Abstract
Trichomonas vaginalis cases refractory to metronidazole (MTZ) treatment had been reported. This study aimed to the assessment of invitro metronidazole resistance among Trichomonas positive cases with treatment failure by determination of metronidazole minimal lethal concentration (MLC), and to the evaluation of the invitro efficacy of nitazoxanide (NTZ) as compared to metronidazole (MTZ) in both resistant and susceptible isolates. Drug testing was carried out by an aerobic tube assay where suspension of Trichomonas trophozoites was exposed for 24 and 48h to serial dilution of metronidazole and nitazoxanide. In refractory isolates n=30, median MLC conc. for MTZ was 100μg/ml versus 50μg/ml for NTZ (P<.0001). After 48h median MLC conc. for MTZ was 25μg/ml versus 12μg/ml for NTZ (P<.0001). NTZ against resistant isolates was twice as active as MTZ at 24h and increased to 2.5 times at 48h while in susceptible isolates, NTZ was twice as active as MTZ at both 24h and 48h. MTZ was about 8 times more active in susceptible than in resistant isolates. So, high doses of metronidazole in resistant cases will likely increase side effects. The study proved the activity of NTZ against trichomoniasis especially in cases with MTZ resistance.
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