Administration Of Metronidazole Research Articles

Analyzing the Efficacy of Metronidazole as Additional Surgical Site Infection Prophylaxis in Patients Undergoing Hysterectomy [ID 2683482

INTRODUCTION: The American College of Obstetricians and Gynecologists recommends cefazolin for antibiotic surgical prophylaxis for hysterectomy procedures. In 2018, hysterectomy surgical site infection (SSI) data at John Peter Smith Hospital demonstrated a higher proportion of anaerobic growth identified on cultures. The addition of metronidazole with cefazolin became surgical prophylaxis protocol at our institution. The purpose of the study is to compare rates of non-superficial SSI before and after the addition of metronidazole in hysterectomy procedures. METHODS: This was a retrospective cohort study of patients who underwent hysterectomy of any surgical approach from January 2015 to July 2023. The primary exposure of interest was administration of metronidazole with additional covariates including age, body mass index, diabetes, oncology status, and wound class. The association between metronidazole administration and non-superficial SSI was examined using a logistic regression model. Appropriate waiver was received from the institutional IRB. RESULTS: Two thousand five hundred thirty-four hysterectomies were included in our cohort. 1,207 (44%) cases had metronidazole administration, with 98% of those cases occurring after the antibiotic was incorporated into the protocol. Of the patients who did not receive metronidazole, 49 (3.7%) patients had a non-superficial SSI compared to 14 (1.2%) patients that had a non-superficial SSI with metronidazole administration. After adjusting for age and oncology status, patients who did not receive metronidazole had higher odds of having a SSI compared those who did (adjusted odds ratio [aOR]: 3.6; 95% CI: 1.97, 6.3; P≤.0001). CONCLUSION: The results demonstrate potential infection prevention benefit with metronidazole to patients undergoing hysterectomy, supporting the institutional prophylaxis protocol. The findings could have further implications across hospitals with similar patient populations.

Posterior reversible encephalopathy syndrome associated with antibiotic therapy: a case report and systematic review.

Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition associated with different etiologies, including antibiotic therapy. To date, most data regarding antibiotic-related PRES are limited to case reports and small case series. Here, we report a novel case description and provide a systematic review of the clinico-radiological characteristics and prognosis of available cases of PRES associated with antibiotic therapy. We performed a systematic literature search in PubMed and Scopus from inception to 10 January 2024, following PRISMA guidelines and a predefined protocol. The database search yielded 12 subjects (including our case). We described the case of a 55-year-old female patient with PRES occurring one day after administration of metronidazole and showing elevated serum neurofilament light chain protein levels and favorable outcome. In our systematic review, antibiotic-associated PRES was more frequent in female patients (83.3%). Metronidazole and fluoroquinolones were the most reported antibiotics (33.3% each). Clinical and radiological features were comparable to those of PRES due to other causes. Regarding the prognosis, about one third of the cases were admitted to the intensive care unit, but almost all subjects (90.0%) had a complete or almost complete clinical and radiological recovery after prompt cessation of the causative drug. Antibiotic-associated PRES appears to share most of the characteristics of classic PRES. Given the overall good prognosis of the disease, it is important to promptly diagnose antibiotic-associated PRES and discontinue the causative drug.

Minocycline/Amoxicillin-Based Bismuth Quadruple Therapy for Helicobacter pylori Eradication: A Pilot Study.

The common adverse effects and the complicated administration of tetracycline and metronidazole greatly affect the clinical application of the classical bismuth quadruple therapy (BQT) for Helicobacter pylori eradication. This pilot study aimed to evaluate the efficacy and safety of minocycline/amoxicillin-based BQT for H. pylori eradication. Firstly, consecutive H. pylori isolates collected at West China Hospital of Sichuan University between 2018 and 2021 were included for susceptibility testing of tetracycline and minocycline using E-test strips. Secondly, both treatment-naïve and experienced patients were included to receive a 14-day minocycline/amoxicillin-based BQT: esomeprazole 40 mg or vonoprazan 20 mg, bismuth colloidal pectin 300 mg, amoxicillin 1000 mg, and minocycline 100 mg, all given twice daily. Among a total of 101 H. pylori isolates, tetracycline resistance was 3.0%, whereas minocycline resistance was nil. A total of 114 patients (treatment-naïve/experienced, 72/42) received the minocycline/amoxicillin-based BQT. The overall intention-to-treat (ITT) and per protocol (PP) eradication rates were 94.7% (108/114) and 97.3% (108/111), respectively. The ITT and PP eradication rates were 91.7% (66/72) and 95.7% (66/69) among the treatment-naïve patients, and both were 100.0% among the treatment-experienced patients. No serious adverse event was recorded. This pilot study suggests that minocycline/amoxicillin-based BQT is an excellent therapy for H. pylori eradication.

PSIX-4 A Veterinary Gastrointestinal Diet Affects Fecal Characteristics, Metabolites, Bile Acids, and Microbiota Concentrations of Antibiotic-Treated Cats

Abstract Antibiotics are often used to treat animals with gastrointestinal diseases or infections, but their use is known to have negative effects on the intestinal microbiota community. Identifying dietary strategies that may aid in the recovery from antibiotic use is of interest. The objective of this study was to determine how a veterinary gastrointestinal diet affected the fecal characteristics and metabolite, bile acid (BA), and microbiota concentrations of cats recovering from metronidazole administration. Twenty-four healthy adult cats were used in an 8-wk completely randomized design study. The study began with a 2-wk baseline phase where all cats consumed a leading grocery brand dry diet (GBD; wk 0 to wk 2). Over the next 2 wk, cats continued to consume GBD and received metronidazole (20 mg/kg BW; wk 2 to wk 4). At wk 4, cats were randomly allotted to one of two treatments [GBD; Blue Buffalo Gastrointestinal Support (BB)] for the remaining 4 wk (wk 5 to wk 8). Fecal scores were recorded daily, and fresh fecal samples were collected at wk 2, 4, 5, 6, 7, and 8 for measurement of pH, dry matter, and metabolite and BA concentrations. Fecal microbiota were analyzed by 16S rRNA sequencing and qPCR, which was used to calculate dysbiosis index. All data were analyzed as repeated measures using the Mixed Models procedure of SAS 9.4, with treatment treated as a fixed effect, cat as a random effect, and significance set at P< 0.05 and trends at P < 0.10. Metronidazole administration had dramatic effects on the outcomes measured, including increased fecal scores (looser stools), reduced fecal pH and dry matter %, reduced fecal short-chain fatty acid (SCFA), branched-chain fatty acid, ammonia, phenol, and indole concentrations, and altered fecal BA concentrations (increased primary BA; reduced secondary BA). Furthermore, fecal bacterial alpha diversity was reduced, dysbiosis index was increased, and the abundance of several individual bacterial taxa were altered. Fecal outcome variables partially recovered over the next 4 wk, with some being impacted by diet. The change in fecal acetate concentrations were greater and the change in total SCFA concentrations tended to be greater in cats fed BB. Dysbiosis index and alpha diversity measures slowly recovered over 4 wk, without differences due to diet. Recovery of about 20 bacterial genera were impacted by diet. Primary and secondary BA concentrations and ratios demonstrated a prolonged impairment of primary to secondary BA conversion. Most of these changes were an effect of time, but the change of fecal cholic acid concentrations were less in cats fed BB. In conclusion, our data demonstrate that metronidazole is a powerful antibiotic that has long-lasting effects on the fecal microbiota and metabolites of cats. The veterinary gastrointestinal diet tested aided in the recovery of some variables measured.

PSIX-3 A Veterinary Gastrointestinal Low-Fat Diet Affects Fecal Characteristics, Metabolites, Bile Acids, and Microbiota Concentrations of Antibiotic-Treated Dogs

Abstract In a recent dog study, the antibiotic metronidazole proved to be an effective disruptor of the fecal microbiota and resulted in looser stools and altered fecal bile acid (BA) profiles. Recovery took several weeks and was aided by a dietary supplement. The objective of this study was to determine how a veterinary gastrointestinal low-fat diet affected the fecal characteristics and metabolite, BA, and microbiota concentrations of dogs recovering from metronidazole administration. Twenty-four healthy adult dogs were used in an 8-wk completely randomized design study. The study began with a 2-wk baseline phase where all dogs consumed a leading grocery brand dry kibble diet (GBD; wk 0 to wk 2). Over the next 2 wk, dogs continued to consume GBD and received metronidazole (20 mg/kg BW; wk 2 to wk 4). At wk 4, dogs were randomly allotted to one of two treatments [GBD; Blue Buffalo Gastrointestinal Support Low-Fat (BB)] for the remaining 4 wk (wk 5 to wk 8). Fecal scores were recorded daily, and fresh fecal samples were collected at wk 2, 4, 5, 6, 7, and 8 for measurement of pH, dry matter, and metabolite and bile acid concentrations. Fecal microbiota populations were also analyzed by 16S rRNA sequencing and qPCR, which was used to calculate dysbiosis index. All data were analyzed as repeated measures using the Mixed Models procedure of SAS 9.4, with treatment treated as a fixed effect, dog as a random effect, and significance set at P < 0.05. As anticipated, metronidazole administration increased (P < 0.0001) fecal scores (looser stools) and drastically altered (P < 0.05) fecal metabolite concentrations, reducing fecal short-chain fatty acid (SCFA), branched-chain fatty acid (BCFA), phenol, and indole concentrations, increasing primary BA concentrations, and decreasing secondary bile acid concentrations. Metronidazole dramatically impacted fecal microbiota populations by reducing alpha diversity, altering the abundance of multiple bacterial taxa, and increasing dysbiosis index. Fecal outcome variables recovered over the next 4 wk, with some being impacted by diet. The change in fecal SCFA and immunoglobulin A concentrations were greater (P < 0.01), while the change in fecal BCFA, phenol, and indole concentrations were decreased (P < 0.05) in dogs fed BB. Dysbiosis index and alpha diversity measures recovered quickly for all dogs and without dietary effects. Recovery of over 25 bacterial genera were impacted by diet (P < 0.05). While many bacterial taxa returned to baseline levels after 4 wk, others had still not fully recovered. Fecal BA concentrations recovered quickly for all dogs. The change in lithocholic acid concentration was less (P < 0.0001) in dogs fed BB, but other BA concentrations were not affected by diet. In conclusion, metronidazole drastically alters the fecal microbiota and metabolites of dogs. While most variables return to normal over time, a veterinary gastrointestinal diet may aid in the recovery.

Association between perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in paediatric uncomplicated appendectomy: a Swiss retrospective cohort study

ObjectiveWe aimed to evaluate the association between post-appendectomy SSI rates and the two most commonly used regimens for perioperative antimicrobial prophylaxis in Swiss children.MethodsWe conducted a retrospective cohort study, analysing data from the Swiss national SSI surveillance database with a study period from 2014 to 2018. All hospitals undertaking paediatric appendectomies in Switzerland participate in the surveillance. We compared the cumulative incidence and odds of post-appendectomy SSI within 30 days of surgery in children ≤ 16 years of age undergoing appendectomy for uncomplicated appendicitis and receiving perioperative antimicrobial prophylaxis with cefuroxime plus metronidazole or with amoxicillin/clavulanic acid using multivariable adjusted logistic regression and propensity-score matching.ResultsA total of 6207 cases were recorded in the study time frame. Overall SSI cumulative incidence was 1.9% (n = 119). 4256 children (54.9% male, median (IQR) age 12 [10, 14] years) received either cefuroxime plus metronidazole (n = 2348, 53.8% male) or amoxicillin/clavulanic acid (n = 1491, 57.0% male). SSI cumulative incidence was 1.1% (25/2348) among children receiving cefuroxime plus metronidazole and 2.8% (42/1491, p < 0.001) when receiving amoxicillin/clavulanic acid. The administration of cefuroxime plus metronidazole was associated with statistically significantly lower SSI odds compared to amoxicillin/clavulanic acid (aOR 0.35, 95%CI [0.20, 0.61], p < 0.001), and this was confirmed upon propensity-score matching.ConclusionWe found lower odds of post-appendectomy SSI in children receiving cefuroxime plus metronidazole compared to amoxicillin/clavulanic acid. Treating amoxicillin/clavulanic acid as the baseline, only 55 children need to receive cefuroxime plus metronidazole perioperative prophylaxis to avert one SSI. Existing guidelines recommending amoxicillin/clavulanic acid may need to be revised.Trial registration ISRCTN47727811, registered retrospectively.

Ring1a protects against colitis through regulating mucosal immune system and colonic microbial ecology

ABSTRACT Inflammatory bowel disease (IBD) represents a prominent chronic immune-mediated inflammatory disorder, yet its etiology remains poorly comprehended, encompassing intricate interactions between genetics, immunity, and the gut microbiome. This study uncovers a novel colitis-associated risk gene, namely Ring1a, which regulates the mucosal immune response and intestinal microbiota. Ring1a deficiency exacerbates colitis by impairing the immune system. Concomitantly, Ring1a deficiency led to a Prevotella genus-dominated pathogenic microenvironment, which can be horizontally transmitted to co-housed wild type (WT) mice, consequently intensifying dextran sodium sulfate (DSS)-induced colitis. Furthermore, we identified a potential mechanism linking the altered microbiota in Ring1aKO mice to decreased levels of IgA, and we demonstrated that metronidazole administration could ameliorate colitis progression in Ring1aKO mice, likely by reducing the abundance of the Prevotella genus. We also elucidated the immune landscape of DSS colitis and revealed the disruption of intestinal immune homeostasis associated with Ring1a deficiency. Collectively, these findings highlight Ring1a as a prospective candidate risk gene for colitis and suggest metronidazole as a potential therapeutic option for clinically managing Prevotella genus-dominated colitis.

Metronidazole-induced linear immunoglobulin A disease in a patient suffering from ulcerative colitis: a case report and focused review of the literature

Linear immunoglobulin (Ig) A disease (LAD) is a rare autoimmune blistering dermatosis caused by linear deposition of IgA1 along the dermoepidermal junction of skin and mucosae. It can affect both children and adults. Although idiopathic in most cases, it can also be associated with infections, malignancies, or drug administration. Among medications, antibiotics are most commonly responsible, particularly vancomycin. We report the case of a 51-year-old female patient who developed mucocutaneous LAD after oral metronidazole administration, which was confirmed by histopathological examination and direct immunofluorescence of one of the bullous lesions. Lesions rapidly cleared after metronidazole discontinuation and a short course of oral methylprednisolone and dapsone. To our knowledge, this is the third reported case of metronidazole-induced LAD, and the first in which metronidazole was not administered in combination with other antibiotics such as ceftriaxone.

Mechanistic Assessment of Anise Seeds and Clove Buds against the Neurotoxicity Caused by Metronidazole in Rats: Possible Role of Antioxidants, Neurotransmitters, and Cytokines.

Long-term use of the nitroimidazole-derived antibiotic metronidazole has been associated with neuronal damage due to its ability to cross the blood-brain barrier. Polyphenol-rich plants, such as anise seeds and clove buds, are suggested to have neuroprotective effects. However, their intracellular protective pathway against metronidazole-induced neurotoxicity remains unexplored. This study aims to evaluate the potential neuroprotective benefits of anise seeds and clove buds and elucidate the proposed metronidazole-induced neurotoxicity mechanism. This study divided rats into six groups, each containing six rats. In Group I, the control group, rats were administered saline orally. Group II rats received 200 mg/kg of metronidazole orally. Group III rats received 250 mg/kg b.w. of anise seed extract and metronidazole. Group IV rats received 500 mg/kg b.w. of anise seed extract (administered orally) and metronidazole. Group V rats received 250 mg/kg b.w. of clove bud extract (administered orally) and metronidazole. Group VI rats were administered 500 mg/kg b.w. of clove bud extract and metronidazole daily for 30 consecutive days. The study evaluated the phenolic compounds of anise seeds and clove buds. Moreover, it assessed the inflammatory and antioxidant indicators and neurotransmitter activity in brain tissues. A histological examination of the brain tissues was conducted to identify neuronal degeneration, brain antioxidants, and apoptotic mRNA expression. The study found that metronidazole treatment significantly altered antioxidant levels, inflammatory mediators, and structural changes in brain tissue. Metronidazole also induced apoptosis in brain tissue and escalated the levels of inflammatory cytokines. Oral administration of metronidazole resulted in a decrease in GABA, dopamine, and serotonin and an increase in ACHE in brain tissue. Conversely, oral administration of anise and clove extracts mitigated the harmful effects of metronidazole. The neurotoxic effects of metronidazole appear to stem from its ability to reduce antioxidants in brain tissue and increase nitric oxide production and apoptosis. The study concludes that neuronal damage caused by metronidazole is significantly mitigated by treatment with anise and clove extracts.

Primary Carrier Status and Alteration in the Colonization of the Extended-Spectrum β-Lactamase Producing Enterobacteriaceae Among Children in Pediatric Intensive Care Unit During the Hospital Stay

Background: Widespread and inappropriate use of antibiotics has led to an increase in antibiotic-resistant bacteria worldwide. Extended-spectrum β-lactamases (ESBLs) are among the most important resistance mechanisms in members of Enterobacteriaceae, which can pose a threat to patients. Objectives: This study aimed to investigate the carrier status and alteration in the fecal transmission of ESBL-producing Enterobacteriaceae (ESBL-E) on admission and during the hospital stay, as well as its correlation with the usage of antibiotics among children in a pediatric intensive care unit (PICU). Molecular typing between the primary and secondary isolates was done to detect the homotypic clonal strains. Methods: Demographic and medical data of PICU children were collected, and the carrier status of ESBL-E was investigated in pairs of their rectal swab samples at the admission and discharge time. Detection of ESBL phenotype and antimicrobial susceptibility to 12 antibiotics were performed by double-disk synergy and disc diffusion methods, respectively. Polymerase chain reaction for detection of blaTEM, blaSHVblaPER, blaCTX-M, and blaVEB genes was performed using specific primers. The phylogenetic relations were analyzed by the enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) method. Results: Extended-spectrum β-lactamase-producing Enterobacteriaceae was detected in 48% of the samples at admission and 42% at discharge time. The highest frequency of resistance was observed in cephazolin, amoxicillin-clavulanic acid, and ampicillin. Children with a history of meropenem administration showed a significantly higher frequency of meropenem resistance Enterobacteriaceae in their samples. Moreover, the administration of metronidazole increased the isolation of ESBL-Escherichia species in hospitalized children. The most common gene associated with the ESBL phenotype was blaCTX-M, while blaPER and blaVEB were not detected in the ESBL-E isolates. The phylogenetic analysis did not confirm the occurrence of the cross-transmission of ESBL-E in the patients during hospitalization. Conclusions: Our results showed a high frequency of ESBL-E in the feces of children upon admission to the PICU, which did not change significantly during the hospital stay. Although the prescription of metronidazole showed an association with the enrichment of ESBL-E due to observed diversity in the molecular types and resistance phenotypes of the isolates, the community seems to be the primary source of ESBL-E transmission in children. Further investigations are needed to understand the role of hospital stay in the colonization and enrichment of ESBL-E in the intestinal tract of children and their association with infections during the medical interventions in the PICU.

TREATMENT OF GIARDIASIS IN DOMESTIC CATS

Giardiasis is a disease caused by Giardia sp. a protozoan which infects the small intestine causing non-specific diarrhea in humans and other mammals. This article aims to help readers find out the causes of giardiasis in cats, and how to treat cases of giardiasis in cats. A 1-year-old queen named Qaqa that weighs 2.15 kg had suffered diarrhea for a month. Previously, the cat had been given an antidiarrheal drug called Guanistrep which helped in reducing the frequency of diarrhea but after finishing the drug, the diarrhea recurred. Clinical examination showed the cat experience inflammation on the anus, slow capillary refill time (CRT), and increased body temperature but there was no indication that the cat was dehydrated. Examination of the feces found the presence of the protozoa Giardia sp. The Hematological examination of the cat indicates leukocytosis, monocytosis, and granulocytosis. The cat was diagnosed with Giardiasis. The therapy given is the administration of Metronidazole, Nutria Gel Plus, and Guanistrep which all were given orally. Two weeks after the administration of the medication, the frequency of the cat's defecation decreased and the feces had a solid consistency. To avoid Giardia sp. infection, owners need to be educated on how to properly care for their cat’s by providing drinking water with mineral water and limiting the interaction with wild animals, as well as maintaining the cleanliness of the cat's residence, especially where the cat eats and drinks.

КОМПЛЕКСНЫЙ ПОДХОД К ЛЕЧЕНИЮ БАКТЕРИАЛЬНОГО ВАГИНОЗА У ПАЦИЕНТОК С СИНДРОМОМ ПОЛИКИСТОЗНЫХ ЯИЧНИКОВ

A two-stage complex method of therapy of bacterial vaginosis (BV) in 29 patients with polycystic ovary syndrome (PCOS) is proposed, consisting in the use of standard metronidazole therapy (vaginal suppositories of 500 mg 2 times a day for 7 days) at the first stage and therapy with Acylact DUO at the second stage (1 candle in the vagina per night of 10 days), effective in relieving clinical manifestations and preventing recurrence of vaginal dysbiosis. Intravaginal administration of metronidazole to patients with polycystic ovary syndrome (PCOS) and bacterial vaginosis (BV) significantly reduced the concentration of anaerobic microorganisms. The appointment with Acylact DUO stimulated the growth of its own lactobacilli and helped to reduce the number of relapses of the disease by increasing the protective properties in the vagina. Normalization of the vaginal microflora was noted in all patients included in the study. After three months, normal vaginal biocenosis was detected in 26 patients (89.6% of women) according to a control smear study to detect key cells as markers of bacterial vaginosis. Clinical manifestations of bacterial vaginosis (itching, burning, pathological discharge) were not detected in any patient. Thus, the conducted study showed high efficiency of complex two-stage treatment of bacterial vaginosis, consisting in the use of vaginal candles containing metronidazole at the first stage, followed by the drug Acylact DUO in patients with polycystic ovary syndrome, provided timely correction of hormonal and metabolic disorders in them.

Gender determinism of the effect of placenta cryoextract on the hepatotropic effects of esomeprazole, clarithromycin and metronidazole in chronic liver damage

Current regimens for the eradication of Helicobacter pylori infection include bismuth drugs, proton pump inhibitors, and a combination of 2–3 antibacterial drugs. Uncontrolled use of antibacterial agents as part of eradication schemes increases the risk of developing their unwanted drug reactions, in particular, hepatotoxicity. As a means with potentially hepatoprotective activity, our attention was drawn to placental cryoextract.&#x0D; The purpose of the study. To characterize the gender aspects of the hepatotropic action of placenta cryoextract in tetrachloromethane hepatitis with background ethanol-induced cirrhosis and liver damage by antiulcer agents.&#x0D; Materials and methods. Research was conducted on 112 male and female rats. Tetrachloromethane hepatitis with background ethanol-induced liver cirrhosis was reproduced by injecting an oil solution of CCl4 in combination with a 5.0% ethanol solution for 45 days. Modulation of the content of sex hormones was achieved by surgical ovariectomy or testectomy.&#x0D; Results and discussion. Administration of esomeprazole, clarithromycin, and metronidazole in chronic liver damage in animals without changes in hormonal status led to a statistically significant (p=0.01) 27.6% increase in the level of bilirubin in homogenates of liver tissues in female rats (78.7±4.5 mmol/l) than in males. The greatest decrease in the content of bilirubin (41.7%, p&lt;0.001) with the use of cryoextract of the placenta was noted in castrated female rats with simulated tetrachlormethone hepatitis with background ethanol-induced cirrhosis of the liver, which were injected with antiulcer agents.&#x0D; Conclusions. Administration of cryoextract of the placenta has a pronounced hepatoprotective effect in animals of both sexes. In male rats with no change in hormonal status with simulated liver injury and the administration of antiulcer drugs, placenta cryoextract therapy was more effective than in female rats, as indicated by a more than 1.6-fold decrease in the content of bilirubin in the liver homogenates of male rats (43.1%, p&lt;0.001) than in females (27.4%, p&lt;0.01).

Impact of Vancomycin Treatment and Gut Microbiota on Bile Acid Metabolism and the Development of Non-Alcoholic Steatohepatitis in Mice.

The potential roles of the gut microbiota in the pathogenesis of non-alcoholic fatty liver disease, including non-alcoholic steatohepatitis (NASH), have attracted increased interest. We have investigated the links between gut microbiota and NASH development in Tsumura-Suzuki non-obese mice fed a high-fat/cholesterol/cholate-based (iHFC) diet that exhibit advanced liver fibrosis using antibiotic treatments. The administration of vancomycin, which targets Gram-positive organisms, exacerbated the progression of liver damage, steatohepatitis, and fibrosis in iHFC-fed mice, but not in mice fed a normal diet. F4/80+-recruited macrophages were more abundant in the liver of vancomycin-treated iHFC-fed mice. The infiltration of CD11c+-recruited macrophages into the liver, forming hepatic crown-like structures, was enhanced by vancomycin treatment. The co-localization of this macrophage subset with collagen was greatly augmented in the liver of vancomycin-treated iHFC-fed mice. These changes were rarely seen with the administration of metronidazole, which targets anaerobic organisms, in iHFC-fed mice. Finally, the vancomycin treatment dramatically modulated the level and composition of bile acid in iHFC-fed mice. Thus, our data demonstrate that changes in inflammation and fibrosis in the liver by the iHFC diet can be modified by antibiotic-induced changes in gut microbiota and shed light on their roles in the pathogenesis of advanced liver fibrosis.

Chromatographic analysis of ciprofloxacin and metronidazole in real human plasma: green analytical chemistry perspective.

Background: Ciprofloxacin and metronidazole are beneficial for treating mixed aerobic/anaerobic infections. Methods: Following the oral administration of ciprofloxacin and metronidazole in healthy volunteers, TLC and HPLC methods were described for their analysis in plasma samples. In the first method, a stationary phase of silica gel TLC F254 plates was used using acetone/water/triethylamine/glacial acetic acid (8:2:0.25:0.1 v/v). The second approach used a C18 column and methanol/aqueous 0.05% triethylamine (25:75 v/v), with a flow rate of 1ml/min and detection at 325nm. Four green metrics were used to evaluate the approaches' environmental impact. Conclusion: The study provided the sensitivity required for determination of the two drugs in the collected samples. The findings showed that results were within permitted ranges with minimal environmental impact.

1010. Metronidazole-associated neurologic adverse events: risk factors analysis

Abstract Background Metronidazole is a widely used antibiotic to treat anaerobic and protozoal infections. However, neurologic adverse events associated with metronidazole have been reported in case series and case reports. Previous publications implicated that long-term usage and cumulative dose are risk factors for this adverse event. Still, little is known about the risk factor of the metronidazole-associated neurologic adverse events. Therefore, we conducted a retrospective study to investigate the risk factors for the metronidazole-associated neurologic adverse events through a matched case-control study. Methods This retrospective study enrolled patients prescribed metronidazole from January 2006 to July 2021 at Severance Hospital, a tertiary hospital in South Korea. Case patients were defined as those who developed central nervous system (CNS) adverse events or peripheral nervous system (PNS) adverse events during the study period with causality assessment. In a 1 to 3 ratio, case patients were compared to a control group of the patients without neurologic adverse events, matched on age and cumulative dose of metronidazole. Results 92838 patients were prescribed metronidazole during the study period. Among them, 52 patients showed metronidazole-associated neurologic adverse events (39 patients with CNS, 27 patients with PNS adverse events, and 14 patients with both). The proportion of chronic kidney disease (CKD), solid organ transplantation, liver cirrhosis (LC), intravenous (IV) administration of metronidazole, and concomitant use of a proton pump inhibitor was significantly higher in the case group. The body weight, hemoglobin, and serum albumin levels were lower, and Sequential Organ Failure Assessment scores were higher in the case group. Multivariate conditional logistic regression analysis demonstrated LC, CKD, IV administration, and lower body weight as risk factors for metronidazole-associated neurologic adverse events. Conclusion In this case-control study, LC, CKD, IV administration, and lower body weight were associated with the metronidazole-associated neurologic adverse events. Prolonged metronidazole treatment in patients with the risk factors requires careful examination for these adverse events. Disclosures All Authors: No reported disclosures.

Effectiveness of postoperative oral administration of cephalexin and metronidazole on surgical site infection among obese women undergoing cesarean section: a randomized, double-blind, placebo-controlled, parallel-group study—phase III

BackgroundCesarean section (CS) is the most frequently performed surgery in the United States. Compared to vaginal delivery, CS has a higher risk of maternal and neonatal mortality, morbidities, and complications, among which surgical site infection (SSI) is the most common. We aimed at evaluating the effectiveness of postoperative oral administration of cephalexin and metronidazole on SSI among obese women undergoing CS.MethodsWe conducted a randomized, double-blind clinical trial comparing the prophylactic effect of oral cephalexin and metronidazole vs cephalexin and placebo on SSI following CS among obese women. who had received preoperative prophylactic cephalosporin antibiotics. The study was conducted at the Ommolbanin Hospital, affiliated with Mashhad University of Medical Sciences from April 2019 to February 2020.ResultThe participants were randomized into the intervention group (n = 210) and the control group (n = 210). At week-1 follow-up, the outcomes were significantly lower in the intervention group as compared to the control group in terms of fever (9% vs 19%, p = 0.003), abnormal discharge from the incision (serous: 8.6% vs 10.5%, purulent: 2.9% vs 16.7%, p < 0.001), incision separation (1% vs 7.1%, p = 0.001), and cellulitis (4.8% vs 13.3%, p = 0.002). At week-2 follow-up, there were no patients in the intervention group with fever, abnormal discharge from the incision, incision separation, or cellulitis and there was a statistically significant difference for fever, abnormal discharge from the incision, and incision separation between the two groups (p < 0.001, p = 0.001, p = 0.014, respectively).ConclusionPost-operative administration of cephalexin and metronidazole for 48-h post-cesarean delivery among obese women, in addition to the standard pre-operative prophylaxis, reduced the overall rate of surgical site infection and wound infection symptoms in a 2-week follow-up.Trial registration The study protocol was approved by the Iranian Registry of Clinical Trials (IRCTID: IRCT20200608047685N2) on 2021-03-15.

Randomized controlled trial demonstrates nutritional management is superior to metronidazole for treatment of acute colitis in dogs.

To describe the outcome of dietary management of canine noninfectious acute colitis with or without concurrent oral administration of metronidazole using a randomized controlled clinical trial. 59 client-owned dogs with noninfectious acute colitis. Dogs with acute noninfectious colitis were enrolled in a 30-day diet trial after exclusion of parasitic infectious etiologies (fecal centrifugation floatation, Giardia/Cryptosporidium antigen testing) and systemic disease (CBC, biochemistry, urinalysis). Dogs were randomized into 3 placebo-controlled groups: group 1, easily digestible diet + placebo tablet; group 2, easily digestible diet + metronidazole tablet; and group 3, psyllium-enhanced easily digestible diet + placebo tablet. Dogs were evaluated serially using fecal scoring for time to remission, average fecal score, relapse after remission, and dysbiosis index. Median remission time was significantly different among the 3 groups (P < .01) with median times of 5 days (range, 4 to 10) for group 1, 8.5 days (range, 7 to 12) for group 2, and 5 days (range, 3 to 6) for group 3. Metronidazole addition affected the fecal dysbiosis index negatively at days 7 to 10. No adverse effects or complications were noted throughout the study. For canine noninfectious acute colitis, dietary management with an easily digestible diet with or without psyllium enhancement proved a superior management strategy compared to metronidazole. The omission of metronidazole reduced the adverse impact significantly on intestinal microbiota. Longitudinal clinical trials are necessary to compare the long-term response, stability, and complications associated with dietary management alone versus combined dietary and antimicrobial therapy for canine acute colitis.

Fast determination of free metronidazole in rat plasma and peritoneal fluid using HPLC-UV method.

Peritonitis refers to the inflammatory reaction of the peritoneum to aggression. In addition, it contributes significantly to sepsis. The presence of free concentrations of antimicrobials above the minimum inhibitory concentration at the site of infection is critical to therapeutic response. Metronidazole (MTZ) is an antimicrobial used to treat peritonitis because of its effectiveness against anaerobic microorganisms. This study investigates free MTZ concentrations in peritoneal microdialysate in Wistar rats. A C18 column (150 × 4.0mm, 5μm) was used for the analysis conducted at 40°C under isocratic conditions. The mobile phase consisted of acetonitrile and an aqueous solution of 50-mM monobasic phosphate buffer and 0.1% triethylamine, with pH3.0 (10:90, v/v). MTZ calibration was linear in the range of 0.5-30.0μg/ml. The intra- and inter-day precision was satisfactory with relative standard deviation ≤5.67%. The accuracy ranged from 90.64 to 103.77%, and the lower limit of quantification was 0.5μg/ml. The developed method was successfully applied in a pilot pharmacokinetic study after MTZ administration (30 mg/kg, intravenously) in rats. The main advantage of the employed method is that it does not require sample processing and protein removal steps. This is the first study to be conducted using MTZ in rats.

Emergency Treatment of Submandibular Abscess Spreading to Buccal and Submental Spaces in Uncontrolled Diabetic Patients: A Case Study

Emergency Treatment of Submandibular Abscess Spreading to Buccal and Submental Spaces in Uncontrolled Diabetic Patients: A Case Study Cahyono Yudianto1*, Endang Sjamsudin2, Winarno Priyanto3, Agus Nurwiadh4, 1Resident of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Padjadjaran/ RSUP Dr. Hasan Sadikin, Bandung, Indonesia 2,3,4Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Padjadjaran/ RSUP Dr. Hasan Sadikin, Bandung, Indonesia *Email correspondence: cahyono19001@mail.unpad.ac.id ABSTRACT Introduction: Dental infections can extend to the maxillofacial space causing severe infections such as abscesses. Abscess in the maxillofacial space aggravated by the systemic disease of diabetes mellitus can delay healing and cause further complications. This case report discusses the emergency treatment of a submandibular abscess that extends to the buccal and submental spaces in a patient with diabetes mellitus. Case Report: A 41-year-old female patient came to the Emergency Department of Hasan Sadikin Hospital in Bandung, complaining of swelling on the right cheek. The swelling was felt for seven days which started in the right submandibular area and extended to the right cheek and submental area. The patient had a history of diabetes mellitus for eight years, and on arrival, his current blood sugar was 365 mg/dL. The patient was diagnosed with a submandibular abscess that extends to the right buccal and submental area with uncontrolled diabetes mellitus. Treatment includes a drainage incision, Penrose drain, extraction of the causative tooth, and administration of ceftriaxone, metronidazole, ketorolac, and omeprazole drugs. Conclusion: Submandibular abscess that extends to several maxillofacial spaces is an emergency condition that requires immediate management to prevent the spread of infection to other tissues, which can cause mortality. Keywords: Abscess, Submandible, Buccal, Submental, Diabetes Mellitus