Vaginal Tablets of Metronidazole (750 mg) plus Miconazole Nitrate (200 mg) versus Oral Metronidazole (2 g) for Bacterial Vaginosis: A Randomized Controlled Trial

Objective: To compare the cure rates, side effects, satisfaction, and recurrence rates of bacterial vaginosis (BV) in women having vaginal tablets of metronidazole (750 mg) plus miconazole (200 mg)—the “NPF group”—versus oral metronidazole (2 g)—the “MET group.” Materials and methods: This September 2019–March 2020 trial enrolled symptomatic women aged 18–45 years diagnosed with BV based on Amsel’s criteria. Excluded were women who were immunocompromised; allergic to metronidazole or miconazole; had BV episodes during the preceding 3 months; or had abnormal vaginal bleeding. After randomization with a ratio 1:1, another vaginal swab was done for Nugent scoring. Two weeks later, the evaluation using Amsel’s criteria and Nugent scores was repeated. Also, symptom resolution, side effects and satisfaction were evaluated. Symptomatic resolution referred to 75% improvement in discharge, irritation, itching, odor, and coital pain. At one and three months, subjective symptomatic recurrence was assessed by telephone. Results: Data on 70 participants were analyzed (NPF, N=34; MET, N=36). Their average age was 32.3±7.9 years (NPF, 34.1±8.1; MET, 30.6±7.3). Without statistical significance, NPF had higher symptom resolution (67.7% vs 58.3%; P=0.420), cure rate by Amsel criteria (82.4% vs 77.8%; P=0.632), and cure rate by Nugent scoring (35.3% vs 16.9%; P=0.075). Both groups reported high satisfaction (NPF, 8.5±1.4; MET, 7.9±2.0; P=0.125). Side effects were comparable, including appetite loss, metallic taste, nausea, and dizziness. Conclusion: For BV treatment, both vaginal ovules containing metronidazole (750 mg) plus miconazole nitrate (200 mg) and oral metronidazole (2 g) show comparable efficacy and side effects.

SP7.1.3 An integrated and upgraded meta-analysis of published randomized, controlled trials exploring the role of oral metronidazole as post-operative proctological analgesic agent

Aims Proctological procedures such as haemorrhoidectomy have been reported with significant post-operative pain affecting quality of life as well as capacity to perform daily activities. The objective of this article is to explore the role of conventionally used antibiotic metronidazole as a proctological analgesic. Methods A systematic review of the randomized, controlled trials reporting the use of oral metronidazole as post-operative proctological analgesic agent in patients undergoing haemorrhoidectomy published on Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis. Results A total of eight randomized, controlled trials on 447 patients were included in this study. In the random effects model analysis using the statistical software Review Manager, the use of oral metronidazole as a post-operative proctological analgesic agent was significantly associated with the reduced pain score on day 1 (Standardized mean difference (SMD), -0.56; 95% CI, -1.04, -0.07; z = 2.26; P = 0.02), day 3 (SMD, -0.82; 95% CI, -1.33, -0.31; z = 3.15; P = 0.002) and day 7 (SMD, -1.48; 95% CI, -2.51, -0.45; z = 2.82; P = 0.005). There was significant heterogeneity (Tau2 = 0.39, chi2 = 38.38, df = 7, [p = 0.00001]; I2 = 82 %) among included studies. Conclusion The use of oral metronidazole as a post-operative proctological analgesic agent following haemorrhoidectomy seems to have proven clinical advantages and may routinely be used.

Prognosis of recurrent bacterial vaginosis based on longitudinal changes in abundance of Lactobacillus and specific species of Gardnerella

Refractory responses to standard-of-care oral metronidazole among recurrent bacterial vaginosis (BV) patients is not rare, and recurrence within a year is common. A better understanding of the bacterial determinants of these outcomes is essential. In this study we ask whether changes in specific species of Gardnerella are associated with poor short or long term clinical outcomes, and if and how resurgence of Lactobacillus species affects these outcomes. We quantify Lactobacillus isolates as a proportion of total vaginal bacteria using the LbRC5 qPCR assay, and 5 prevalent species of Gardnerella using primers that target species-specific polymorphisms within the cpn60 gene. The study includes 43 BV patients: 18 refractory, 16 recurrent, and 11 remission patients, sampled daily for up to two weeks post-treatment; clinical outcomes were tracked for up to 9 months. Persistently high titers of Gardnerella Gsp07 were associated with refractory responses, and persistently low abundance of Gardnerella Gsp07 and G. swidsinskii / G. leopoldii were associated with remission. Lactobacillus species abundance rose in 4–14 days after initiation of treatment in most but not all recurrent and remission patients, although increases were more sustained among remission patients. The findings suggest that Gardnerella Gsp07 and G. swidsinskii / G. leopoldii are markers of poor clinical outcome or may directly or indirectly suppress recovery of Lactobacillus species, thereby interfering with clinical recovery. Therapies that target these strains may improve patient outcome.

Use of Antibiotics in Cleft Palate Post Operative Patients

Background: Cleft palate surgeries are one of the most common surgeries done by Plastic surgeons. Aim: To determine the role of postoperative antibiotics in terms of incidence of complications in cleft palate surgery. Study Design: Prospective randomized control trial. Place and duration of study: Department of Plastic Surgery, Bashir Hospital, Sialkot from May 2016 to January 2019 Methodology:. Patients were randomly divided into two groups. Both groups received a single dose of injection Ceftriaxone (50mg/kg) about 30 minutes before incision. Group A (n=25) received a 5-day regimen of oral Amoxicillin + Clavulanic acid (15mg/kg/dose in three divided doses per day) post operatively. Group B (n=25) received 5-day regimen of oral Amoxicillin + Clavulanic acid (15mg/kg/dose in three divided doses per day) plus oral Metronidazole (7.5mg/kg/dose in three divided doses) for 5 days postoperatively. Patients were followed up postoperatively at 2 weeks, 1month and 2 months for complication such as infection and wound dehiscence. Result. .Candidates belonging to Group A, (Amoxicillin + Clavulanic acid group) were reported to have Infection 6 (24%) (P 0.005) and delay oral intake. Candidates who were administered oral Amoxicillin + Clavulanic acid (15mg/kg/dose in three divided doses per day) plus oral Metronidazole (7.5mg/kg/dose in three divided doses) 2 patients (8%) had infection in group B which was settled with improvement in oral hygiene. Conclusion: whose candidates who were admitted or stayed for longer duration of time in hospital had insufficient and poor dietary intake. One of the candidates was again admitted due to being dehydrated along with rotavirus whereas group A 24% patients got infected on the other end group B only 8% patients got infected.In net shell, this study revealed that use of postoperative antibiotics (Amoxicillin + Clavulanic acid and metronidazole) can reduce the incidence of infection and results in better surgical outcome of cleft palate surgery Keywords: cleft palate repair, Amoxicillin, Clavulanic acid, Metronidazole, Prophylactic Antibiotics

Intravenous fosfomycin as salvage therapy for osteomyelitis caused by multidrug-resistant Pseudomonas aeruginosa

Purpose A case of osteomyelitis caused by multidrug-resistant (MDR) Pseudomonas aeruginosa is reported. Summary An 84-year-old Caucasian male with an underlying history of type 2 diabetes, peripheral vascular disease, and coronary artery disease had chronic nonhealing wounds on his right foot. Wound care and a course of intravenous (IV) ertapenem with oral ciprofloxacin were ineffective. His initial wound culture grew Staphylococcus aureus, group G streptococcus and P. aeruginosa; the Pseudomonas was susceptible to multiple agents. The patient eventually required midtarsal amputation and angioplasties to his right leg. Twenty days after the operation, 2 openings were discovered at the surgical site, 1 of which was probed to the bone. He was readmitted 5 weeks after the operation. A repeat wound swab grew MDR P. aeruginosa and Finegoldia magna. The Pseudomonas was susceptible to gentamicin and colistin. The patient had revision of the infected amputation site with the goal of salvaging his right lower limb. The patient developed acute renal failure after 26 days of IV gentamicin, IV ceftriaxone, and oral metronidazole. Additional susceptibility testing was performed to identify alternatives. The bacteria were considered susceptible to IV fosfomycin, the last resort, by our microbiology laboratory. This was combined with ceftolozane/tazobactam followed by meropenem to treat the residual infection. After 2 weeks of IV fosfomycin, the patient’s wound improved and further amputation was avoided. Conclusion Our case demonstrates that IV fosfomycin may provide an effective salvage therapy when combined with β-lactams for the treatment of severe diabetic foot infection or osteomyelitis caused by MDR P. aeruginosa.

Efektivitas Pemberian Vankomisin Oral Terhadap Kolitis Infektif pada Anak

Latar belakang. Kolitis bermanifestasi sebagai diare kronik dan pada anak perlu diwaspadai karena memiliki komplikasi gangguan tumbuh kembang dan kematian. Sepuluh hingga dua puluh persen kasus diare infeksi akibat perawatan di rumah sakit disebabkan oleh Clostridium difficile. Metronidazol dan vankomisin oral masih menjadi terapi obat lini pertama untuk infeksi Clostridium difficile. Pada pasien diare berat, studi menunjukkan vankomisin oral menjadi pilihan utama dibandingkan metronidazole.Tujuan. Mengetahui efektifitas pemberian vankomisin oral terhadap metronidazol oral dalam menyembuhkan kolitis infektif kronik pada anak.Metode. Pencarian literatur melalui Pubmed dan Cochrane pada bulan Juli 2019 dengan kata kunci “children OR pediatric” AND “infective colitis OR Clostridium difficile” AND “oral vancomycin” AND “ oral metronidazole”.Hasil. Penelusuran artikel pada makalah ini menemukan dua artikel yang relevan terhadap pertanyaan klinis. Igarashi dkk. merupakan meta analisis terhadap lima uji klinis acak dengan total 1101 pasien dan dipublikasikan pada tahun 2018. Artikel yang kedua adalah studi pilot prospektif observatif dari Antoon dkk pada 8 subyek anak berusia 8-17 tahun pada tahun 2016.Kesimpulan. Vankomisin oral disarankan untuk digunakan dalam kolitis infektif berat. Untuk kasus kolitis infektif yang ringan atau sedang, data menunjukkan hasil yang seimbang untuk vankomisin dan metronidazol. Berdasarkan uji observasional, vankomisin oral tidak diabsorbsi dalam darah pada anak.