Mg Of Metronidazole Research Articles

Rifaximin and Metronidazole Fixed Dose Combination: New Treatment Option in the Management of Diarrhea

Background: Endemic infectious diarrhea is a widespread problem around the world, caused by a combination of viruses, bacteria, and parasites. While commonly used fluoroquinolone antibiotics are effective for specific types of acute diarrhea, they carry potential side effects. Aim: To assess the effectiveness and tolerability of a fixed-dose combination of rifaximin and metronidazole as an alternative treatment approach for the management of acute diarrhea. Study Design: A multicentre, open-label, non-comparative and non-randomized trial was conducted in 370 patients suffering from acute diarrhea due to various factors. Methodology: Patients were given a tablet containing fixed-dose combination of 200 mg of rifaximin and 400 mg of metronidazole twice daily for 5 days. The primary outcomes evaluated were changes in the number of loose/watery stools, the presence of fever, nausea, vomiting, abdominal pain and gas/flatulence from baseline to day 5. A global assessment using a 3-point scale (Excellent/Good/Poor) was done by the investigators for efficacy and tolerability evaluation. Adverse drug reactions were monitored throughout the study period. Results: After 5-day therapy, the average number of watery stools per day decreased significantly from 7.853 ± 3.773 to 0.766 ± 0.949 (P < .001). None of the patients experienced fever and vomiting, while few patients experienced nausea (0.31%), abdominal pain (0.31%), and gas/flatulence (0.93%) at the end of the study. According to the evaluation by the investigators, all patients reported good to excellent efficacy and tolerability. Conclusions: The combination therapy of rifaximin and metronidazole is clinically effective and safe to treat acute diarrhea caused by different factors and can serve as a new treatment option for managing acute diarrhea.

Gastric cancer prevention by community eradication of Helicobacter pylori: a cluster-randomized controlled trial.

Gastric cancer is a leading cause of cancer-related deaths in China. Affecting more than 40% of the world's population, Helicobacter pylori is a major risk factor for gastric cancer. While previous clinical trials indicated that eradication of H. pylori could reduce gastric cancer risk, this remains to be shown using a population-based approach. We conducted a community-based, cluster-randomized, controlled, superiority intervention trial in Linqu County, China, with individuals who tested positive for H. pylori using a 13C-urea breath test randomly assigned to receiving either (1) a 10-day, quadruple anti-H. pylori treatment (comprising 20 mg of omeprazole, 750 mg of tetracycline, 400 mg of metronidazole and 300 mg of bismuth citrate) or (2) symptom alleviation treatment with a single daily dosage of omeprazole and bismuth citrate. H. pylori-negative individuals did not receive any treatment. We examined the incidence of gastric cancer as the primary outcome. A total of 180,284 eligible participants from 980 villages were enrolled over 11.8 years of follow-up, and a total of 1,035 cases of incident gastric cancer were documented. Individuals receiving anti-H. pylori therapy showed a modest reduction in gastric cancer incidence in intention-to-treat analyses (hazard ratio 0.86, 95% confidence interval 0.74-0.99), with a stronger effect observed for those having successful H. pylori eradication (hazard ratio 0.81, 95% confidence interval 0.69-0.96) than for those who failed treatment. Moderate adverse effects were reported in 1,345 participants during the 10-day treatment. We observed no severe intolerable adverse events during either treatment or follow-up. The findings suggest the potential for H. pylori mass screening and eradication as a public health policy for gastric cancer prevention. Chinese Clinical Trial Registry identifier: ChiCTR-TRC-10000979 .

Would it really be necessary to use metronidazole as an adjunct in the surgical treatment of periodontitis?

Prospective, parallel, randomized, double-blind, clinical trial. Participants were at least 30 years old, who were systemically healthy, with stages III-IV, grades B-C periodontitis. Of the 50 eligible individuals for the study, 40 were divided into 2 equal groups. The test group received doses of 500 mg of metronidazole, while the control group received a placebo, both administered three times a day for 7 days, commencing immediately after periodontal surgery. All patients were followed up at 3-, 6-, 9-, and 12-months post-surgery. The study utilized probing depth, clinical attachment level, bleeding on probing, and plaque index as parameters for determining the outcomes at each assessment. Microbiological samples were collected for the detection and quantification of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Tannerella forsythia DNA. In order to analyze quantitative variables in a comparison between the test and control groups, Student's t-tests or Mann-Whitney U tests were utilized. For categorical results, chi-square or Fisher tests were employed. For both probing depth and clinical attachment level, repeated measures ANOVA was used. The statistical significance level was set at p ≤ 0.05. The study found statistically significant differences for probing depth (mean difference, MD = 0.31 mm, 95% confidence interval, CI [0.13; 0.49]; p = 0.001) and clinical attachment level (MD = 0.64 mm, 95% CI [0.02; 1.27]; p = 0.044) only 3 months after surgery, with a reduction observed in the test group. However, despite being statistically significant, these results lack clinical relevance. Although the study found statistically significant results for clinical attachment level (MD = 0.66 mm, 95% CI [0.01; 1.31]; p = 0.045) and probing depth (MD = 0.28 mm, 95% CI [0.09; 0.46]; p = 0.004), these findings do not represent clinically significant gains. Therefore, no evidence was demonstrated to support the use of systemic metronidazole as adjunctive therapy to periodontal surgery.

Concomitant and Bismuth Quadruple Therapy for Helicobacter pylori Eradication in Southern Italy: Preliminary Data from a Randomized Clinical Trial.

Concomitant therapy (CT) and bismuth quadruple therapy (BQT) are recommended in geographical areas with high clarithromycin resistance for Helicobacter pylori (H. pylori) eradication. We compared CT and BQT as the first lines of treatment in a randomized controlled trial. Consecutive patients with H. pylori diagnosed by concordance of both a urea breath test and histology were recruited. For BQT, patients received 3 PyleraTM capsules q.i.d.; for CT, 1000 mg of amoxicillin b.i.d, 500 mg of clarithromycin b.i.d and 500 mg of metronidazole b.i.d. As a proton pump inhibitor, 40 mg of pantoprazole b.i.d was administered. Both regimens lasted 10 days. In total, 46 patients received CT and 38 BQT. Both groups were comparable for age (p = 0.27) and sex (p = 0.36). We did not record any drop outs; therefore, the intention to treat and per protocol rates coincided. The most common symptoms were heartburn and post-prandial fullness, which were equally present in both groups. The success rate was 95.6% for CT and 100% for BQT (p = 0.56). Side effects were recorded in 23.9% and 31.6% of patients in the CT and BQT arms, respectively (p = 0.47). The most common ones were abdominal pain (8) and diarrhea (6). In conclusion, CT and BQT are equally effective in our area with high clarithromycin resistance, southern Italy, and showed comparable safety.

Unilateral Periorbital Necrotizing Fasciitis – A Case Report

IntroductionPeriorbital necrotizing fasciitis is rare due to the excellent blood supply to the area, but nevertheless can sometimes lead to death. Knowledge of the symptoms of the disease enables rapid diagnosis, which reduces the possibility of serious complications of the disease and its mortality. To date, few publications describing the disease entity have been presented.Patient descriptionA 70-year-old male patient was admitted to the hospital with necrotizing fasciitis of the left upper eyelid region, diagnosed on the basis of fulminant development of necrosis and a positive bacteriological test for S. pyogenes.ResultsContrast-enhanced computed tomography showed the presence of a pathological inflammatory infiltrate within the eyelid of the left eye and subcutaneous tissue at the preseptal level of the orbit and left cheek. Blood tests showed leukocytosis (total white blood cell count of 17.33 x 109/ L with 87.1% neutrophils) and elevated C reactive protein parameters (240.64 mg/ L). Empirical intravenous antibiotic therapy was administered: 1 g of amoxicillin with 200 mg of clavulanic acid every 8 hours, 500 mg of metronidazole every 8 hours, and ciprofloxacin into the left and right conjunctival sacs 3 mg/ml every 6 hours. Surgical debridement of upper eyelid necrosis was performed on the second day of hospitalization.ConclusionsThe peculiar anatomical structure of the periocular region promotes the dynamic development of necrotizing fasciitis. The close proximity of the central nervous system and the eyeball threatens irreversible consequences, including loss of vision or death. Early appropriate targeted treatment can effectively stop the development of the disease and prevent severe complications.

Development of double crosslinked sodium alginate/chitosan based hydrogels for controlled release of metronidazole and its antibacterial activity

Double network sodium alginate/chitosan hydrogels were prepared using calcium chloride (CaCl2) and glutaraldehyde as the crosslinking agents by the ionotropic interaction method for controlled metronidazole release. The effect of polymer ratios and CaCl2 amount is investigated by the developing porosity, gel fraction, and extent of swelling in simulated physiological fluids. Interaction between the polymers with the formation of crosslinked structures, good stability, phase nature, and morphology of the hydrogels is revealed by Fourier-transform infrared spectroscopy, thermogravimetric analysis, X-ray diffraction, and scanning electron microscopy. A sodium alginate/chitosan hydrogel (weight ratio of 75:25) crosslinked with two percent CaCl2 is chosen for the in-situ loading of 200 mg of metronidazole. The drug release kinetics using different models show that the best-fit Korsmeyer-Peppas model suggests metronidazole release from the matrix follows diffusion and swelling-controlled time-dependent non-Fickian transport related to hydrogel erosion. This composition displays enhanced antimicrobial activity against Staphylococcus aureus and Escherichia coli.

Sensory-motor polyneuropathy due to the use of antiparasitic drugs: A case report

Introduction: The term polyneuropathy refers to a generalized involvement of peripheral nerves, usually involving mainly the distal nerves and, more often, presenting with sensory, motor, and autonomic symptoms and clinical findings. Drug-induced peripheral neuropathy (DIPN) is a persistent condition, most often associated with anticonvulsants, chemotherapy, cardiovascular, psychotropic, and antimicrobial drugs, such as Metronidazole. In this article, we report the case of a patient who developed polyneuropathy secondary to the use of Metronidazole. Case Report: D.D.S.L., a 45-year-old female, previously healthy, presented with abdominal discomfort. Entamoeba histolytica was detected after investigation, and she started a 7-day cycle of 500 mg of Metronidazole three times a day for seven days, without clinical response. A new therapeutic approach was attempted, with three cycles of 2 grams of Secnidazole single dose and Tinidazole for four weeks. However, the patient presented dysesthesia in the distal third of the thighs, followed by allodynia in the four limbs and trunk. After new abdominal discomfort, three months after the first medication cycle, another pharmacological cycle was started. Neurological examination and electroneuromyography (ENM) examination suggested axonal sensorimotor polyneuropathy in all four limbs. Conclusion: Polyneuropathy can be caused by many factors, including some frequently prescribed drugs such as Metronidazole and other medications in the 5-nitroimidazole group. Therefore, although the relationship between these drugs and polyneuropathy is not fully elucidated, their neurotoxicity is indisputable, even in rare cases, but with significant variability in terms of the dose-dependent potential for this disease.

A case report of metronidazole-induced encephalopathy in Bangladesh

Metronidazole-induced encephalopathy (MIE) is a rare disorder that can be reversible but fatal if not recognized early. Here, the author presents a case of encephalopathy in a 36-year-old patient who took 500 mg of metronidazole three times daily for three weeks. The patient was classified as a probable MIE case on the Naranjo causality assessment scale. An interesting neuroimaging finding in this patient was an isolated dentate nucleus signal abnormality. Author aims to report reversible clinical and radiological features of MIE in this patient and compare them with documented cases in recent and old literature. Data from this case report may guide clinicians to make judicious considerations in the early detection of MIE and may influence future researchers to focus on identifying critical mechanisms of devastating adverse effects, predictability of neurotoxicity.

Development of Thermoresponsive Hydrogels with Mucoadhesion Properties Loaded with Metronidazole Gel-Flakes for Improved Bacterial Vaginosis Treatment.

Bacterial vaginosis is an infectious disease that has significantly affected women's health. Metronidazole has been widely used as a drug for treating bacterial vaginosis. Nevertheless, the currently available therapies have been found to be inefficient and inconvenient. Here, we developed the combination approach of gel flake and thermoresponsive hydrogel systems. The gel flakes were prepared using gellan gum and chitosan, showing that the incorporation of metronidazole was able to provide a sustained release pattern for 24 h with an entrapment efficiency of >90%. Moreover, the gel flakes were incorporated into Pluronics-based thermoresponsive hydrogel using the combination of Pluronic F127 and F68. The hydrogels were found to exhibit the desired thermoresponsive properties, showing sol-gel transition at vaginal temperature. Following the addition of sodium alginate as a mucoadhesive agent, the hydrogel was retained in the vaginal tissue for more than 8 h, with more than 5 mg of metronidazole retained in the ex vivo evaluation. Finally, using the bacterial vaginosis infection model in rats, this approach could decrease the viability of Escherichia coli and Staphylococcus aureus with reduction percentages of more than 95% after 3 days of treatment, with the healing ability similar to normal vaginal tissue. In conclusion, this study offers an effective approach for the treatment of bacterial vaginosis.

Cerebellar ataxia after a single day of metronidazole use: Case report

Cerebellar ataxic syndromes, although uncommon, have been reported previously in patients taking metronidazole. However, almost all cases describe instances where patients were taking prolonged or high doses of the drug. We report a 65-year-old man who consumed 400 mg of metronidazole 3 times over 1 day and presented with slurring of speech, imbalance while walking and diplopia. The symptoms developed the day after consumption of metronidazole. Examination showed slurring of speech, gaze-evoked nystagmus, and dysmetria in all limbs. MRI brain revealed symmetric hyperintense lesions in the dentate nucleus and pons on T2-weighted imaging and FLAIR, which have a well-established association with metronidazole-induced central nervous system (CNS) toxicity. On discontinuation of the drug, symptoms improved, and complete recovery was noted at follow-up 2 weeks later. This case indicates that CNS side effects of metronidazole may not necessarily occur only at high doses or after prolonged courses of metronidazole, but may occur as an idiosyncratic reaction to the drug. Reasons for variable susceptibility require further investigation.

Elution profiles of metronidazole from calcium sulfate beads.

Antibiotic beads are used to treat local bacterial infections by delivering high drug concentrations to infected tissue. This study examined the elution characteristics of metronidazole from metronidazole-calcium sulfate (MCa) and metronidazole-calcium-potassium sulfate (MCaK) beads over 20 days and the antibacterial efficacy of the beads after storage. The MCa and MCaK beads were prepared by mixing 250 mg of metronidazole and 10 g of calcium sulfate hemihydrate with water and a 3% potassium sulfate solution, respectively. The beads were placed in phosphate-buffered saline for the elution study. The metronidazole eluents were determined using high-performance liquid chromatography. The microstructures were examined by scanning electron microscopy (SEM), and the antimicrobial activity was evaluated by a microbioassay. For the 20-day study, the total amount of metronidazole released was greater in the MCa beads than in the MCaK beads by 6.61 ± 0.48 mg (89.11% ± 3.04%) and 4.65 ± 0.36 mg (73.11% ± 4.38%), respectively. The amounts of eluted drugs from the MCa and MCaK beads were higher than the minimum inhibitory concentration at 0.5 µg/mL against anaerobic bacteria at both 20 days and 14 days. SEM showed that calcium crystals on the outer surface had dissolved after elution, and thinner calcium crystals were prominent in the MCaK beads. The MCa and MCaK beads exhibited antibacterial activity after setting, followed by storage at room temperature or 4°C for 21 days. The MCa beads could release more drug than the MCaK beads, but all eluted metronidazole amounts were effective in controlling bacterial infections. Both metronidazole beads could be stored at ambient temperature or in a refrigerator.

Comparative Efficacy of 14-Day Tegoprazan-Based Triple vs. 10-Day Tegoprazan-Based Concomitant Therapy for Helicobacter pylori Eradication.

Tegoprazan, a novel potassium-competitive acid blocker, is currently available for the treatment of Helicobacter pylori infection. We compared the efficacies of tegoprazan-based triple and concomitant therapies in a real-world practice. Data of patients treated with a 14-day tegoprazan-based triple therapy (50 mg of tegoprazan + 1000 mg of amoxicillin + 500 mg of clarithromycin twice daily) or 10-day tegoprazan-based concomitant therapy (50 mg of tegoprazan + 1000 mg of amoxicillin + 500 mg of clarithromycin + 500 mg of metronidazole twice daily) were retrospectively reviewed. Primary endpoint was eradication rate in the intention-to-treat (ITT) population. Of the 928 included patients, 551 and 377 were treated with triple and concomitant therapies, respectively. Eradication rate from ITT analysis was 76.4% (95% confidence interval [CI], 72.7−79.8%) in the triple therapy group and 85.9% (95% CI, 82.2−89.2%) in the concomitant therapy group (p < 0.001). Eradication rate in the per-protocol analysis was also higher in the concomitant therapy group than in the triple therapy group (triple vs. concomitant therapy: 84.5% [81.1−87.5%] vs. 91.1% [87.8−93.8%]). Overall adverse event rate was 29.0% in the triple therapy group and 45.9% in the concomitant therapy group (p < 0.001). Adherence rate was similar between the two groups (triple vs. concomitant therapy: 90.0 vs. 92.6%, p = 0.180). Overall, the 10-day tegoprazan-based concomitant therapy had superior efficacy than the 14-day tegoprazan-based triple therapy for H. pylori eradication. Although concomitant therapy showed common adverse events, adherence was comparable between the two therapies.

The Influence of Omeprazole on the Dissolution Processes of pH-Dependent Magnetic Tablets Assessed by Pharmacomagnetography.

Pharmacomagnetography involves the simultaneous assessment of solid dosage forms (SDFs) in the human gastrointestinal (GI) tract and the drug plasmatic concentration, using a biomagnetic technique and pharmacokinetics analysis. This multi-instrumental approach helps the evaluation, as GI variables can interfere with the drug delivery processes. This study aimed to employ pharmacomagnetography to evaluate the influence of omeprazole on the drug release and absorption of metronidazole administered orally in magnetic-coated tablets. Magnetic-coated tablets, coated with Eudragit® E-100 (E100) and containing 100 mg of metronidazole, were produced. For the in vivo experiments, 12 volunteers participated in the two phases of the study (placebo and omeprazole) on different days to assess the bioavailability of metronidazole. The results indicated a shift as the pH of the solution increased and a delay in the dissolution of metronidazole, showing that the pH increase interferes with the release processes of tablets coated with E100. Our study reinforced the advantages of pharmacomagnetography as a tool to perform a multi-instrumental correlation analysis of the disintegration process and the bioavailability of drugs.

The Concentration of Metronidazole in the Distal Interphalangeal Joint following Intravenous Regional Limb Perfusion via the Cephalic Vein in Standing Horses.

The aim of this study was to determine the concentration of metronidazole in the distal interphalangeal joint (DIPJ) of the thoracic limb after administering metronidazole to standing horses by intravenous regional limb perfusion (IVRLP). Eleven healthy horses had a wide rubber tourniquet applied to the proximal aspect of the antebrachium for 0.5 hours and 500 mg of metronidazole diluted in physiologic saline solution to a total volume of 108 mL was administered by cephalic IVRLP. Synovial fluid samples were collected from the DIPJ before perfusion and at 0.25, 0.5, 2, 12 and 24 hours. Blood samples were obtained at the same time points for serum analysis. Concentrations of metronidazole were determined by liquid chromatography/tandem mass spectrometry. Four horses were excluded due to low synovial fluid concentrations and not completing the full tourniquet application time. The C max in the synovial fluid was 327 ± 208 µg/mL, and the t max was 26 ± 7 minutes. Only the concentrations of metronidazole at time points 0.25 and 0.5 hours were significantly different (p < 0.001) from synovial concentration before perfusion. The serum C max was 1.78 ± 0.93 µg/mL, and the t max was 76 ± 52min. Metronidazole administered by IVRLP reached high concentrations in the synovial fluid at 0.5 hours. However, the concentrations rapidly decreased below the minimum inhibitory concentration of potential target pathogens. Effectiveness of metronidazole administered by IVRLP as a sole therapy against anaerobic infections of synovial structures of the distal limb cannot be determined by a pharmacokinetic study. However, the present study serves as the basis for future carefully planned clinical trials.

Prevention of dry socket in mandibular 3rd molars with single preoperative oral dose of metronidazole and amoxicillin compared to conventional therapy.

To compare the efficacy of metronidazole and amoxicillin as preoperative single dose treatment with conventional therapy in prevention of dry socket. A double blind randomized controlled trial was conducted at the oral and maxillofacial surgery OPD at DUHS, Karachi. Patients attending and requiring surgical extraction of madibular 3rd molar during October 2018 till April 2019 were randomly divided into 3 groups. Ethical approval was taken from Institutional Review Board of DUHS, Karachi. Informed consent was also taken from patients. First group was given single preoperative oral dose of 400mg metronidazole one hour before extraction, second group was treated with single oral dose of 500mg amoxicillin an hour before tooth extraction, and both of the groups were given painkillers postoperatively. Third group was given 500mg of Amoxicillin BD, 400mg of metronidazole and painkillers postoperatively. Every group had a follow-up on fifth postoperative day. Dry socket was reported among patients 19(8.4 %), among them 4 were males and 15 were females. Chi-square test was used to calculate the p-value (0.066). Results of the present trial were statistically insignificant. Incidence of dry socket in amoxicillin group was 3 (5.5%), in metronidazole was 4 (7.5) and in conventional therapy group was 12(16%). Present trial was not effective in preventing the occurrence of dry socket by means of single preoperative oral dose of metronidazole and amoxicillin compared to conventional therapy. However, clinically percentage of occurrence of dry socket was higher in conventional group compared to amoxicillin and metronidazole group.

Проблемы диагностики и лечения бактериального вагиноза в активном репродуктивном возрасте

Aim: to assess the efficacy and safety of vaginal capsules containing metronidazole 100 mg and myconazole nitrate 100 mg in women with bacterial vaginosis (including recurrent vaginosis). Patients and Methods: 62 women were enrolled. Group 1 included 32 women with firstly diagnosed bacterial vaginosis. Group 2 included 30 women with recurrent bacterial vaginosis. Vaginal capsules containing 100 mg of metronidazole and 100 mg of miconazole nitrate (Gynocaps) or Gynocaps plus peroral metronidazole 250 mg twice daily (combined therapy) were prescribed. Group 1 and group 2 were divided into subgroups, i.e., 1A (n=20) and 1B (n=12), 2A (n=18) and 2B (n=12), based on treatment (monotherapy or combined therapy, respectively). Treatment efficacy was assessed 1 month and 12 months after completing treatment. Results: the major symptom in both groups was off-white vaginal discharge. Diffuse vulvar redness was more common in group 1 while petechiae were more common in group 2 (p&lt;0.05). Lactobacillus spp. counts were reduced in all women, mixed infections were predominant. In group 2, significantly higher counts of anaerobic and yeast flora compared to group 1 were reported (p&lt;0.05). In group 1, no significant differences in the improvement of clinical signs after both treatment regimens were reported. Meanwhile, in group 2, clinical signs improved more rapidly after combined treatment. However, combined treatment was associated with adverse effects. A reduction in the total bacterial mass and logarithmic growth of anaerobic microflora was observed irrespective of the treatment regimen. No recurrences of bacterial vaginosis were reported. Conclusions: a 10-day treatment course of combined vaginal capsules containing metronidazole 100 mg and miconazole nitrate 100 mg improves clinical signs, eliminates complaints, and improves vaginal microflora owing to Lactobacillus growth without adverse reactions. In recurrent vaginosis, this agent should be used in combination with antibiotics. KEYWORDS: bacterial vaginosis, active reproductive age, metronidazole, miconazole nitrate, Lactobacillus. FOR CITATION: Chebotareva Yu.Yu. Diagnosis and treatment of bacterial vaginosis during active reproductive age. Russian Journal of Woman and Child Health. 2021;4(3):218–224 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-218-224.

Сучасний погляд на цервіковагінальний дисбіоз, викликаний сполученням бактеріальний вагіноз асоційованих бактерій та дріжджоподібних грибів роду Candida (Огляд літератури та власні дані)

The article presents modern literature data on the definition and etiopathogenesis of cervicovaginal dysbiosis caused by opportunistic microflora, as well as own data of a comparative study of the effectiveness of treatment of symptomatic cervicovaginal dysbiosis caused by a combination of bacterial vaginosis associated microorganisms and fungi of the genus Candida, using combined drugs containing ternidazole, neomycin, nystatin and prednisolone Na-metasulfobenzoate salt (Terzhinan®) or metronidazole and miconazole. The objective: comparing the effectiveness of treatment of symptomatic cervicovaginal dysbiosis caused by a combination of vaginally associated microorganisms and fungi of the genus Candida, using combined drugs containing ternidazole, neomycin, nystatin and salts of Na-metasulfonobenzoate prednisolone or metoconazole. Materials and methods. The study included 107 women of reproductive age with symptomatic mixed cervicovaginal dysbiosis caused by a combination of bacterial vaginosis associated microorganisms and fungi of the genus Candida, and 30 conditionally gynecologically and somatically healthy control subjects with cervicovaginal eubiosis. Blindly examined women with cervicovaginal dysbiosis were divided into two groups: the main group – 56 patients treated with intravaginal tablets Terzhinan®, the comparison group – 51 women who used vaginal suppositories containing metronidazole and miconazole. The dynamics of clinical data and the state of the cervicovaginal microbiota were evaluated by PCR before the start, one and three months after the end of treatment. Results. An open comparative analysis showed that with topical therapy with Terzhinan® vaginal tablets a month after the end of treatment, a positive clinical effect was observed in 89.29% of women and a microbiological effect in 91.07% of patients, after three months – in 85.71% and in 89.29% of patients, respectively, whereas with topical therapy with vaginal suppositories containing 750 mg of metronidazole and 200 mg of miconazole, respectively, one month after the end of treatment – in 68.73% and 72.55% of cases and after three months – in 62, 75% and 66.67% of cases. Conclusion. Topical monotherapy with Terzhinan® vaginal tablets in comparison with vaginal suppositories containing metronidazole and miconazole demonstrates the clinical and microbiological advantages of Terzhinan® in the treatment of cervicovaginal dysbiosis caused by bacterial vaginosis associated microflora and yeast-like fungi of the genus Candida. Keywords: cervicovaginal microbiota, cervicovaginal dysbiosis, opportunistic microorganisms, bacterial vaginosis associated microorganisms, yeast-like fungi of the genus Candida, Terzhinan®, vaginal suppositories with metronidazole and miconazole, clinical efficacy, microbiological efficacy, safety, long-term results.

Helicobacter pylori test-and-treat strategy for second-year junior high school students aimed at the prevention of gastric cancer in Takatsuki City.

More than 90% of gastric cancer cases are caused by Helicobacter pylori infections. To prevent gastric cancer, an H pylori test-and-treat strategy targeting young people has been implemented in various places in Japan. In this study, we evaluated the effectiveness of an H pylori test-and-treat strategy for second-year junior high school students in Takatsuki City. In 2014-2017, a urine-based H pylori test was used for initial screening. The final infection status was determined by a 13 C-urea breath test (13 C-UBT). Successful H pylori eradication was confirmed by 13 C-UBT 3months after treatment. First-line eradication therapy was changed from 10mg of rabeprazole, 750mg of amoxicillin, and 200mg of clarithromycin twice daily for 7days in 2014 to 20mg of vonoprazan, 750mg of amoxicillin, and 200mg of clarithromycin twice daily for 7days in 2015-2017. Second-line eradication therapy included 10mg of rabeprazole, 750mg of amoxicillin, and 250mg of metronidazole twice daily for 7days. In total, 8067 of 13055 students participated this project and 206 students were diagnosed with H pylori infection. The success rate of first-line therapy was 45.9% in 2014 and 83.8% after the revised first-line therapy was administered. The final eradication rate was 98.5%. There were no severe side effects. Our results support the use of the H pylori test-and-treat strategy for junior high school students as a safe approach for the prevention of gastric cancer. H pylori eradication therapy with vonoprazan could be a standard therapy in children.

Metronidazole-induced cerebellar syndrome

A 73-year-old man with type 2 diabetes and paroxysmal atrial fibrillation was admitted to our hospital with nausea, numbness in both lower legs, frequent falls and difficulty in speaking that...

Short versus Long-Term Antibiotic Prophylaxis in Cesarean Section: A Randomized Clinical Trial.

Objective:The objective of the present study was to compare the efficacy of intravenous (IV) 48 h course of cefuroxime/metronidazole with long-term course using 48 h cefuroxime/metronidazole plus 5 days oral regimen of cefuroxime and metronidazole for the prevention of post cesarean section wound infection.Methods:Two hundred and forty-eight women were randomized into two equal groups. Women in each arm of the study received IV cefuroxime 750 mg twelve hourly and IV metronidazole 400 mg eight hourly for 48 h. Those in the long-term arm received additional tablets of cefuroxime 500 mg twelve hourly and Tabs 400 mg of metronidazole eight hourly for 5 days. After the surgery, surgical site infections were evaluated. Length of hospital stay and the cost of antibiotics were also assessed.Results:The wound infection rate was not statistically significantly different between the 2 groups (1.3% vs. 3.3%, P = 0.136). The incidence of endometritis was 2.1%, with no statistically significant difference seen between the two groups (0.4% vs. 1.6%, P = 0.213). Escherichia coli was the most common isolate seen in 36.4% of infected wounds. The short arm group stayed for significantly shorter days in the hospital (2.9 ± 1.0 vs. 3.8 ± 1.1 days,P < 0.001), and the cost of antibiotics was also significantly less in the short arm group (P < 0.001). Organisms associated with nosocomial infections were seen only in the long arm that stayed in the hospital for longer days.Conclusions:Short-term prophylactic antibiotics are as effective as long-term prophylaxis and have other benefits such as shorter duration of hospital stay, reduced cost of antibiotics, and reduction of nosocomial infections.