Topical Antimicrobial Therapy Research Articles

Point-of-Care Ultrasound Findings in a Case of Orbital Cellulitis: A Case Report

Ophthalmologic complaints are common in the emergency department. The utility of point-of-care ultrasound (POCUS) as an accessible, noninvasive modality to evaluate ocular pathology is of great value-particularly in settings where resources are limited or where ophthalmologic consultation may not be readily available. A 21-year-old woman presented to the emergency department with periorbital edema, erythema, and drainage that was worsening despite topical and oral antimicrobial therapy. Mild proptosis was present on examination. POCUS was performed to investigate her symptoms further. A modified ocular ultrasound revealed prominence and edema of the retro-orbital soft tissue with echogenic fat, consistent with the diagnosis of orbital cellulitis. These findings were corroborated with computed tomography imaging. Why Should an Emergency Physician Be Aware of This?: Few reports describe the utility of POCUS in evaluating patients for orbital cellulitis. This case emphasizes the value of POCUS in assessing patients presenting to the emergency department with ocular complaints and demonstrates ultrasound-specific findings that may lead the clinician toward the diagnosis of orbital cellulitis. © 2021 Elsevier Inc.

Acute corneal hydrops of presumed traumatic origin: An uncontrolled case series (three horses)

SummaryThis case series describes acute corneal hydrops in three young horses. Due to similarities in the clinical appearance and progression of the disease with that which is reported in humans and cats with acute corneal hydrops, traumatic Descemet’s membrane rupture was suspected to be the underlying aetiology in these equine cases. The horses presented with acute severe corneal oedema with intrastromal bullae formation and anterior bulging of the corneal contour. Focal posterior corneal changes were also seen in two of three cases. Mild anterior uveitis was also present. Other causes of corneal oedema (e.g. glaucoma) were ruled out based on presentation and clinical examination. Treatment approaches were medical and included various combinations of prophylactic topical antimicrobial therapy in case of secondary corneal ulceration, anti‐inflammatory therapy for uveitis, targeted oedema therapy with topical hypertonic saline and corneal cross‐linking, and placement of a temporary partial tarsorrhaphy for corneal tamponade. The outcome was excellent in all cases, with rapid resolution of the ocular changes. Acute corneal hydrops of presumed traumatic Descemet’s membrane rupture origin should be considered in cases of young horses presenting with acute corneal oedema. However, further studies are warranted to better characterise the disease and to try to confirm the suspected aetiology.

A novel treatment strategy using continuous local antibiotic perfusion: A case series study of a refractory infection caused by hypervirulent Klebsiella pneumoniae

BackgroundConventional topical antimicrobial therapy cannot maintain a constant local concentration, resulting in uncontrolled infection and complications. We propose continuous local antibiotic perfusion (CLAP), which can maintain a constant appropriate local antibiotic concentration for a long time with less invasiveness and complications. CLAP is clearly different from traditional treatment because it uses negative pressure to direct the continuously infused antibiotic solution to the center of infection and excrete it outside the body. This study aimed to demonstrate the effectiveness of CLAP by presenting cases in which even refractory bone and soft-tissue infections caused by the hypervirulent Klebsiella pneumoniae (hvKp) could be cured without significant tissue loss and dysfunction. MethodsThis study is a case series in which four patients with limb infection due to hvKp were treated by CLAP. hvKp was defined by a positive string test. The therapy included intra-soft-tissue antibiotic perfusion and intramedullary antibiotic perfusion. Gentamicin (60 mg/50 cc) was infused continuously through dual-lumen tubes and bone marrow needles at low-flow rates (2 mL/h). Negative pressure was used to collect the antimicrobial solution and eliminate the dead space. ResultsThe infection was controlled in all four patients after a mean period of 44.3 days. The mean maximum blood concentration of gentamicin was 1.6 μg/dL, and no cases of renal dysfunction or ototoxicity occurred. After CLAP, wound closure was required in two patients and iliac bone grafting was required in one patient. As sequelae, there were one case of osteoarthritis and one case of higher brain dysfunction due to hypoxia. ConclusionsOur results suggest that intractable hvKp infections can be controlled by CLAP. CLAP may give us the option to directly control local infections with less systemic complications. Therefore, it is considered a valuable treatment for further basic and clinical research, and this research report may be a first step.

The Use of Ozenoxacin in Pediatric Patients: Clinical Evidence, Efficacy and Safety.

Impetigo is the most common childhood skin infection in the world. There are two patterns of impetigo: nonbullous (or impetigo contagiosa) and bullous. The nonbullous type is due to Staphylococcus aureus and group A beta-haemolytic Streptococcus and occurs in 70% of impetigo cases. Impetigo is often a self-limited disease, but complications can sometimes occur. Therapy depends on the extent and site of the lesions and on the presence of systemic symptoms. The increase in multidrug resistance pathogens, such as methicillin-resistant Staphylococcus aureus, mupirocin-resistant Staphylococcus aureus or quinolone-resistant Staphylococcus aureus, requires the development of new antibiotics against these agents. The aim of this review is to evaluate the efficacy and safety of ozenoxacin in children compared to those of other approved topical antimicrobial therapies. The bactericidal activity against both susceptible and resistant organisms is a relevant feature of ozenoxacin because the bacterial strain and potential for resistance are generally not known at the beginning of therapy. Additionally, its minimal dermal absorption and its capability to reach high concentrations in the upper layers of the epidermidis agrees with the recommended practice aimed at avoiding the emergence of bacterial resistance in presence of a good safety profile. Further studies with real-life analyses and pharmacoeconomic evaluation are needed to confirm its role as first-line and second-line therapy in children with impetigo.

Effectiveness and safety of early adjuvant amniotic membrane transplant versus standard antimicrobial treatment for infectious keratitis: a systematic review protocol.

The objective of this review is to systematically examine the effectiveness of early adjuvant amniotic membrane transplant versus standard antimicrobial therapy for infectious keratitis. Infectious keratitis is a major cause of corneal blindness worldwide. Broad-spectrum topical antimicrobial therapy is currently the gold standard for treatment. Amniotic membrane transplant has been employed as an adjuvant therapy to promote corneal healing; however, high-quality evidence is limited. This review will consider studies that include patients of all ages with all types of infectious keratitis, including bacterial, fungal, viral, acanthamoeba, mixed, and culture-negative presumed infectious keratitis. The authors will exclude patients who have undergone other types of primary surgery other than amniotic membrane transplant during the initial management and those who had less than seven days' follow-up from the commencement of the treatment. Electronic databases, including MEDLINE, Embase, Cochrane CENTRAL, and relevant registries, will be searched for pertinent studies. Titles, abstract, and full text of the relevant studies will be independently assessed by two reviewers. Extracted data will include authors, year of publication, sample size, types of amniotic membrane transplant techniques, types of causative microorganisms, main outcomes, visual acuity, and adverse events. No restriction will be applied to the date or language. Bibliographies of the included articles will be independently and manually screened by two authors to identify further relevant studies. Eligible studies will be critically appraised by two independent reviewers for methodological quality. A meta-analysis will be performed for the included randomized controlled trials when there are sufficient similarities. This systematic review has been registered with PROSPERO (CRD42020175593).

Medication-related osteonecrosis of the jaw in a Duchenne muscular dystrophy patient.

• To date, this is the first description of MRONJ lesions in DMD patients. Close monitoring is advised. • aPDT can be a good adjuvant therapy for the treatment of MRONJ, because it is a non-invasive technique, well accepted for this population. • Topical antimicrobial therapies like aPDT are well recommended for polypharmacy patients who present MRONJ lesions.

Conjunctival bacterial infection among hospitalized neonates

Background: Conjunctivitis is a common infection among neonates and it is a known cause of preventable childhood blindness. There is geographical variation in the distribution of aetiological agents. Objective: To assess the prevalence of conjunctivitis among hospitalized neonates receiving care in a tertiary health care centre in South-west Nigeria, and describe its clinical and bacteriological correlates. Methods: The hospital records of neonates diagnosed with conjunctivitis at the Olabisi Onabanjo University Teaching Hospital, Sagamu between January 2015 and December 2019 were reviewed. Their bio-data, perinatal history, laboratory results and treatment received were extracted for analysis. Results: One hundred and twenty-two neonates had conjunctivitis out of a total number of 2,286 admissions, giving a prevalence rate of 5.3%. Male infants had almost double the risk of developing the disease compared to female infants (OR = 1.6; 95% CI: 1.09-2.35). Eighty-six (70.5%) babies were term, while 21 (17.2%) and 15 (12.3%) were preterm and small-for-gestational-age respectively. Most cases of neonatal conjunctivitis (82.0%) occurred in the first week of life while the mean ±SD age of onset was 5.3±4.5 days. Staphylococcus aureus and Klebsiella species were the commonest bacterial isolates affecting 57.1% and 23.0% neonates respectively. Moderately-high rates of resistance to erythromycin and gentamicin were observed among the bacterial isolates. Conclusion: Neonatal conjunctivitis is commonly due to Staphylococcus aureus and Klebsiella species in this setting. It is commoner among male infants. Most cases run a mild course with good response to topical antimicrobial therapy.

Topical drugs for the treatment of non-streptococcal acute tonsillopharyngitis in children: results of a multicenter study

Acute tonsillopharyngitis (ATP) is a very common disease in children. In non-streptococcal ATP, systemic antibiotics are usually not indicated, but topical antimicrobial therapy is advisable. To evaluate the effectiveness of the combination of cetylpyridinium chloride with gramicidin C in the form of a spray in children with ATP in a prospective multicenter non-interventional study. The groups of patients did not differ significantly in terms of demographic indicators and initial clinical manifestations. Body temperature initially did not differ, but was significantly lower in the main group after 1 (p=0.003) and 4 (p=0.04) days. The sore throat pain intensity decrease in the main group significantly exceeded this indicator in the control group after 1 (p<0.001) and 4 (p <0.001) days. Initially, swallowing pain was observed in all patients, after 4 days the complaint was significantly less frequent in the main group (p<0.001). The total assessment of objective data was significantly lower in the main group after 4 (p<0.001) and 8 (p<0.001) days. No adverse effects of pharmacotherapy were observed. The study showed high efficacy and safety of the cetylpyridinium chloride and gramicidin C (in the form of a spray) combination for non-streptococcal ATP in children aged 6-15 years.

Development of thermosensitive hydrogel containing methylene blue for topical antimicrobial photodynamic therapy

Due to the emergence of antibiotic resistance, antimicrobial photodynamic therapy (aPDT) has recently been demonstrated as a promising alternative to antibiotics to treat wound infections caused by multidrug-resistant (MDR) pathogens. This study aimed to evaluate the bacterial killing efficiency of aPDT mediated by methylene blue (MB) loaded thermosensitive hydrogels against methicillin-resistant Staphylococcus aureus (MRSA). Box-Behnken Design method was employed to investigate the impacts of the polymer compositions, Poloxamer 407, Poloxamer 188 and Carbopol 934P, on the gelation temperature (Tsol-gel) and release rate of MB. The viscosity and in vitro bacterial killing efficiency of three selected formulations with Tsol-gel ranged 25–34 °C and MB release in 2 h (the incubation time used for aPDT experiment) ≥ 70%, were assessed. The viscosity was found to increase with increasing P407 content and increasing total gel concentration. In the in vitro aPDT experiment, all tested MB-hydrogels demonstrated >2.5 log10 colony forming unit (CFU) reduction against three clinical relevant MRSA strains. Interestingly, the bacterial reduction increased with decreasing amount of gel added (reduced MB concentration). This was possibly attributed to the increased viscosity at higher gel concentration reducing the diffusion rate of released MB towards bacterial cells leading to reduced aPDT efficiency. In summary, aPDT with the thermosensitive MB hydrogel formulations is a promising treatment strategy for wound infections.

A study on intralesional triamcinolone acetonide injection- A non-surgicaltechnique of treatment of chalazion

The main objective of this study was to evaluate the safety and efficacy profile of intralesional triamcinolone acetonide (TA) injection for the treatment of primary chalazion. We study included 20 patients in our study who had chalazion persis ting for nearly one month. All of them did not respond to applied topical antimicrobial therapy. These patients were taking intralesional triamcinolone injection as a mode of treatment of chalazion (dosage of 2 – 4 mg). Patients were being evaluated 1 day, 14 days and 1 month after intralesional triamcinolone injection. We noted that treating chalazion with intralesional triamcinolone injection was much more convenient for patients, less time consuming to treat and did not require extra topical antimicrobial treatment. Keywords: Chalazion, Triamcinolone injection, Efficacy of therapy.

Thermal burns of the spectacle associated with supplementary heating in native New Zealand geckos

ABSTRACTCase history: Gradual onset of ocular opacity was observed in three gold-striped geckos (Woodworthia chrysosiretica), and five Pacific geckos (Dactylocnemis pacificus) held in two adjacent terrariums in a zoological institution located in the North Island of New Zealand. Ultraviolet light and heat had been provided for the previous 3–4 years by a fluorescent bulb, but in the last 4 weeks of winter a ceramic heat bulb had been added, situated 10 cm above the upper mesh of the cageClinical findings: All eight geckos presented with mostly bilateral lesions of varying severity confined to the central or upper quadrant of the spectacles. These lesions ranged from variable areas of opacity within the stroma of the spectacle to similarly distributed ulcers of the surface epithelium of both spectacles. The spectacle lesions in the Pacific geckos responded well to treatment with topical combined antimicrobial therapy, within 18–29 days. The gold-striped geckos suffered complications including dysecdysis, severe spectacle ulceration and perforation, mycotic spectaculitis, and widespread mycotic dermatitis resulting in death or leading to euthanasia.Pathological findings: In the three gold-striped geckos, there were extensive areas of deep ulceration and replacement of the spectacle with a thick serocellular crust containing large numbers of fungal elements. The affected areas of the stroma were expanded by large deposits of proteinaceous and mucinous material, pyknotic cellular debris and moderate numbers of heterophils and macrophages as well as infiltrating fungal hyphae.Diagnosis: Mycotic spectaculitis with ulceration and perforation, and disseminated mycotic dermatitis likely secondary to thermal burns.Clinical relevance: This is the first report of thermal burns of the spectacle in any reptile. There was species variation in the burn severity with gold-striped geckos showing more severe lesions, possibly due to a mix of behavioural and anatomical factors. The thermal burns to the spectacles in three cases were complicated by delayed healing, perforation, dysecdysis and severe mycotic infection.

Corneal Collagen Cross Linking With Photo-Activated Chromophore for keratitis (PACK-CXL) As AdjunctiveTherapy for Infectious Keratitis

ABSTRACTObjectives: The aim of this work is to evaluate efficacy and safety of corneal collagen cross linking as adjunctive therapy for infectious keratitis.Patients and Methods: Seventy eight (78) eyes with clinically suspected infectious keratitis were enrolled in this study. The range of age of the enrolled patients was more than or equal to 18 years. They were classified into two groups each of 39 eyes, Group A: received topical appropriate broad spectrum antimicrobial therapy alone and Group B: received combined topical appropriate conventional broad spectrum antimicrobial therapy and corneal collagen cross linking for infectious keratitis (PACK-CXL). Identification of organisms was done by lab study before treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT ( AS-OCT).Results: Complete healing and resolution was observed in 76.9 % of eyes and 97.4 % of patients in groups (A & B), respectively. They showed a statistically significant difference (P

Effect on total microbial load and community composition with two vs six-week topical Cadexomer Iodine for treating chronic biofilm infections in diabetic foot ulcers.

This study compares two vs six weeks of topical antimicrobial therapy with Cadexomer Iodine in patients with diabetic foot ulcers (DFUs) complicated by chronic biofilm infections. Patients with non-healing DFUs with suspected chronic biofilm infections were eligible for enrolment. Patients were randomised to receive either two or six weeks of treatment with topical Cadexomer Iodine. Tissue biopsies from the ulcers were obtained pre-and-post treatment and underwent DNA sequencing and real-time quantitative polymerase chain reaction (PCR) to determine the total microbial load, community composition, and diversity of bacteria. Scanning electron microscopy confirmed biofilm in all 18 ulcers with suspected chronic biofilm infections. Cadexomer Iodine resulted in 14 of 18 (78%) samples achieving a mean 0.5 log10 reduction in microbial load. Regardless of treatment duration, there was no statistical difference in the reduction of total microbial loads. No difference in the rate of wound healing in the two groups was seen at 6 weeks. Cadexomer Iodine reduces the total microbial load in DFUs with chronic biofilm infections and affects microbial community composition and diversity. All ulcers in both groups showed an initial reduction in wound size with application of Cadexomer Iodine, which might reflect its effect on biofilms.

Surgical Management of Chronic Rhinosinusitis in Cystic Fibrosis.

Cystic fibrosis patients frequently develop chronic rhinosinusitis as a result of their propensity to form inspissated mucus and impairment of mucociliary clearance. They exhibit variable symptom burden even in the setting of positive radiographic and endoscopic findings. Current evidence suggests a positive effect of managing sinonasal disease on pulmonary health. Topical antimicrobial and mucolytic therapies are frequently required to manage the disease with surgery reserved for refractory cases. Endoscopic sinus surgery has been demonstrated to be safe and efficacious in controlling symptoms of chronic rhinosinusitis in patients with comorbid cystic fibrosis. However, the impact of surgery on pulmonary health remains an active area of investigation. In addition, a growing body of research has suggested a more extended surgical approach creating large sinonasal cavities with gravity-dependent drainage pathways, followed by adjuvant medical therapies, as an ideal strategy to optimally control disease and prevent pulmonary exacerbations. In this manuscript, we provide an up-to-date review of current evidence in the surgical management of chronic rhinosinusitis in cystic fibrosis patients.

Topical Approach Versus Systemic Antimicrobial Therapy for Treating Diabetic Foot Infection in Ninevah

Infection may be a common character of advanced diabetic foot unwellness and therefore the commonest reason for diabetes-related hospitalizations and lower extremity amputations. The topical (local) treatment has the benefits of avoiding systemic adverse effects, providing an enhanced target area concentration, and permitting the utilization of agents not offered for systemic treatment. The aim of this study is to show the effect of topical antimicrobial approach versus systemic antimicrobial therapy for treating diabetic foot infection in Ninevah. We included randomized controlled trial that allocated people individually as a two-group patient, parallel (topical and systemic) studies involving patients with an infected diabetic foot. The results were expressed in a reduction in risk (efficacy) 91% and the relative risk 0.09 with 95% confidence intervals (0.011–0.696). The results suggest that topical infiltration treatment, when accompanied by appropriate wound care, can provide a therapeutic alternative to a broad-spectrum systemic antibiotic agent.

The bacterial and fungal microbiome of the skin of healthy dogs and dogs with atopic dermatitis and the impact of topical antimicrobial therapy, an exploratory study

Canine atopic dermatitis is a genetically predisposed inflammatory and pruritic allergic skin disease that is often complicated by (secondary) bacterial and fungal (yeast) infections. High-throughput DNA sequencing was used to characterize the composition of the microbiome (bacteria and fungi) inhabiting specific sites of skin in healthy dogs and dogs with atopic dermatitis (AD) before and after topical antimicrobial treatment. Skin microbiome samples were collected from six healthy control dogs and three dogs spontaneously affected by AD by swabbing at (non-) predilection sites before, during and after treatment. Bacteria and fungi were profiled by Illumina sequencing of the 16S ribosomal RNA gene of bacteria (16S) and the internally transcribed spacer of the ribosomal gene cassette in fungi (ITS). The total cohort of dogs showed a high diversity of microbes on skin with a strong individual variability of both 16S and ITS profiles. The genera of Staphylococcus and Porphyromonas were dominantly present both on atopic and healthy skin and across all skin sites studied. In addition, bacterial and fungal alpha diversity were similar at the different skin sites. The topical antimicrobial treatment increased the diversity of bacterial and fungal compositions in course of time on both AD and healthy skin.

Is Topical or Systemic Antimicrobial Therapy More Effective for the Treatment of Feline Acne With Secondary Bacterial Infection?

&lt;strong&gt;PICO question&lt;/strong&gt;&lt;br /&gt;&lt;p&gt;In cats with feline acne and secondary bacterial folliculitis or furunculosis, is topical or systemic antimicrobial therapy superior for reducing time to resolution and severity of clinical signs?&lt;/p&gt;&lt;strong&gt;Clinical bottom line&lt;/strong&gt;&lt;br /&gt;&lt;p&gt;There is no sufficient evidence to compare topical versus systemic treatment in feline acne with secondary folliculitis/furunculosis.&lt;/p&gt;&lt;br /&gt; &lt;img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /&gt; &lt;img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" /&gt;

Graft of Small Patch of Partial Thickness in Equine Wound

Background: Cutaneous wounds in locomotor limbs represent one of the most frequent disorders in equine medicine. Wounds in equines are distinguished from those in other species by unique characteristics, including different healing rates among breeds, wound location and high propensity to formation of exuberant granulation tissue during the healing process. The wound healing process that cannot be sutured can be accelerated by the use of skin grafts, lowering the treatment cost.The objective of this report was to divulgate the success upon treatment of an extensive lacerated wound in the metatarsal region of a horse using autologous skin grafts.Case: A 3-year-old, female, American quarter horse weighting 450 kg was brought to veterinary hospital with lower limb injury. According to the owner’s report, the animal had one of its limbs stuck in a plain wire fence. A wound was observed in the metatarsal region during physical examination, the lesion caused an extensive skin laceration that showed the dorsal surface of the metatarsal bone and the digital extensor tendon. After injury assessment, wound debridement was carried out by surgery intervention followed by antisepsis and application of autologous plasma every two days as post-surgical care and wound preparation to receive the graft. Forty-five days after the first intervention, grafts were collected from the neck and implanted in the wound. The procedure achieved 70% of success. After approximately 75 days, transplantation was performed in other regions of the wound using the same technique. The duration of treatment at the Veterinary Hospital of the Universidade Paranaense (UNIPAR) was eight months, and then the animal returned home, where dressings were applied for two months to avoid the risk of contamination and until complete recovery.Discussion: The debridement of the wound and edges approximation were of great value in order to begin the process of wound granulation. The established therapy with scarring with gauze and use of antiseptics only in the initial stages of treatment, the frequent exchange of bandages every two days, preventing the accumulation of exudate and the use of autologous plasma favored the formation of the granulation bed and was sufficient to avoid infection and the formation of exuberant granulation tissue. Factors such as excessive movement and local infection were also attributed as responsible for the longer healing period, so the use of the spring coupled to the horseshoe decreased the joint movement, proving tobe effective in patients with severe extensor tendon lacerations. The use of the spring coupled to the horseshoe promoted a correct biomechanical alignment and no walking complication or deficiency was observed. The correct anatomical structural positioning prevents the formation of flexural deformities and fibrosis of the joint capsule. The use of micrografts wasbeneficial and simple to perform and the use of grafts contributed to a better cosmetic result. The main factor contributed to the grafting success was the use of dressing, which was regularly changed, and topical antimicrobial therapy correctly applied to avoid contamination. Based on the clinical result of this patient, it was concluded that the use of small autologous grafts can provide good recovery and healing of extensive wounds in horses when proper care with dressings and antimicrobial medication is provided after surgical interventions.Keywords: equine, surgery, graft, healing.

Antibiotic resistance and biofilm tolerance: a combined threat in the treatment of chronic infections.

Since the introduction of antibiotics into human medicine in the 1940's, antibiotic resistance has emerged at an alarming rate and is now a major threat to public health. This problem is amplified by pathogenic bacteria existing most commonly in biofilm form, creating additional bacterial tolerance to antimicrobial agents. Biofilm is now considered to be a primary cause of chronic infection, and antibiotic-resistant bacteria are prevalent in biofilm form. In particular, chronic non-healing wounds commonly harbour complex polymicrobial, pathogenic biofilm that is tolerant to systemic and topical antimicrobial therapy. Antibiotic stewardship programmes have emerged globally to improve antibiotic prescribing practices, and to curb the emergence and spread of bacterial resistance. In this regard, new antimicrobial strategies must be considered, one of which is to use antibiofilm/antimicrobial combinations to disrupt biofilm, thereby facilitating effectiveness of antimicrobial agents, and reducing the opportunity for antibiotic resistance gene transfer within biofilm. This strategy is being considered in several clinical conditions, one of which is chronic non-healing wounds, where antibiotics are used excessively and often indiscriminately. A combination antibiofilm/antimicrobial wound dressing has been shown to facilitate healing in previously biofilm-impaired non-healing wounds. This approach must be considered as part of antibiotic stewardship programmes to reduce the usage and implications of antibiotic therapy, and improve outcomes associated with chronic infections.

Combined oral and topical antimicrobial therapy for male partners of women with bacterial vaginosis: Acceptability, tolerability and impact on the genital microbiota of couples - A pilot study

ObjectivesRecurrence following recommended treatment for bacterial vaginosis is unacceptably high. While the pathogenesis of recurrence is not well understood, recent evidence indicates re-infection from sexual partners is likely to play a role. The aim of this study was to assess the acceptability and tolerability of topical and oral antimicrobial therapy in male partners of women with bacterial vaginosis (BV), and to investigate the impact of dual-partner treatment on the vaginal and penile microbiota.MethodsWomen with symptomatic BV (Nugent Score of 4–10 and ≥3 Amsel criteria) and their regular male sexual partner were recruited from Melbourne Sexual Health Centre, Melbourne, Australia. Women received oral metronidazole 400mg twice daily (or intra-vaginal 2% clindamycin cream, if contraindicated) for 7-days. Male partners received oral metronidazole 400mg twice daily and 2% clindamycin cream topically to the penile skin twice daily for 7-days. Couples provided self-collected genital specimens and completed questionnaires at enrolment and then weekly for 4-weeks. Genital microbiota composition was determined by 16S rRNA gene sequencing. Changes in genital microbiota composition were assessed by Bray-Curtis index. Bacterial diversity was measured by the Shannon Diversity Index.ResultsTwenty-two couples were recruited. Sixteen couples (76%) completed all study procedures. Adherence was high; most participants took >90% of prescribed medication. Medication, and particularly topical clindamycin in males, was well tolerated. Dual-partner treatment had an immediate and sustained effect on the composition of vaginal microbiota (median Bray-Curtis score day 0 versus day 8 = 0.03 [IQR 0–0.15], day 0 vs day 28 = 0.03 [0.02–0.11]). We observed a reduction in bacterial diversity of the vaginal microbiota and a decrease in the prevalence and abundance of BV-associated bacteria following treatment. Treatment had an immediate effect on the composition of the cutaneous penile microbiota (median Bray-Curtis score day 0 vs day 8 = 0.09 [0.04–0.17]), however this was not as pronounced at day 28 (median Bray-Curtis score day 0 vs day 28 = 0.38 [0.11–0.59]). A decrease in the prevalence and abundance of BV-associated bacteria in the cutaneous penile microbiota was observed immediately following treatment at day 8.ConclusionCombined oral and topical treatment of male partners of women with BV is acceptable and well tolerated. The combined acceptability and microbiological data presented in this paper supports the need for larger studies with longer follow up to characterize the sustained effect of dual partner treatment on the genital microbiota of couples and assess the impact on BV recurrence.