prevention in men unwilling to undergo PC. This trial will provide insight into the causative role of the foreskin microbiota on HIV susceptibility, and the impact of simple microbiota-focused clinical interventions. This may pave the way for future clinical trials using low-cost, nonsurgical intervention(s) to reduce HIV risk in uncircumcised heterosexual men. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03412071 . Retrospectively registered on 26 January 2018.


Assuntos
Anti-Infecciosos/administração & dosagem , Bactérias/efeitos dos fármacos , Linfócitos T CD4-Positivos/efeitos dos fármacos , Clindamicina/administração & dosagem , Prepúcio do Pênis/microbiologia , Infecções por HIV/prevenção & controle , Peróxido de Hidrogênio/administração & dosagem , Metronidazol/administração & dosagem , Tinidazol/administração & dosagem , Administração Cutânea , Administração Oral , Anti-Infecciosos/efeitos adversos , Bactérias/imunologia , Bactérias/patogenicidade , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD4-Positivos/microbiologia , Circuncisão Masculina , Clindamicina/efeitos adversos , Feminino , Prepúcio do Pênis/virologia , Infecções por HIV/imunologia , Infecções por HIV/transmissão , Infecções por HIV/virologia , Heterossexualidade , Interações Hospedeiro-Patógeno , Humanos , Peróxido de Hidrogênio/efeitos adversos , Masculino , Metronidazol/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Tinidazol/efeitos adversos , Resultado do Tratamento , Uganda
9.
J Chromatogr Sci ; 57(8): 724-729, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31251331

RESUMO

A high performance liquid chromatography method had been developed and validated for rapid simultaneous separation and determination of three anti-helicobacter drugs, oxytetracycline (OXY), tinidazole (TIN) and esomeprazole (ESM) in human plasma within 6 minutes. Drugs extraction method from plasma was based on protein precipitation technique. Separation was carried out on a Equisil BDS C18 column (5 µm, 150 × 4.60 mm) using a mobile phase of acetonitrile: 0.025 M KH2PO4 (25: 75, v/v) adjusted to pH 3.50 with ortho-phosphoric acid at ambient temperature. The flow rate was 1 mL/min and maximum absorption was measured using Diode Array (DAD) detector at 285 nm. The retention times of OXY, TIN and ESM were recorded to be 2.68, 3.52 and 5.17 minutes, respectively, indicating a shorter analysis time. Limits of detection were also reported to be 0.10, 0.07 and 0.04 µg/mL for OXY, TIN and ESM, respectively, showing a high degree of the method sensitivity. The method was then validated according to FDA guidelines for the determination of the drugs clinically in human plasma specially regarding pharmacokinetic and bioequivalence studies.


Assuntos
Antibacterianos/sangue , Cromatografia Líquida de Alta Pressão/métodos , Esomeprazol/sangue , Oxitetraciclina/sangue , Tinidazol/sangue , Humanos , Limite de Detecção , Plasma/química
10.
Artigo em Inglês | MEDLINE | ID: mdl-31210116

RESUMO

BACKGROUND: Giardiasis is an important cause of waterborne and foodborne diarrhea, daycare center outbreaks, and traveler's diarrhea. OBJECTIVE: The study aimed to provide an update on the evaluation, diagnosis, and treatment of giardiasis. METHODS: A PubMed search was completed in Clinical Queries using the key terms "giardiasis", "Giardia lamblia", "Giardia duodenalis" and "Giardia intestinalis". The search strategy included metaanalyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature. Patents were searched using the key term "giardiasis" from www.freepatentsonline.com. RESULTS: Giardiasis is caused by the protozoan parasite Giardia lamblia. The parasite is transmitted by the fecal-oral route, frequently through ingestion of contaminated water and food or person-to person transmission. Risk factors for infection include children in day-care settings, child-care workers, institutionalized individuals, travelers in endemic areas, ingestion of contaminated or recreational water, immunodeficiency, cystic fibrosis, and oral-anal sex. Approximately 50 to 75% of infected children are asymptomatic. Other children present acute or chronic diarrhea. Direct fluorescent antibody tests that detect intact organisms, enzyme immunoassays that detect soluble antigens, and multiplex real-time polymerase chain reaction assays that detect specific genes of the parasite in stool samples have improved sensitivity and specificity compared with microscopic examination of stool specimens for the detection of Giardia trophozoites or cysts. Drugs used in the treatment of symptomatic giardiasis are reviewed in this study. Moreover, recent patents related to the management of giardiasis are also discussed. CONCLUSION: Metronidazole, tinidazole, and nitazoxanide are drugs of choice. Resistance to common antigiardial drugs has increased in recent years, therefore, the search for new molecular targets for antigiardial drugs is urgently needed. In general, treatment of asymptomatic carriers is not recommended. Purification of water supply is an important preventive measure.


Assuntos
Giardia/fisiologia , Giardíase/epidemiologia , Metronidazol/uso terapêutico , Tinidazol/uso terapêutico , Animais , Doenças Assintomáticas , Criança , Ensaios Clínicos como Assunto , Diarreia , Giardíase/diagnóstico , Giardíase/tratamento farmacológico , Humanos , Patentes como Assunto , Fatores de Risco
11.
Gac Med Mex ; 155(Suppl 1): S32-S37, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31182876

RESUMO

Introduction: In Mexico, seroprevalence of Entamoeba histolytica is 8.4%. The intestinal amebiasis in patients with acute leukemia of novo, after the start of chemotherapy (CT) in the Hematology Service of the CMN 20 de Noviembre is 12%, even if patients show a negative baseline coprological test. Objective: To find out if the administration of tinidazole, in patients with acute leukemia and negative coprological test, at the beginning of the CT, decreases the incidence of amoebic colitis during the induction to remission. Method: Prospective and not comparative study. Patients with de novo diagnosis of acute leukemia who initiate induction and initial coprological CT. Tinidazole was indicated, 2 g/day for 5 days in the first week of CT started. They were monitored until the induction was concluded and hematopoietic recovery started. Results: 38 patients, 15 women and 23 men with a mean age of 44 years (16-72), with acute lymphoblastic leukemia 19, myeloblastic 16 and promyelocytic 3. Cases without and with intestinal amebiasis were 35 and 3, respectively. Patients with amebiasis only received tinidazole for 3 days and it was given 2 days after the CT started. Conclusion: Tinidazole, in patients with acute de novo leukemia who initiate induction CT, is effective in the prevention of intestinal amebiasis, during the induction stage, if administered at 2 g/day, for five days, starting on day 1 of the CT.


Assuntos
Colite/prevenção & controle , Colite/parasitologia , Disenteria Amebiana/prevenção & controle , Tinidazol/uso terapêutico , Adolescente , Adulto , Idoso , Antineoplásicos/uso terapêutico , Colite/complicações , Disenteria Amebiana/complicações , Feminino , Humanos , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
12.
Int J Pharm ; 562: 66-75, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30878588

RESUMO

In view of the high incidence and long-term treatment of dental caries, personalized dental fillers with long therapeutic action have broad application prospects in the dental clinic. The objective of this study was to fabricate and evaluate novel dental fillers using state-of-the-art 3D printing technology. Tinidazole (TNZ), a commonly used antibacterial drug in the dental clinic, was chosen as the model compound. Models of molars with carious cavities were obtained via 3D scanning. TNZ dental fillers were indirectly produced by thermal pressing using customized 3D printed molds. In addition, bio-relevant in vitro dissolution and mechanical testing methods were developed using customized 3D printed release and compression molds, respectively. It was observed that the formability, mechanical properties, and release behavior of the TNZ dental fillers were affected by mold materials, plasticizers, and release modifiers. The developed dental fillers were capable of sustained releasing TNZ over one week. The TNZ release characteristics can be tailored based on clinical requirements by varying hydroxypropyl methylcellulose E5 (HPMC-E5) concentrations and filler dimensions. Moreover, computational simulation based on the finite element method showed that the biomechanical behavior of the TNZ dental fillers met the daily use requirement. The present study demonstrated that the state-of-the-art 3D printing technology can be used to design and fabricate personalized dental fillers with high mechanical strength and "on-demand" drug release characteristics.


Assuntos
Antibacterianos/química , Materiais Dentários/química , Tinidazol/química , Liberação Controlada de Fármacos , Derivados da Hipromelose/química , Plastificantes/química , Impressão Tridimensional
13.
J Gastrointestin Liver Dis ; 28(1): 11-14, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30851166

RESUMO

BACKGROUND AND AIM: Standard 10-day sequential therapy is advised as first-line therapy for Helicobacter pylori (H. pylori) eradication by current Italian guidelines. Some data suggested that a 14-day regimen may achieve higher eradication rates. This study compared the efficacy of sequential therapy administered for either 10- or 14-days. METHODS: This prospective, multicenter, open-label study enrolled patients with H. pylori infection without previous treatment. Patients were receiving a sequential therapy for either 10 or 14 days with esomeprazole 40 mg and amoxicillin 1 g (5 or 7 days) followed by esomeprazole 40 mg, clarithromycin 500 mg and tinidazole 500 mg (5 or 7 days), all given twice daily. Bacterial eradication was checked using 13C-urea breath test. Eradication cure rates were calculated at both Intention-to-treat (ITT) and per-protocol (PP) analyses. RESULTS: A total of 291 patients were enrolled, including 146 patients in 10-day and 145 in the 14-day regimen. The eradication rates were 87% (95% CI = 81.5-92.4) and 90.3% (95% CI = 85.5-95.1) at ITT analysis with the 10- and 14-day regimen, respectively, and 92.7% (95% CI = 88.3-97) and 97% (95% CI = 94.2-99.9) at PP analysis (p =0.37). Among patients, who earlier had interrupted therapy, bacterial eradication was achieved in 8 out of 9 who completed the first therapy phase and performed at least >/=3 days of triple therapy in the second phase. CONCLUSION: This study found that both 10- and 14-day sequential therapies achieved a high eradication rate for first-line H. pylori therapy in clinical practice.


Assuntos
Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Claritromicina/administração & dosagem , Esomeprazol/administração & dosagem , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Inibidores da Bomba de Prótons/administração & dosagem , Tinidazol/administração & dosagem , Adulto , Amoxicilina/efeitos adversos , Antibacterianos/efeitos adversos , Carga Bacteriana , Claritromicina/efeitos adversos , Esquema de Medicação , Quimioterapia Combinada , Esomeprazol/efeitos adversos , Feminino , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/microbiologia , Helicobacter pylori/patogenicidade , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inibidores da Bomba de Prótons/efeitos adversos , Fatores de Tempo , Tinidazol/efeitos adversos , Resultado do Tratamento
14.
Infez Med ; 27(1): 58-67, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30882380

RESUMO

Five-nitroimidazole (5-NI) compounds are among the most commonly used medications in the treatment of giardiasis. However, after more than five decades of their initial indication for such treatment, there are some concerns about the efficacy of 5-NIs in giardiasis. This study sought to compare the efficacy of any 5-NI with any other antigiardial drug for the treatment of Cuban children with giardiasis. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched CUMED, EBSCOhost and PubMed databases. Two reviewers independently assessed trial eligibility, trial quality and extracted appropriate data. The primary outcome was the parasitological cure. The effect estimate was the pooled relative risk (RR) with 95% confidence intervals (CI). We included seven RCTs in the systematic review, involving a total of 1046 children. When the effect of 5-NIs was compared with that of benzimidazole compounds, the pooled effect was significant and favored 5-NIs [the relative risk (RR) is 1.35, 95% CI =1.05 to 1.75], with high heterogeneity (4 studies, I2 =79%). Compared with chloroquine, the pooled effects of the 5-NIs were not significant [RR is 0.96, 95% CI=0.79 to 1.18, (2 studies, I2=68%)]. Our results support the use of 5-NIs (mainly tinidazole) as first-line therapy for Cuban pediatric patients infected with Giardia and may continue being used as reference drugs in future RCTs of giardiasis. These data could help inform policy decisions in Cuba. Caution is needed in extrapolating such data in other settings.


Assuntos
Antiprotozoários/uso terapêutico , Benzimidazóis/uso terapêutico , Giardíase/tratamento farmacológico , Nitroimidazóis/uso terapêutico , Criança , Cloroquina/uso terapêutico , Cuba , Humanos , Paromomicina/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Tiazóis/uso terapêutico , Tinidazol/uso terapêutico , Resultado do Tratamento
15.
Cochrane Database Syst Rev ; 1: CD006085, 2019 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-30624763

RESUMO

BACKGROUND: Infection with the protozoan Entamoeba histolytica is common in low- and middle-income countries, and up to 100,000 people with severe disease die every year. Adequate therapy for amoebic colitis is necessary to reduce illness, prevent development of complicated disease and extraintestinal spread, and decrease transmission. OBJECTIVES: To evaluate antiamoebic drugs for treating amoebic colitis. SEARCH METHODS: We searched the available literature up to 22 March 2018. We searched the Cochrane Infectious Diseases Group Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, mRCT, and conference proceedings. We contacted individual researchers, organizations, and pharmaceutical companies, and we checked reference lists. SELECTION CRITERIA: Randomized controlled trials of antiamoebic drugs given alone or in combination, compared with placebo or another antiamoebic drug, for treating adults and children with a diagnosis of amoebic colitis. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the eligibility and methodological quality of trials and extracted and analysed the data. We calculated clinical and parasitological failure rates and rates of relapse and adverse events as risk ratios (RRs) with 95% confidence intervals (CIs), using a random-effects model. We determined statistical heterogeneity and explored possible sources of heterogeneity using subgroup analyses. We carried out sensitivity analysis by using trial quality to assess the robustness of reported results. MAIN RESULTS: In total, 41 trials (4999 participants) met the inclusion criteria of this review. In this update, we added four trials to the 37 trials included in the first published review version. Thirty trials were published over 20 years ago. Only one trial used adequate methods of randomization and allocation concealment, was blinded, and analysed all randomized participants. Only one trial used an E histolytica stool antigen test, and two trials used amoebic culture.Tinidazole may be more effective than metronidazole for reducing clinical failure (RR 0.28, 95% CI 0.15 to 0.51; 477 participants, eight trials; low-certainty evidence) and is probably associated with fewer adverse events (RR 0.65, 95% CI 0.46 to 0.92; 477 participants, 8 trials; moderate-certainty evidence). Compared with metronidazole, combination therapy may result in fewer parasitological failures (RR 0.36, 95% CI 0.15 to 0.86; 720 participants, 3 trials; low-certainty evidence), but we are uncertain which combination is more effective than another. Evidence is insufficient to allow conclusions regarding the efficacy of other antiamoebic drugs. AUTHORS' CONCLUSIONS: Compared with metronidazole, tinidazole may be more effective in reducing clinical failure and may be associated with fewer adverse events. Combination drug therapy may be more effective for reducing parasitological failure compared with metronidazole alone. However, these results are based mostly on small trials conducted over 20 years ago with a variety of poorly defined outcomes. Tests that detect E histolytica more accurately are needed, particularly in countries where concomitant infection with other bacteria and parasites is common.


Assuntos
Amebicidas/uso terapêutico , Disenteria Amebiana/tratamento farmacológico , Entamoeba histolytica , Amebicidas/efeitos adversos , Animais , Quimioterapia Combinada , Disenteria Amebiana/parasitologia , Humanos , Metronidazol/efeitos adversos , Metronidazol/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Tinidazol/efeitos adversos , Tinidazol/uso terapêutico
16.
Sex Transm Dis ; 46(1): e1-e2, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30106840

RESUMO

Metronidazole-resistant trichomoniasis is an uncommon condition that presents significant therapeutic challenges. Combination therapy with high-dose oral tinidazole and vaginal paromomycin cream has been uniformly successful. We present a case report of a patient who responded to combination therapy with high-dose oral tinidazole and intravaginal paromomycin.


Assuntos
Metronidazol/uso terapêutico , Tinidazol/uso terapêutico , Vaginite por Trichomonas/tratamento farmacológico , Trichomonas vaginalis/efeitos dos fármacos , Administração Intravaginal , Administração Oral , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Paromomicina/uso terapêutico , Resultado do Tratamento , Vaginite por Trichomonas/diagnóstico , Vagina/parasitologia
17.
Pharm Dev Technol ; 24(3): 348-356, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29799300

RESUMO

Microporous polymeric matrices prepared from poly(ɛ-caprolactone) [PCL] were evaluated for controlled vaginal delivery of the antiprotozoal agent (tinidazole) in the treatment of the sexually transmitted infection, trichomoniasis. The matrices were produced by rapidly cooling co-solutions of PCL and tinidazole in acetone to -80 °C to induce crystallisation and hardening of the polymer. Tinidazole incorporation in the matrices increased from 1.4 to 3.9% (w/w), when the drug concentration in the starting PCL solution was raised from 10 to 20% (w/w), giving rise to drug loading efficiencies up to 20%. Rapid 'burst release' of 30% of the tinidazole content was recorded over 24 h when the PCL matrices were immersed in simulated vaginal fluid. Gradual drug release occurred over the next 6 days resulting in delivery of around 50% of the tinidazole load by day 7 with the released drug retaining antiprotozoal activity at levels almost 50% that of the 'non-formulated' drug in solution form. Basic modelling predicted that the concentration of tinidazole released into vaginal fluid in vivo from a PCL matrix in the form of an intravaginal ring would exceed the minimum inhibitory concentration against Trichomonas vaginalis. These findings recommend further investigation of PCL matrices as intravaginal devices for controlled delivery of antiprotozoal agents in the treatment and prevention of sexually transmitted infections.


Assuntos
Antitricômonas/administração & dosagem , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Tinidazol/administração & dosagem , Tricomoníase/tratamento farmacológico , Administração Intravaginal , Antitricômonas/química , Antitricômonas/farmacologia , Química Farmacêutica/métodos , Cristalização , Preparações de Ação Retardada , Sistemas de Liberação de Medicamentos , Liberação Controlada de Fármacos , Feminino , Humanos , Testes de Sensibilidade Parasitária , Polímeros/química , Porosidade , Doenças Sexualmente Transmissíveis/parasitologia , Tinidazol/química , Tinidazol/farmacologia , Vagina/parasitologia
18.
J Chromatogr Sci ; 57(1): 81-86, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30395212

RESUMO

Sensitive, selective and accurate high-performance thin layer chromatographic HPTLC method for quantitative determination of Norfloxacin (NF), Tinidazole (TZ) and 2-Methyl-5-nitroimidazole (MNZ) as potential impurity of Tinidazole is developed and validated in the presented work. Calibration curves were linear over the concentration ranges of 0.4-2.4, 0.4-1.6, 0.2-1.2 µg/band for NF, TZ and MNZ, respectively. The method depends on separation and quantitation of NF, TZ and MNZ on aluminium plates pre-coated with silica gel HPTLC 60F254 as stationary-phase using chloroform: methanol: formic acid (7.5:1: 0.3, by volume) as developing system followed by densitometric measurement of bands at 298 nm. The developed method was validated and proved to meet the requirements delineated by ICH guidelines with respect to linearity, accuracy, precision, specificity and robustness. The validated method was successfully applied for determination of studied drugs in bulk powders and in their pharmaceutical formulation indicating the ability of proposed method to be used for routine quality control analysis of these drugs.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Cromatografia em Camada Delgada/métodos , Norfloxacino/análise , Tinidazol/análise , Contaminação de Medicamentos , Limite de Detecção , Modelos Lineares , Norfloxacino/química , Reprodutibilidade dos Testes , Tinidazol/química
19.
Acta Cir Bras ; 33(11): 945-953, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30517321

RESUMO

PURPOSE: To investigate the effect of oxymatrine on periodontitis in rats and related mechanism. Methods: Ninety SD rats were divided into control, model, 10, 20 and 40 mg/kg oxymatrine and tinidazole groups. The periodontitis model was established in later 5 groups. The 10, 20 and 40 mg/kg oxymatrine groups were intragastrically administrated with 10, 20 and 40 mg/kg oxymatrine, respectively. The tinidazole group was intragastrically administrated with 100 mg/kg tinidazole. The treatment duration was 4 weeks. The tooth mobility, gingival and plaque indexes, serum inflammatory factor levels and gingival tissue matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinase (TIMP) protein levels were detected. Results: After treatment, compared with model group, in 40 mg/kg oxymatrine group the rat general conditions were obviously improved, the tooth mobility, gingival index and plaque index were significantly decreased (P<0.05), the serum tumor necrosis factor-α, interleukin-1ß and prostaglandin E2 levels were significantly decreased (P<0.05), the MMP-2 and MMP-9 protein levels were significantly decreased (P<0.05), and the TIMP-2 protein level was significantly increased (P<0.05). Conclusions: Oxymatrine can alleviate the experimental periodontitis in rats. The mechanism may be related to its inhibiting inflammatory factor secretion and regulating MMPs/TIMP protein expression.


Assuntos
Alcaloides/farmacologia , Anti-Inflamatórios/farmacologia , Metaloproteinases da Matriz/efeitos dos fármacos , Periodontite/tratamento farmacológico , Quinolizinas/farmacologia , Inibidores Teciduais de Metaloproteinases/efeitos dos fármacos , Animais , Índice de Placa Dentária , Dinoprostona/sangue , Feminino , Gengiva/patologia , Interleucina-1beta/sangue , Masculino , Metaloproteinases da Matriz/análise , Periodontite/metabolismo , Distribuição Aleatória , Ratos Sprague-Dawley , Valores de Referência , Reprodutibilidade dos Testes , Tinidazol , Inibidores Teciduais de Metaloproteinases/análise , Resultado do Tratamento , Fator de Necrose Tumoral alfa/sangue
20.
Indian J Pharmacol ; 50(4): 197-203, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30505056

RESUMO

BACKGROUND: From the past five decades, metronidazole and tinidazole have been used for treating nonresistant and resistant giardiasis and trichomoniasis. However, due to the occurrence of drug resistance to standard therapy idealizes us to explore some additional therapies which is cost-effective, easy accessibility, and natural which has least side effects. Manuka honey obtained from Leptospermum scoparium is well known for its antibacterial and wound healing properties and is thought to be a better option as an additional therapy. OBJECTIVE: The present study was conducted to find out the effect of manuka honey on anaerobic protozoans that includes Giardia and Trichomonas under in vitro conditions in comparison to metronidazole and tinidazole. MATERIALS AND METHODS: Axenic culture of Giardia lamblia strain Portland 1 and Trichomonas vaginalis strain 413 was used for drug sensitivity assay to tinidazole, metronidazole, and manuka honey with the highest concentration of 17.1 µg/ml, 24.7 µg/ml, and 50%v/v by using (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, a tetrazole). For this, head-to-head comparison has been done and IC 50 of the standard drug as well as manuka honey was calculated. RESULTS: The result showed that percentage inhibition on the growth of both the parasites is dependent on concentration as well as exposure time of the drug. The calculated IC 50 was found to be 5.6%v/v and 1.5%v/v for manuka honey with respect to G. lamblia and T. vaginalis. CONCLUSION: The present study suggests that manuka honey can be used as an additional therapy for the patient with giardiasis or trichomoniasis. However, in vivo study in the near future will elucidate more about the effectiveness of honey in treating parasitic infections.


Assuntos
Antiprotozoários/farmacologia , Giardia lamblia/efeitos dos fármacos , Mel , Trichomonas vaginalis/efeitos dos fármacos , Antiprotozoários/administração & dosagem , Giardíase/tratamento farmacológico , Giardíase/parasitologia , Concentração Inibidora 50 , Leptospermum/química , Metronidazol/farmacologia , Fatores de Tempo , Tinidazol/farmacologia , Tricomoníase/tratamento farmacológico , Tricomoníase/parasitologia
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