Systemic treatment of human trichomoniasis with a derivative of nitro-imidazole, 8823 RP

Antibiomania: A Rare Case of Metronidazole-Induced Mania

Metronidazole is a very commonly used drug for the treatment of ailments caused by bacteria and parasites. It can treat a vast array of conditions like rosacea, sexually transmitted diseases (STDs), liver abscess, bedsores, etc. Metronidazole comes with generic side-effects like nausea, vomiting, dizziness, metallic taste, and also rare side-effects like paresthesia, syncope, cerebellar symptoms, psychosis but mania is a rare side-effect. Here, we present a case of metronidazole induced mania in a 50-year-old male with no past medical history who initially presented with a complaint of mild fever, loss of appetite, and fatigue from the past 10-12 days. On further examination and investigations, diagnosis of the amebic liver abscess was made on the basis of USG, serum serology for amebiasis IgG, and a CT scan. Consequently, the patient was started on the drug of choice for amebic liver abscess; IV metronidazole 1.5g/day divided over the day into three doses. Other drugs that were administered were pantoprazole, paracetamol, and ondansetron. On the ninth day of admission, the patient's wife as well as the physician-daughter of the patient reported a change in the behavior of the patient which became a major concern for the family. The patient was restless, energetic, unable to sleep, had racing thoughts, elated mood, petulant, and kept singing loudly in the private patient room. There was no history of any psychiatric illness in the family. Mr. K´s manic symptoms were managed using haloperidol and lorazepam. Upon discontinuing metronidazole, there was a gradual improvement in the manic symptoms, and symptoms improved, haloperidol and lorazepam were able to be tapered down and eventually stopped. Mr. K did not require any use of any selective serotonin reuptake inhibitor (SSRIs), monoamine oxidase inhibitors (MAOIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), or any other atypical psychotropic drug. Manic-psychosis side-effect is a rare entity caused by antibiotics and the symptoms of which would disappear in a few days after stopping the antibiotic. It is also notable that this patient recovered without the use of any psychotropic drugs. Physicians should be aware of the possible neuropsychiatric side-effects of antibiotics which can lead to unnecessary workup. This side-effect did not require the use of any psychotropic drugs in this patient.

Effect of Echinophora platyloba, Stachys lavandulifolia, and Eucalyptus camaldulensis plants on Trichomonas vaginalis growth in vitro

BACKGROUND

Trichomonas vaginalis is a protozoan parasite which causes vaginitis in women worldwide. Metronidazole with vast side effects is drug of choice for this infection. In search for an alternative drug, in this study the effect of three plants on Trichomonas vaginalis has been investigated in vitro.

MATERIALS AND METHODS

Alcoholic and watery extracts of Echinophora platyloba, Stachys lavandulifolia, and Eucalyptus camaldulensis were prepared. In TYIS culture medium containing alive Trichomonas vaginalis different concentrations of extracts of three plants were added. Following, 24, 48, and 72 h incubation the number of parasite in each test tube was counted.

RESULTS

Eucalyptus camaldulensis showed a strong effect on Trichomonas vaginalis growth. However, no significant effect was observed with Echinophora platyloba or Stachys lavandulifolia extracts.

CONCLUSION

Eucalyptus camaldulensis can be considered as an alternative drug for treatment of infective vaginitis which is caused by bacteria, fungi and parasites.

Study on ITS1 Gene of Iranian Trichomonas vaginalis by Molecular Methods

BACKGROUND

Trichomoniasis is a worldwide protozoan parasitic disease and metronidazole is a choice drug for its treatment. Because of disease importance in public health and its controversial ideas about the prevalence of drug resistance, this study was carried out.

METHODS

Fifty-two suspected vaginal samples were collected from 2006 to 2007 in Gynecology Maryam Hospital, Tehran, Iran. All isolates were examined by microscopic, culture and PCR techniques. The PCR products were analyzed by RFLP and CSGE methods and two suspected samples were sequenced.

RESULTS

Trichomonas vaginalis was identified from all 52 samples. Of 52 isolates, 45 samples were successfully cultured and amplified by PCR except one. Seven were positive only by PCR. Finally, ITS1 fragment was successfully amplified in 51 of 52. CSGE analysis and PCR products digestion by MspI followed by sequencing showed nucleotide mutation at position 209 (C209T) of the ITS1 fragment in two (3.9%) of them.

CONCLUSION

The results showed mutation in ITS1 fragment of T. vaginalis in two (3.9%) of Iranian isolates which may be related to metronidazole resistance.

Antimicrobial susceptibilities of anaerobic bacteria: recent clinical isolates

Minimal inhibitory concentrations of clindamycin, minocycline, metronidazole, penicillin, and carbenicillin were determined by agar dilution against 150 recent clinical isolates of anaerobic bacteria. Ninety-nine percent of Bacteroides fragilis and all B. melaninogenicus, Clostridium perfringens, and Fusobacterium were inhibited by clindamycin at 3.1 mug/ml. Only 58% of other clostridial species were inhibited by this concentration of clindamycin. Minocycline at 3.1 mug/ml inhibited 72% of C. perfringens, 81% of other Clostridium species, and 66, 75, and 100% of B. fragilis, B. melaninogenicus, and Fusobacterium, respectively. Metronidazole at 12.5 mug/ml inhibited all bacteria tested. B. fragilis was resistant to both penicillin and carbenicillin at 6.2 mug/ml. Concentrations of 25 mug/ml for penicillin and 100 mug/ml for carbenicillin were needed to inhibit more than 90% of B. fragilis. Organisms other than B. fragilis were moderately or extremely susceptible to the penicillins.

In vitro resistance of Neisseria gonorrhoeae to metronidazole

Susceptibility of 64 clinical isolates of Neisseria gonorrhoeae to metronidazole was determined by the agar dilution technique using Mueller-Hinton and chocolate agar media. All isolates were resistant to metronidazole at 12.5 mug/ml in either medium. This lack of activity of metronidazole against N. gonorrhoeae would suggest that the ability to recover N. gonorrhoeae in patients being treated with metronidazole for concurrent Trichomonas vaginalis infections should not be hampered.

Activities of dicationic compounds against Trichomonas vaginalis

We evaluated 44 novel cationic compounds for activity against metronidazole-sensitive and -resistant Trichomonas vaginalis isolates. Six compounds in three different structural classes demonstrated 50% inhibitory concentrations as low as 1 microM against both sensitive and resistant isolates, suggesting a mode of action independent of parasite biochemical pathways that confer resistance to 5-nitroimidazoles.

In vitro metronidazole and tinidazole activities against metronidazole-resistant strains of Trichomonas vaginalis

The in vitro activities of tinidazole and metronidazole against Trichomonas vaginalis isolates clinically resistant to metronidazole were compared. Minimal lethal concentrations (MLCs) of tinidazole were significantly lower than MLCs of metronidazole. Increased metronidazole resistance correlated with increased tinidazole resistance. These data support a role for tinidazole in the treatment of trichomoniasis.

Treatment of giardiasis

Giardia lamblia is both the most common intestinal parasite in the United States and a frequent cause of diarrheal illness throughout the world. In spite of its recognition as an important human pathogen, there have been relatively few agents used in therapy. This paper discusses each class of drugs used in treatment, along with their mechanism of action, in vitro and clinical efficacy, and side effects and contraindications. Recommendations are made for the preferred treatment in different clinical situations. The greatest clinical experience is with the nitroimidazole drugs, i.e., metronidazole, tinidazole, and ornidazole, which are highly effective. A 5- to 7-day course of metronidazole can be expected to cure over 90% of individuals, and a single dose of tinidazole or ornidazole will cure a similar number. Quinacrine, which is no longer produced in the United States, has excellent efficacy but may be poorly tolerated, especially in children. Furazolidone is an effective alternative but must be administered four times a day for 7 to 10 days. Paromomycin may be used during early pregnancy, because it is not systematically absorbed, but it is not always effective. Patients who have resistant infection can usually be cured by a prolonged course of treatment with a combination of a nitroimidazole with quinacrine.

Laboratory studies with the systemic trichomonacide, metronidazole

Laboratory studies with the trichomonacidal agent, metronidazole, show that 66 strains of T. vaginalis were killed in three days by concentrations of 0.0625 mug./ml. to 1 mug./ml. Estimations of serum and urine levels in nine volunteers, the serum levels in 31 women, and the urine levels in 33 women show that metronidazole is rapidly absorbed and excreted in high concentration in the urine. Development of resistance to metronidazole by T. vaginalis has not been demonstrated either in vivo or in vitro. No toxic effect was demonstrated in the blood, liver, or kidney.

New concepts in the diagnosis and pathogenesis of Trichomonas vaginalis

Trichomonas vaginalis infection is the most commonly encountered sexually transmitted disease. There is a need for more accurate and rapid laboratory diagnostic methods, leading to better control and treatment strategies. Various virulence factors such as adherence, contact-independent factors, hemolysis and acquisition of host macromolecules have been shown to play a role in the pathogenesis of this infection. Detection of the factors that are only present in the pathogenic isolates of trichomonads will lead to a better understanding of the epidemiology of this pathogen. Culture technique is highly specific compared with microscopic techniques, but it is time consuming. Immunological techniques lack proper correlation with clinical manifestations. The application of monoclonal antibodies, either singly or in a group that recognizes a common antigen, along with methods such as detection of common DNA fragment from clinical specimens, may have a promising future in the laboratory diagnosis of trichomoniasis.

Antibacterial activities of the antiparasitic drugs nifurtimox and benznidazole

Both nifurtimox and benznidazole, which are used for the treatment of Chagas' disease, also display marked antibacterial activities. Characteristically for nitroheterocyclic compounds, they are much more active against anaerobic and microaerophilic bacteria than against aerobic bacteria. Nitroreductase-deficient aerobes are completely resistant, whereas SOS-repair-deficient strains are moderately susceptible. Those strains are rapidly killed.

Antibacterial activity of GO 10213, a nitroimidazole derivative

Compound GO 10213, a 5-nitroimidazole substituted at the 2 position, is more active against aerobic, microaerophilic, and anaerobic bacteria than metronidazole. The MICs for Salmonella typhimurium (2 to 128 micrograms/ml), Campylobacter spp. (0.06 to 16 micrograms/ml) and Bacteroides spp. (0.03 to 0.25 micrograms/ml) are definitely lower than those of metronidazole. Niridazole, a 5-nitrothiazole, is still more active.

Comparison of four techniques for the routine diagnosis of Trichomonas vaginalis infection

Specimens from 495 patients attending Johannesburg hospitals and family planning clinics were examined for Trichomonas vaginalis by microscopy of Giemsa (GS), Papanicolaou (PAP), and acridine-orange (AO) stained smears, and by culture in Feinberg-Whittington medium. Culture, Pap and GS stained smears from vaginal swabs yielded fewer positives than AO stained smears. Although Pap-stained cytological smears gave the highest number of positives, in 30% of these cases the presence of T.vaginalis could not be confirmed by examination of vaginal swabs. Of the positive AO-stained smears, 93% were also positive by at least one other technique.

Bactericidal activity of metronidazole against Bacteroides fragilis

Metronidazole was found to be active against Bacteroides fragilis strains isolated from human lesions. The minimal inhibitory concentrations (MIC) were from 0.16 to 2.5 mug/ml and the minimal bactericidal concentrations (MBC) were from 0.16 to 2.5 mug/ml; usually the MIC and MBC figures were equivalent. These levels are easily attainable in the serum following normal therapeutic doses. The drug is not toxic and side effects are rare and it would therefore seem highly suitable for treating Bacteroides infections and also may be considered prophylactically in certain situations that are described.

Nifuratel compared with metronidazole in the treatment of trichomonal vaginitis

Nifuratel (Magmilor) was compared with metronidazole (Flagyl) in the treatment of trichomonal vaginitis by a randomized double-blind trial. Only 18 out of 47 patients (38%) treated with nifuratel were found to be cured, whereas 42 out of 49 patients (85%) treated with metronidazole were cured. Severe reactions, necessitating withdrawal of treatment, occurred in three patients treated with nifuratel. There were no serious side-effects with metronidazole. The results of this trial indicate that nifuratel is not a satisfactory substitute for metronidazole in the treatment of trichomoniasis.

Trichomoniasis. Clinical trial of metronidazole (Flagyl)

Metronidazole was given in various dosage regimens to 97 patients having microscopically diagnosed trichomoniasis. At the first examination after treatment all 97, including 76 to whom metronidazole had been given orally only, were found by culture and wet smear to be free of trichomonads. Reexamination of the 65 patients followed up for periods ranging from two weeks to 14 months revealed reappearance of trichomonads in eight cases. Nineteen husbands were treated. No patient had a recurrence after treatment of the husband. No effect of metronidazole on pregnancy or on fetal development was seen. Side effects, noted in 19 cases (20 per cent), generally were mild and transient and in no case were severe enough to terminate therapy before cure was effected.