Oral Tinidazole Research Articles

Successful treatment of Mycoplasma genitalium urethritis with high-dose tinidazole

Abstract A 30-year-old male patient with symptomatic Mycoplasma genitalium urethritis failed treatment with oral azithromycin, two-stage doxycycline-moxifloxacin, and minocycline. Molecular testing confirmed the presence of macrolide resistance mutations. Treatment with oral tinidazole 2 grams daily for seven days resulted in clinical and microbiologic cure.

Impact of antimicrobials on penile HIV susceptibility and immunology in uncircumcised men: A randomized phase 1/2 clinical trial

Within the penile microbiome, bacteria associated with seroconversion, immunology, and cells (BASIC species) enhance HIV susceptibility in heterosexual uncircumcised men by inducing foreskin inflammation and HIV target cell recruitment. This phase 1/2 clinical trial randomizes HIV-uninfected Ugandan men (n= 125) to either oral tinidazole, topical metronidazole, topical clindamycin, or topical hydrogen peroxide to define impact on exvivo foreskin HIV susceptibility, penile immunology, and BASIC species density. Antimicrobials are well tolerated, and 116 (93%) participants complete the protocol. Topical metronidazole and oral tinidazole reduce the inner foreskin tissue density of HIV-susceptible CD4+ Tcells (predefined primary endpoint). Antimicrobials also have varying but substantial effects on reducing prepuce inflammation and BASIC species density, reducing density of foreskin Tcell subsets, and increasing foreskin epithelial integrity. Immune alterations correlate strongly with changes in the abundance of BASIC species. Clinical interventions targeting the penile microbiota, particularly topical metronidazole, may reduce HIV susceptibility in uncircumcised men.

Characterization and Treatment of Recurrent Bacterial Vaginosis.

Bacterial vaginosis (BV) is a common but treatable condition, with a number of effective available treatments, including oral and intravaginal metronidazole and clindamycin and oral tinidazole. However, as many as 50% of women with BV experience recurrence within 1 year of treatment for incident disease. Some reasons for recurrence include the persistence of residual infection, resistance, and possibly reinfection from either male or female partners. Persistence may occur due to the formation of a biofilm that protects BV-causing bacteria from antimicrobial therapy. Poor adherence to treatment among patients with genitourinary infections may lead to resistance. However, the underlying mechanisms of recurrent etiology of BV are not known. Recommended treatment for recurrent BV consists of an extended course of metronidazole treatment (500 mg twice daily for 10-14 days); if ineffective, metronidazole vaginal gel 0.75% for 10 days, followed by two times per week for 3-6 months, is an alternate treatment regimen. Past studies of clindamycin and tinidazole in the treatment of recurrent BV have focused on patients with evidence of metronidazole resistance. Secnidazole may be an attractive new option due to one-time dosing. Initial studies on biofilm disruption, use of probiotics and prebiotics, and botanical treatments have shown some promise, but must be studied further before use in the clinic. Despite limitations, antimicrobial therapy will remain the mainstay of treatment for recurrent BV for the foreseeable future.

Protocol for a randomized clinical trial exploring the effect of antimicrobial agents on the penile microbiota, immunology and HIV susceptibility of Ugandan men

BackgroundThe 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/designThis 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.DiscussionThere 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 registrationClinicalTrials.gov, NCT03412071. Retrospectively registered on 26 January 2018.

Metronidazole-resistant trichomoniasis: beneficial pharmacodynamic relationship with high-dose oral tinidazole and vaginal paromomycin combination therapy

Metronidazole (MTZ)-resistant trichomoniasis is an uncommon condition which is a significant therapeutic challenge. To date, combination therapy with high dose oral tinidazole (TDZ) and vaginal paromomycin (PARO) cream has been successful in all published cases, but it is unclear whether the results are from these medications singly or together.

Efficacy and safety of oral tinidazole and metronidazole in treatment of bacterial vaginosis: a randomized control trial

Aims: Oral metronidazole 500 mg twice a day for one week is currently the treatment of choice for bacterial vaginosis (BV). Complete treatment by this regimen takes time and occurs less often. This drug has significant side effects too. Using a drug in the shortest treatment course may increases the success of treatment. To evaluate the effectiveness and safety of oral tinidazole compare to metronidazole in treatment of BV. Methods : In this randomized, controlled, double-blind, comparative, clinical trial, 110 non-pregnant women aged between 15-45 years with confirmed diagnosis of BV by Amsels criteria were randomly assigned to receive either 2 g tinidazole tablet once daily for 2 days (n=55) or 500 mg metronidazole table twice daily for 7 days (n=55).The cure and recurrence rate were evaluated in both groups after 2 and 4 weeks follow up visits. For statistical analysis t-test, test, fisher's exact test and Mann-Whitney test were used. Results: The results showed that cure rate after 2 weeks in tinidazole tablet group was 84.6? and in metronidazole group was 85.4? (p=0.9), and after 4 weeks recurrence rate in tinidazole and metronidazole groups was 6.9?and 12.1?respectively (P=0.3). Conclusions: Tinidazole table 2 g once daily for 2 days is as effective as metronidazole tablet 500 mg twice a day for 7 days in treatment of BV.

Pilot Study of a New Treatment Option for Vaginal Trichomoniasis

Standard therapy for vaginal trichomoniasis is oral metronidazole or tinidazole — but this treatment can cause gastrointestinal distress, and some

Resistant Trichomoniasis: Successful Treatment With Combination Therapy

Metronidazole-resistant vaginal trichomoniasis remains a major therapeutic challenge. Two women with symptomatic metronidazole-resistant trichomoniasis had multiple unsuccessful courses of therapy with a broad array of medications. Both patients finally responded to combination treatment with intravaginal paromomycin cream and high-dose oral tinidazole.

Vaginitis: Diagnosis and Management

Vaginitis is one of the most common ambulatory problems to occur in women. It is a disorder responsible for > 10% of visits made to providers of women's health care. Although vaginal infections are the most common cause, other considerations include cervicitis, a normal vaginal discharge, foreign-body vaginitis, contact vaginitis, atrophic vaginitis, and desquamative inflammatory vaginitis. The medical history and examination are an important source of clues to the underlying diagnosis. However, making a definitive diagnosis requires skillful performance of office laboratory procedures, including the vaginal pool wet mount examination, determination of the vaginal pH, and the whiff test. Vaginal and cervical cultures, nucleic acid tests, and point-of-care tests are available and may be required in selected patients. Once a specific diagnosis is made, effective therapy can be prescribed. Candida vaginitis is generally treated with either the vaginal administration of an imidazole or triazole antifungal agent or the prescription of oral fluconazole. Oral nitroimidazole agents, metronidazole or tinidazole, are the only effective treatments for trichomoniasis in the United States. Bacterial vaginosis, which has been linked to important gynecologic and pregnancy complications, can be treated with an available oral or topical agent containing either a nitroimidazole or clindamycin.

Trichomonas vaginalis: an unusual presentation

We report a case of Trichomonas vaginalis (TV) presenting as vulval ulceration in a 41-year-old woman. There was complete resolution of her symptoms only after oral tinidazole. The delayed diagnosis and importance of using the correct tests for the diagnosis of TV are discussed.

Tinidazole in the treatment of bacterial vaginosis.

Bacterial vaginosis (BV) is the commonest cause of vaginal discharge in women of childbearing age. Oral metronidazole has long been established as an effective therapy in the treatment of BV. However, adverse effects due to metronidazole are frequent and this may lead to problems with adherence to a 7-day course of treatment and subsequently result in treatment failure. Oral tinidazole has been used to treat bacterial vaginosis for over 25 years but in a number of different dosage regimens. Placebo controlled trials have consistently shown increases in cure rate with tinidazole. Longer courses of treatment (eg, 1 g daily for 5 days) appear to be more effective than a 2 g oral single dose. Comparative studies suggest that oral tinidazole is equivalent to oral metronidazole, intravaginal clindamycin cream, and intravaginal metronidazole tablets, in efficacy in treating BV. However, tinidazole has a more favorable side effect profile than oral metronidazole notably with better gastrointestinal tolerability and less metallic taste. Bacterial vaginosis is associated with high rates of recurrence and appropriate management of such recurrences can prove difficult. Recurrent BV has been linked with persistence of Gardnerella vaginalis after treatment; however the clinical implications of the possible greater activity of tinidazole against G. vaginalis are not yet clear. Repeated courses of oral metronidazole may be poorly tolerated and an alternative but equally effective treatment that is better tolerated may be preferable. In comparison to oral metronidazole, cost is clearly an issue as oral metronidazole is considerably cheaper and available in generic form. However where avoidance of oral metronidazole is necessary because of side effects, oral tinidazole is a cost-effective alternative.

Failure of Nitazoxanide to Cure Trichomoniasis in Three Women

Failure of Nitazoxanide to Cure Trichomoniasis in Three Women

Treatment of Recurrent Bacterial Vaginosis With Tinidazole

Recurrent bacterial vaginosis is a difficult clinical condition. In women with recurrent bacterial vaginosis, relapses are common, even after prolonged courses of maintenance therapy. Because of its spectrum of activity, tinidazole was used in a patient with recurrent bacterial vaginosis. A 23-year-old woman taking oral contraceptives had a single sexual partner. She was treated for recurrent bacterial vaginosis with multiple courses of metronidazole gel 0.75%, including regimens of maintenance therapy. The patient experienced repeated recurrences shortly after stopping treatment. A single course of oral tinidazole resulted in a prolonged period where she was free of bacterial vaginosis. Treatment options for recurrent bacterial vaginosis are currently limited. Tinidazole may be a useful option in women with recurrent bacterial vaginosis.

Oral tinidazole treatment during pregnancy and teratogenesis

Placental transfer of tinidazole an anti-infective drug possesses tricho-monocidal and amoebicidal activity was proved in early human pregnancy therefore it should not be given in the first trimester of pregnancy. The teratogenic potential of tinidazole was evaluated in the large population-based data set of the Hungarian Case–Control Surveillance of Congenital Abnormalities. Cases with isolated congenital abnormalities (CAs) and multiple CAs were selected from the Hungarian Congenital Abnormality Registry between 1980 and 1996. As controls two newborn infants without CAs were selected for every case from the National Birth Registry of the Central Statistical Office matching according to sex week of birth and district of parents’ residence. The exposure data were obtained prospectively through antenatal care logbooks and other medical records in addition retrospectively by questionnaires completed by mothers finally all non-respondent case and 200 non-respondent control families were visited at home by regional nurses to obtain necessary data. Exposure information was available for 85.5% of cases (response: 73.6%; home visit: 11.9%) and 69.3% (response: 68.9%; home visit: 0.4%) of controls. (excerpt)

Efficacy of the combination of 2 g oral tinidazole and acidic buffering vaginal gel in comparison with vaginal clindamycin alone in bacterial vaginosis: a randomized, investigator-blinded, controlled trial

Objective: To evaluate the efficacy of tinidazole (T) (Trimonase ®, Mipharm, Italy) and an acidic vaginal gel (Miphil ®) (M) in comparison with vaginal clindamycin (CL) (Cleocin ® Pharmacia Upjohn) in BV. Design: A multicentre, randomised, investigator-blinded, controlled trial. Population and methods: 64 women with BV were enrolled. Thirty-two were allocated to receive oral T 2 g, single dose, and 32 were assigned to CL 2% for 7 consecutive days. After week 1, T group were treated with an acidic vaginal gel, 2 g every 3 days, for additional 3 weeks, whereas CL group did not received any additional treatment. Patients were evaluated at week 1 and 4. Vaginal pH, the BV-blue test (Gryphus Diagnostics, USA) and the whiff test were performed at baseline and at week 4. Main outcomes measures: Clinical cure rate; normalisation of vaginal pH (pH<4.5); and laboratory cure rate (defined as a clinical cure rate and a negative results of BV-blue and whiff test). Results: At baseline, vaginal pH values were (mean±S.D.) 5.4±0.7 and 5.3±0.5 in T and CL groups, respectively. Six patients (2 in T group and 4 in CL group) withdrew from the study due to side effects. At week 1, the clinical cure rates were 84% in both T and CL treated group ( P=N.S.). At week 4, clinical cure rates were 94% in T+M group and 77% in CL group ( P=N.S.). The laboratory cure rates were 81% in T+M group and 59% in CL group ( P<0.04). Vaginal pH normalisation (i.e. pH <4.5) was achieved in 78% and in 38% of T+M and CL groups, respectively ( P<0.0007). Conclusions: In the short term, 2 g single oral dose tinidazole was at least as effective as 7-day of vaginal clindamycin. The sequential treatment of tinidazole and acidic vaginal gel was superior to vaginal clindamycin in lowering vaginal pH and achieving a higher laboratory tests normalization rate at 1-month follow-up.

Helicobacter pylori infection in childhood: Results of management with ranitidine bismuth citrate plus amoxicillin and tinidazole

To verify whether a triple therapy bismuth citrate plus amoxicillin and tinidazole eradicates H. pylori infection in pediatric patients. Fifty children (30 females; mean age 12.4 +/- 1.1 years, range 10-15 years) suffering from upper abdominal complaints and Helicobacter pylori (H. pylori)-associated gastroduodenal disease were treated with a 4 week course of ranitidine bismuth citrate (400 mg, twice daily) plus oral tinidazole (20 mg/kg) and amoxicillin (50 mg/kg) for the first 2 weeks. The endoscopic diagnoses were: esophagitis (seven cases), gastritis (six cases), gastroduodenitis (43 cases), duodenitis (one case), gastric ulcer (two cases) and duodenal ulcer (13 cases). Helicobacter pylori was eradicated in 40 (80%) patients and clinical improvement was noticed in 39 (78%) of symptomatic subjects. Duodenal ulcers were healed in all the children, but lymphoid nodular hyperplasia was persistent in all patients, independent of the H. pylori status. The potentially drug-related adverse events (blackening of the tongue, six patients; diarrhea, one patient; disturbance of taste, two patients) were registered in seven (14%) patients and dark stools were observed in 48 (96%) patients. No children withdrew from the study because of either side-effects or clinical laboratory changes. No patient had toxic levels of blood bismuth (values ranged between 2.1 and 5.4 microg/L, mean value 3.4 +/- 1.04 microg/L). Findings suggest that the present treatment regimen is effective enough in the resolution of H. pylori-associated peptic ulcer disease of childhood.

Managing Resistant Trichomonas Vaginitis.

Vaginal trichomoniasis is a sexually transmitted disease of worldwide importance that is commonly treated with metronidazole. Although surprisingly uncommon, resistance to metronidazole has nevertheless been widely reported. Patients with suspected resistant trichomoniasis should have the diagnosis confirmed either by visualization of motile trichomonads on saline microscopy or by culture. In addition, reinfection from a partner must be ruled out through a careful history. Data regarding treatment of metronidazole-resistant trichomoniasis are mainly limited to case reports or series. Most cases can be treated successfully with increasing doses of oral metronidazole. Other promising options include oral tinidazole and topical paromomycin cream.

Difficult-to-treat trichomoniasis: results with paromomycin cream.

Vaginal trichomoniasis poses a difficult therapeutic challenge when metronidazole is ineffective or contraindicated. We conducted a retrospective study of 6.25% paromomycin cream in the treatment of nine women referred with cases of vaginal trichomoniasis where metronidazole resistance or allergy was present. Results obtained immediately and 1 month after treatment were reviewed. The median age of the patients was 46 years; four women were nulliparous. The median symptom duration was 1 year. Five women were allergic to metronidazole. In four cases, resistance to high doses of metronidazole was demonstrated. Smears or cultures were positive immediately after treatment for three patients; a fourth relapsed 2 weeks later. Of these patients for whom treatment failed, one was cured with a 3-week course of paromomycin cream, and another was successfully treated with paromomycin cream and oral tinidazole. Three patients developed vaginal ulcerations that resolved spontaneously. Adverse effects may be a result of local formulation. Paromomycin cream was useful for treatment of cases of trichomonas infection where metronidazole resistance or allergy was encountered.

Helicobacter pylori-associated gastritis in Kuwait: endoscopy-based study in symptomatic and asymptomatic children.

Information is limited concerning the prevalence of Helicobacter pylori infection in asymptomatic children. Since January 1989, we have endoscoped 60 children for recurrent abdominal pain or for obtaining small-intestinal biopsy (their ages were a mean of 6.6 (range 9 months-13 years); there were 37 boys and 23 girls. Antral biopsies were obtained from all subjects and these were studied for the presence of gastritis and stained for H. pylori using modified Gram's stain. All biopsies were cultured for H. pylori. Children endoscoped for small-intestinal biopsy (n = 18) were used for comparison. Of the 42 children who had abdominal pain, 24 showed histological gastritis and 13 had H. pylori on microscopy (31% H. pylori-associated gastritis). In the compared group, five showed histological gastritis, and all had H. pylori on microscopy (27.7%). Culture was positive in 15; sensitivity was 85.7%. Six children, three pairs of siblings, had H. pylori gastritis supporting environmental etiology. Two had coinfection with intestinal giardiasis. Seven children were treated with daily oral amoxycillin (50 mg/kg) and tinidazole (20 mg/kg) for 6 weeks. In 3 (42.3%) H. pylori colonization cleared with healing of gastritis and resolution of symptoms. These results indicate that H. pylori gastritis is equally prevalent in symptomatic and asymptomatic children (31 and 27.7%, respectively; p > 0.05) in our population. It seems that the combination of oral amoxycillin and tinidazole is a poor choice in the treatment of H. pylori-associated gastritis in Kuwaiti children.

Systemic Timentin® is superior to oral tinidazole for antibiotic prophylaxis in elective colorectal surgery

Systemic Timentin® is superior to oral tinidazole for antibiotic prophylaxis in elective colorectal surgery