Ornidazole induced Stevens-Johnson syndrome without body surface involved: A case report

RATIONALE

Ornidazole is a synthetic nitroimidazole derivative that is commonly prescribed for antiparasitic or anti-anaerobic infections. It is generally well tolerated, with known side effects including gastrointestinal tract, anaphylaxis, and central nervous system reactions. Ornidazole-induced binocular reactive keratitis and several mucocutaneous lesions have been rarely reported.

PATIENT CONCERNS

A 52-year-old woman who suffered from vaginitis and received an ornidazole vaginal plug (0.5 g). Approximately 20 minutes after the suppository was inserted into the vagina, her lips were swollen and valva and labia were burning. Her eyes were red, sore, and watery.

DIAGNOSIS

She was diagnosed as Steven-Johnson syndrome by the ophthalmologist. According to the Naranjo scale, the adverse drug reaction was evaluated to be probable and severe.

INTERVENTIONS

Dexamethasone was intravenous administrated as anti-inflammatory therapy for 10 days. Eye drops were locally given to relieve edema and promote healing of the epithelium. The symptoms of her eyes, lips, vulva and crissum were soon relieved.

OUTCOMES

The patient was discharge from hospital with improved symptoms.

LESSONS

In order to avoid severe adverse effect, the patient should not use metronidazole ether orally or vaginally. The case emphasized the importance of rapid and accurate diagnosis of Steven-Johnson syndrome induced by ornidazole vaginal plug, especially when the eye symptoms were the chief complaint without body skin involved.

Effect of moxa smoke on sperm parameters and oxidative stress in rats with asthenozoospermia

Asthenozoospermia is a leading cause of male infertility, characterized by reduced sperm motility. In this study, we determined sperm motility and the activities of antioxidant enzymes and oxidation products in the testis of rats with ornidazole (ORN)-induced asthenozoospermia and further examined and compared the differential effects of moxa smoke (MS) and cigarette smoke (CS) on sperm motility and oxidative stress (OS) of asthenozoospermic rats. The smoke intervention was initiated 11 days after intragastric administration of ORN, followed by the examination of testis index, sperm parameters, OS-related gene levels, and testicular histopathology. Sperm motility and antioxidant enzyme activities, as well as oxidation products significantly decreased in ORN-induced rats compared with MS-treated rats (p < .05-.001). MS treatment restored the reduced sperm motility and activities of glutathione peroxidase, superoxide dismutase, and catalase, but increased the malondialdehyde and nitric oxide synthetase levels in ORN-induced rats (p < .05-.001). Also, the histopathological changes in the testis of ORN-induced rats were improved by MS treatment. The study highlighted that MS was an effective factor in moxibustion therapy, which notably improved the sperm motility of asthenozoospermic rats by inhibiting OS in the reproductive system.

Pharmacokinetics and safety of injected ornidazole compared to its enantiomer levornidazole in healthy Chinese subjects

OBJECTIVE

To compare the pharmacokinetics of levornidazole and ornidazole in healthy Chinese subjects after a single intravenous injection, and to determine whether the chiral inversion of levornidazole occurs in vivo.

MATERIALS AND METHODS

The study was a randomized, open-label, two-period crossover, single-dose design. A total of 12 subjects were enrolled in this study. Subjects received an intravenous injection of either levornidazole sodium chloride injection (200 mL: 0.5 g) or ornidazole sodium chloride injection (200 mL: 0.5 g) once per period. The plasma concentrations of levornidazole, ornidazole, and their metabolites were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Phenix WinNolin software (version 6.4) was used to calculate the pharmacokinetic parameters of levornidazole, ornidazole, and their metabolites.

RESULTS

Dexornidazole was not detected in the plasma or urine. After a single intravenous injection of levornidazole or ornidazole, there was no significant difference in Cmax between the two drugs (p < 0.05). The AUC0-∞ and AUC0-t of levornidazole were slightly lower than those of ornidazole. Metabolites M1 and M4 were detected in the plasma of both drugs, and their pharmacokinetic parameters were similar. Metabolites M1, M2, and M4 were present in urine. The average cumulative urinary excretion rates of levornidazole and its metabolites M1 and M4 were: during 0 - 24 hours (8.14 ± 0.80%, 0.560 ± 0.072%, and 1.42 ± 0.19%) and 0 - 60 hours (10.5 ± 1.0%, 0.960 ± 0.084%, and 2.52 ± 0.20%), the average cumulative urinary excretion rates of ornidazole and its metabolites M1 and M4 were: 0 - 24 hours (8.64 ± 0.98%, 0.486 ± 0.074%, and 1.46 ± 0.21%), 0 - 60 hours (11.8 ± 1.0%, 0.888 ± 0.070%, and 2.76 ± 0.20%). The incidence of adverse reactions was similar between the two drugs.

CONCLUSION

No chiral inversion of levornidazole occurred in vivo after intravenous administration of levornidazole. The pharmacokinetic parameters and cumulative excretion rates of levornidazole and ornidazole were similar. The safety results were basically consistent between the two drugs.

Taurine Increases Spermatozoa Quality and Function in Asthenospermia Rats Impaired by Ornidazole

Asthenospermia has been considered as one of the crucial causes of male infertility, which was closely related to epididymal dysfunction. Lots of documents have revealed that taurine palys an important role in male reproduction, including antioxidation, membrane stabilization, stimulation of sexual hormone secretion and elevation of sperm quality. The objective of this study was to expose the effect of taurine on spermatozoa quality and function in ornidazole-induced asthenospermia rats. We found that taurine treatment could obviously recover the decline of cauda epididymal sperm count, viability and motility, and the elevation of sperm abnormality in asthenospermia animals. Spermatozoa acrosin, LDH-X, SDH and CCO activities of model rats also were notably increased by taurine administration. The present data indicated that taurine could raise spermatozoa quality and function by elevating mitochondrial energy metabolism. Notably, taurine supplementation markedly raised serum GnRH, LH and T levels in asthenospermia rays, suggesting taurine rescued asthenosperm by means of stimulating hypothalamic-pituitary-testicular axis secretion. We also found that concentrations of asthenospermia epididymal carnitine, SA, α-Glu and ACP, and mRNA expression levels of MMP7 and IDO2 were significantly rised by taurine administration, indicating taurine may protect epididymal epithelium structure, improve secretion activity, and maintain intraluminal microenvironment homeostasis. Finally, the present results showed taurine effectively increased cauda epididymal SOD, GSH and γ-GT levels in model rats, reduced ROS and MDA production, suggesting epididymal antioxidant ability of asthenospermia rats could be elevated by taurine treatment. To sum up, our results indicated that taurine can promote spermatozoa quality and function in ornidazole-induced asthenospermia rats by facilitating epididymal epithelium secretion and luminal microenvironment homeostasis.

Evaluation of efficacy and tolerability of fixed dose combination of ofloxacin with ornidazole infusion (infusion O2) in the management of diarrhoea and dysentery

Acute diarrhoea in adults is one of the most commonly encountered medical emergency in general practice and is responsible for considerable morbidity around the world. To evaluate the efficacy and tolerability of fixed dose combination of ofloxacin with ornidazole infusion (infusion O2) in the management of diarrhoea and dysentery, a study was carried out among 290 patients, age group from 18 to 65 years suffering from diarrhoea, dysentery, gastro-enteritis. Study drug infusion O2, (Medley Pharmaceutical, Mumbai) containing ofloxacin 200 mg + ornidazole 500 mg was administrated twice daily for a duration of 5 days. Number of soft or watery stool, body temperature, nausea, abdominal pain, gas and flatulence were recorded at baseline and at the end of the study. Tolerability and efficacy was evaluated based on the global assessment by the investigator based on a 3-point scale marked as excellent/good/poor. Two hundred and fifty-six-patients (160 male and 96 female) were included for final analysis, 34 patients lost to follow-up. Mean number of watery stool per day was reduced from 9.273 +/- 0.4537 to 1.375 +/- 0.07001 (p < 0.0001) by infusion O2. Body temperature was significantly reduced from 38.055 +/- 0.045 degrees C to 36.778 +/- 0.016 degrees C (p < 0.0001) at the end of the study. Pretreatment symptom nausea was significantly reduced in 90.34% of patients. Improvement in vomiting symptoms was reported in 72.35% of patients after administration of anti-emetic drug; 96.84% and 77.25% of patients reported improvement in abdominal pain and gas/flatulence respectively at the end of the trial by infusion O2. As per investigators' assessment about efficacy of trial drug, 98.43% of patients reported good to excellent and 1.56% reported poor efficacy. As per investigators' assessment about tolerability 98.43% of patients reported good to excellent and 1.17% reported poor tolerability. Minor incidences of nausea, gastritis, metallic taste were reported in 7.42%, 7.14%, and 5.85% of patients respectively. No serious adverse events were reported which led to withdrawal of patient from the study. Result of this study shows that, combination of ofloxacin with ornidazole infusion (infusion O2) significantly reduces number of watery stool and associated symptoms like nausea, abdominal pain, flatulence/gas with excellent tolerability.

Acute pancreatitis following doxycycline and ornidazole coadministration

CONTEXT

Drugs are related to the etiology of acute pancreatitis in approximately 1.4-2.0% of cases. Although antibiotics constitute a small number of the drugs suspected, tetracycline is the most encountered antibiotic among those drugs.

CASE REPORT

A 33-year-old woman was admitted to the emergency room complaining of nausea and abdominal pain after the use of doxycycline 500 mg and ornidazole 500 mg twice daily for three days for a vaginal infection. She experienced epigastric pain, which worsened over time and radiated to her back. After a detailed evaluation, she was diagnosed as having mild acute pancreatitis which improved with medical treatment. All other possible causes of pancreatitis were eliminated.

CONCLUSIONS

Antibiotic-associated pancreatitis usually has a silent and mild course. To the best of our knowledge the literature reports only two cases of doxycycline-induced acute pancreatitis reported and there are no reports of pancreatitis associated with ornidazole. Our case is the first case reported in which doxycycline and ornidazole coadministration induced acute pancreatitis.

[Multicenter randomized controlled clinical study on levornidazole and sodium chloride injection in the treatment of pelvic anaerobic infections]

OBJECTIVE

to evaluate clinical efficacy and safety of levornidazole in the treatment of pelvic anaerobic infections.

METHODS

a multicenter randomized controlled clinical study was conducted to evaluate clinical efficacy and safety of levornidazole. One hundred and fourty-three patients with pelvic anaerobic bacteria infection were classified into 70 cases treated by levornidazole in study group and 73 cases treated by Ornidazole in control group. Those patients in two groups were both administered at a dose of 0.5 g twice daily for 5 - 7 days. The rate of clinical efficacy, bacteria clearance and adverse effect were recorded and compared between two groups.

RESULTS

at the endpoint, the rate of clinical efficacy were 80% (56/70) in study group and 81% (59/73) in control group, which did not reach significant difference (P > 0.05). The rate of bacteria clearance were 97% (36/37) in study group and 92% (22/24) in control group, which also did not reach significant difference (P > 0.05). The rate of adverse reaction of 3% (20/70) in study group was significantly lower than 22% (16/73) in control group (P < 0.05).

CONCLUSION

it is effective and safe to treat pelvic anaerobic infections with levornidazole and sodium chloride injection.

[Protective effect of L-carnitine on the testis and epididymis against ornidazole-induced injury in male rats]

OBJECTIVE

To investigate the protective effect of L-carnitine on the testis and epididymis against ornidazole (ORN)-induced injury in male rats.

METHODS

Forty male SD rats weighing 200 -230 g were randomly divided into 5 groups, Group A treated with 0.5% sodium carboxymethyl cellulose, and Groups B, C, D and E with ORN at the daily dose of 400 mg/kg, 800 mg/kg, 400 mg/kg plus LC 100 mg/kg and 800 mg/kg plus LC 100 mg/kg, respectively, all by oral gavage for 20 days continuously. Twenty-four hours after the last administration, all the rats were put to death, their testes and epididymides harvested, weighed and subjected to HE staining. The indexes of the testes and epididymides were obtained and their histopathological changes observed.

RESULTS

Compared with Group A, Groups B and C showed significant decreases in the indexes of the testis and epididymis (P < 0.05 and P < 0.01), while Group D exhibited no difference and Group E extremely significant difference (P < 0.01). HE staining revealed that the spermatogenic cells at all levels of testicular seminiferous tubules were neatly arranged in Group B, caduceus in some seminiferous tubules, with decreased number of sperm and sporadic spermatogenic cells in the epididymal duct. Necrotic and caduceus spermatogenic cells were observed in the seminiferous tubules of Group C, with significantly decreased number of sperm and lots of non-sperm cell components in the epididymal duct. No obvious changes were found in the testicular seminiferous tubules, nor evident reduction in the number of sperm in the epididymal duct of Group D. Group E showed decreased number of sperm in the testicular seminiferous tubules, necrotic and caduceus spermatogenic cells, obviously reduced number of sperm and a lot of non-sperm cell components in the epididymal duct.

CONCLUSION

ORC can induce histopathological changes in the testis and epididymis of male rats, and L-carnitine plays a role in protecting the testis and epididymis from ORN-induced injury in male rats.

[L-carnitine improves the reproductive function of male rats with ornidazole-induced asthenospermia]

OBJECTIVE

To explore the protective effect of L-carnitine (LC) on the reproductive function of male rats with asthenospermia induced by ornidazole (ORN).

METHODS

Forty male SD rats (200-230 g) were randomly divided into Groups A (control: 0.5% carboxymethylcellulose solution), B (medium-dose ORN: 400 mg/kg/d), C (medium-dose ORN + LC: ORN 400 mg/kg/d + LC 100 mg/kg/d), D (high-dose ORN: 800 mg/kg/d), and E (high-dose ORN + LC: ORN 800 mg/kg/d + LC 100 mg/kg/d). All the rats were treated via gastric gavage for 20 days consecutively, and then killed for the detection of sperm motility and the sperm count of the cauda epididymis.

RESULTS

Compared with Group A, there was a significant decrease in sperm motility and sperm count in Groups B and D (P < 0.05), while Group C showed a significant increase in both the parameters as compared with B (P < 0.05), but with no significant difference from A (P > 0.05). Group E exhibited no obvious improvement in sperm motility and sperm count, with no difference from D (P > 0.05).

CONCLUSION

L-carnitine can improve the sperm motility and sperm count of the male rats with ornidazole-induced asthenospermia.

Severe hepatitis with prolonged cholestasis and bile duct injury due the long-term use of ornidazole

Nitroimidazole derivatives are commonly used in the treatment of protozoal and anaerobic infections, and reports of their hepatotoxicity are rare. We report a case of severe hepatitis due to the long-term (8 weeks) use of ornidazole. A 27-year-old woman presented for evaluation of elevated serum transaminase and total bilirubin levels. Liver biopsy revealed portal inflammation, hepatocellular and canalicular cholestasis, porto-portal and portocentral bridging fibrosis, and a tendency to form nodules. No aetiological factors associated with chronic liver disease were identified. The abdominal ultrasonographic findings were compatible with chronic liver disease. We therefore made the diagnosis of severe hepatitis resulting from the long-term use of ornidazole. We conclude that nitroimidazole derivatives may lead to serious liver damage, especially in female patients.

Treatment of rheumatoid arthritis with ornidazole: a randomized, double-blind, placebo-controlled study

The aim of our study was to evaluate the clinical efficacy, safety, and tolerability of ornidazole in patients with rheumatoid arthritis (RA). This was 3 months, randomized, double-blind,placebo-controlled study. A total of 160 patients with active RA were randomly assigned to receive 1,000 mg ornidazole (n = 53), 500 mg ornidazole (n = 55), or placebo (n = 52). A significantly greater percentage of patients treated with 1,000 mg ornidazole met the American College of Rheumatology 20% improvement criteria (achieved an ACR20 response) at 3 months compared with patients who received placebo (62.0 vs. 32.4%; P < 0.001). Greater percentages of patients treated with 1,000 mg ornidazole also achieved ACR50 responses (38.3 vs. 10.9%; P < 0.001) and ACR70 responses (19.6 vs. 1.2%; P < 0.001) compared with patients who received placebo. Ornidazole treatment was also associated with significant reductions in pain and duration of morning stiffness, significant improvement in the quality of life and both the physician's and patient's global assessments, and significant reductions in disease activity as assessed by objective laboratory measures (erythrocyte sedimentation rate and C-reactive protein level). Ornidazole was well tolerated. There were no dose-limiting toxic effects. In this 3-month-trial ornidazole was safe, well tolerated, and associated with improvement in the inflammatory symptoms of RA.

[Clinical and microbiological efficacy of metronidazole and ornidazole in the treatment of urogenital trichomoniasis in men]

The aim of the study was to compare the efficacy of metronidazole and ornidazole in the treatment of urogenital trichomoniasis in men. The drugs were used randomly in usual doses as monotherapy: 210 patients, metronidazole and 217 patients, ornidazole. The clinical efficacy of metronidazole and ornidazole was stated in 57.6 and 94.5% of the patients and the microbiological efficacy was stated in 77.1 and 98.2% of the patients respectively. The side effects were recorded in 59.0 and 3.7% of the patients respectively. Thus, ornidazole proved to be a more efficient and safe agent vs. metronidazole in the treatment of urogenital trichomoniasis.

Ornidazole for prophylaxis of postoperative Crohn's disease recurrence: a randomized, double-blind, placebo-controlled trial

BACKGROUND & AIMS

Crohn's disease almost inevitably recurs after ileocolonic resection, and effective prophylactic therapy has not been identified. We investigated the efficacy and safety of ornidazole, a nitroimidazole antibiotic, for the prevention of clinical recurrence of Crohn's disease after curative ileocolonic resection in a placebo-controlled double-blind clinical trial.

METHODS

Eighty patients were randomized to ornidazole 1 g/day or placebo started within 1 week of resection and continued for 1 year. The primary end point was the proportion of patients with clinical recurrence at 1 year. Secondary end points were endoscopic recurrence at 3 months and 12 months after resection.

RESULTS

Two patients in the ornidazole group withdrew consent and were not dosed. Ornidazole significantly reduced the clinical recurrence rate at 1 year from 15 of 40 (37.5%) patients in the placebo group to 3 of 38 (7.9%) patients in the ornidazole group (Fisher exact test, 8.03; P = .0046; odds ratio, 0.14; 95% confidence interval, 0.037-0.546). Ornidazole reduced endoscopic recurrence at 12 months from 26 of 33 (79%) in the placebo group to 15 of 28 (53.6%) in the ornidazole group (chi2 , 4.37; P = .037; odds ratio, 0.31; 95% confidence interval, 0.10-0.94). Endoscopic recurrence at 3 and 12 months predicted clinical recurrence. Significantly more patients in the ornidazole group dropped out from the study because of side effects (P = .041).

CONCLUSIONS

Ornidazole 1 g/day is effective for the prevention of recurrence of Crohn's disease after ileocolonic resection.

Teratogenic evaluation of metronidazole and ornidazole usingDrosophila melanogasteras an experimental model

BACKGROUND

Drosophila and vertebrates show similarities that suggest that the mechanisms involved in the induction of developmental defects may be similar in both. Therefore, Drosophila has been proposed as a useful, rapid, and economical model in the preliminary screening for teratology studies. The objective of the present study was to investigate the effect of metronidazole (MTZ) and ornidazole (ONZ) on the developmental stages of Drosophila melanogaster.

METHODS

Samarkand wild-type females were allowed to lay eggs for 24 hr in media containing MTZ or ONZ at concentrations of 0, 500, 1000, and 2000 microg/ml. When larvae completed their development, the emerging flies were counted and examined for morphological abnormalities.

RESULTS

After the analysis of 400-1000 flies for each concentration, ONZ-treated flies did not show an incidence of malformations above control values, although a significant high number of individuals with reduced body size was observed (p < 0.005, chi2 test). On the other hand, the 1000- and 2000-microg/ml MTZ-treated series presented higher frequencies of total abnormalities than did concurrent and historic controls (p < 0.05, chi2 test), indicating an MTZ effect during developmental morphogenesis.

CONCLUSIONS

These findings contribute to the characterization of both nitroimidazoles, which are widely used, especially in underdeveloped countries. At the same time, this Drosophila bioassay is sensitive enough to detect differential effects of MTZ and ONZ (abnormalities vs. growth effects), showing specificity and selectivity.

Ornidazole-induced liver damage: report of three cases and review of the literature

Metronidazole and ornidazole, synthetic nitroimidazole derivatives, are used in the treatment of infections caused by anaerobic bacteria and protozoa. The drugs are well tolerated and serious side effects are very rarely encountered. Hepatotoxicity is a rare side effect and hitherto only six cases have been reported. We describe three patients who developed hepatitis after ornidazole use and review the previously reported cases. All three cases used ornidazole in conventional doses and developed hepatitis and associated cholestasis. They improved 1-2 months after discontinuation. We concluded that nitroimidazole derivatives may cause hepatotoxic damage resembling acute cholestatic hepatitis. Early recognition and withdrawal of the drug may prevent further damage.

[Aseptic meningitis ornidazole-induced in the course of infectious endocarditis]

INTRODUCTION

Drug-induced aseptic meningitis (DIAM) has been reported as an uncommon adverse reaction to treatment, nonsteroidal anti-inflammatory drugs (NAIDS) stand for most of the published cases. EXEGIS: Our observation reports the first case of a meningeal syndrome with fever, after the administration of ornidazole, with biological aseptic meningitis with lymphocyte prodominance. Spontaneous recovery occurred within a few days and without sequelae. It involved a patient with endocarditis and revealing an intramucous sigmoid adenocarcinoma. The rest of the infection tests was negative.

CONCLUSION

We concluded that we were in the presence of a DIAM, with ornidazole as the most probable implicated agent. This diagnosis is suggested in front of a recurring meningeal syndrome without any other apparent etiology, hence the importance of the questioning of the patient. Pending objective evidence usually provided by rechallenge, an antibiotic therapy is necessary, because it is, above all, a diagnosis of exclusion.

Nitroimidazole-induced chronic hepatitis

Drug-induced chronic hepatitis is a rare pathological condition. There is no reported case with chronic hepatitis secondary to nitroimidazole use. We report a patient who developed nitroimidazole-induced chronic hepatitis following acute exacerbation of hepatitis three times after nitroimidazole use.

Ornidazole-induced autoimmune hepatitis

Ornidazole is a commonly prescribed antiparasitic drug for parasitic infestations, including amoebiasis, giardiasis and Trichomonas vaginalis. Several cases of antibiotic-induced autoimmune hepatitis (AIH) or AIH-like syndrome have been reported recently. In this report, we describe a 35-year-old woman with two relapses of AIH induced by ornidazole prescribed for diarrhoea and vaginal infection.

Efficacy of omeprazole plus two antimicrobials for the eradication of Helicobacter pylori in a Turkish population

Omeprazole combined with 2 antimicrobials has been suggested as a first-line option for Helicobacter pylori eradication in recent years. However, controversy exists regarding the efficacy of this protocol. This open-label, prospective clinical study investigated the efficacy of omeprazole-based triple therapy for H pylori eradication in 518 patients with H pylori-positive functional dyspepsia with or without duodenal ulcer. Amoxicillin, macrolides (clarithromycin or roxithromycin), and nitroimidazoles (metronidazole, ornidazole, or tinidazole) were the antibiotics used in the study. Nonulcer patients were randomly assigned to 1 of 8 different treatment protocols and duodenal ulcer patients were randomly assigned to 1 of 4 different treatment protocols consisting of omeprazole (20 mg once daily for nonulcer patients, 20 mg twice daily for ulcer patients for 14 days) with a combination of 2 of the above antimicrobials (for 10 days). H pylori infection was assessed by histologic findings and a rapid urease test before therapy and 4 weeks after therapy ended. Four hundred fifty-nine patients completed their regimens; 327 had functional dyspepsia (180 men, 147 women; median age, 39 years; range, 18 to 70 years) and 132 had ulcers (81 men, 51 women; median age, 40 years; range, 18 to 70 years). Eradication of H pylori was achieved in 58.8% (270 of 459) of all patients, 58.1% (190 of 327) of nonulcer dyspeptic patients, and 60.6% (80 of 132) of duodenal ulcer patients. The eradication rate varied from 47.2% to 69.4% in different treatment protocols. There were no statistically significant differences in eradication rates in any treatment group. All drugs were generally well tolerated in all groups, and no patient discontinued treatment because of side effects. Therapy with omeprazole and 2 antimicrobials for H pylori had limited efficacy in a Turkish population. The reason for these results, which conflict with those of other studies, is not clear. Further investigations of regimens for the eradication of H pylori in our population are necessary.

One-week therapy with omeprazole, clarithromycin and metronidazole or ornidazole, followed by 3 weeks' treatment with omeprazole, eradicates Helicobacter pylori equally and heals duodenal ulcer

OBJECTIVE

To estimate and compare the efficacy of 'triple' 1-week regimens--omeprazole, clarithromycin and a nitroimidazole (metronidazole or ornidazole)--followed by omeprazole, for an additional 3 weeks, on Helicobacter pylori eradication and duodenal ulcer (DU) healing, in a country with a high resistance rate of H. pylori to metronidazole.

DESIGN

Open, prospective, two-centre study.

METHODS

Patients older than 18 years with active duodenal ulcer (DU), diagnosed by endoscopy and found to be infected with H. pylori (modified Giemsa stain and CLO test, Delta West, Australia), were included in the study. Three triple-drug regimens, given for 7 days, were used. (1) omeprazole (Om) 20 mg once a day, plus clarithromycin (Cl) 250 mg twice daily, plus ornidazole (Or) 500 mg twice daily (O1COr); (2) Om 20 mg twice daily, plus Cl 250 mg twice daily, plus Or 500 mg twice daily (OCOr); and (3) Om 20 mg twice daily, plus Cl 250 mg twice daily, plus metronidazole (M) 500 mg twice daily (OCM). Two hundred and three consecutive H. pylori-positive patients were included in the study, randomly assigned as follows: 50 patients (group A1: 32 men, 18 women, age 23-77 years) on O1COr; 47 patients (group A2: 29 men, 18 women, age 27-77 years) on OCOr; and 106 (group B: 71 men, 35 women, age 18-83 years) on OCM. Ulcer healing and H. pylori eradication were assessed endoscopically, 8-9 weeks after the start of treatment. H. pylori was considered eradicated if both histology and rapid urease test (six biopsies, antrum-body) were negative.

RESULTS

Eleven patients were lost to follow-up; 192 patients were analysed. Group A1: 48; group A2: 44; group B: 100. 'Per-protocol' analysis: H. pylori eradication, 90-93% (P = 0.901); ulcer healing, 90-98% (P = 0.300). 'Intention to treat' analysis: H. pylori eradication, 85-88% (P = 0.887); ulcer healing, 86-91% (P = 0.657). Compliance was excellent, no serious side effects were observed and no patients withdrew due to side effects.

CONCLUSIONS

No differences were observed in the H. pylori eradication and the healing rate among the groups. It seems that twice daily omeprazole is no better than single daily dosage and that ornidazole is as effective as metronidazole. In addition, in the studied population which is believed to have a high prevalence of metronidazole resistance, all the regimens used were effective.

A randomised study of ornidazole as a radiosensitiser in carcinoma of the cervix: long term results

This paper presents long-term results of a randomised study of ornidazole as a radiosensitiser in locally advanced carcinoma of the cervix. A total of 76 patients were randomised and followed-up with a median of 85 months. All patients were treated with external and intracavitary irradiation. The 10 year actuarial local control rate was 61% in patients receiving ornidazole, compared with 50% for placebo group. This difference was not statistically significant. Ten year actuarial overall and disease-free survival rates were also similar in the two treatment groups. Although, when analysed by stage, there was a significant advantage in the local control (54% vs 15%; P = 0.044) and disease-free survival rates (37% vs 8%; P = 0.047) in ornidazole group for stage IIIB cases, its implication is obscure because of the small number of patients. In this study moderate and severe complication rates were found to be 30%. These results suggest that ornidazole seems to have relatively weak sensitisation and it may show a possibility of a marginal benefit with unconventional irradiation using relatively large radiation doses. However, the results are insufficient for a real gain in the probability of local tumour control and survival.

Alternative treatment protocols in giardiasis: a pilot study

The aim of the study was to test new treatment protocols for giardiasis, which are less toxic, cheaper, and easier to use than the conventional treatment. 48 children who had been diagnosed as having giardiasis in a health-screening program involving 2 schools, were randomized to receive four different treatment protocols. The children were split into 4 treatment groups: I, mebendazole 100 mg t.i.d. for 1 day; II, mebendazole 100 mg t.i.d. for 7 days; III, metronidazole 15 mg/kg as one dose for 7 days; and IV, ornidazole 40 mg/kg as a single dose. The results were evaluated by microscopic examination of stools. The responses to the treatments revealed that the effectiveness of ornidazole was 100%, metronidazole 92.9%, mebendazole for 7 days 58.3%, and mebendazole for 1 day 41.7%. Minor side-effects were seen in only 3 children receiving ornidazole: 1 had urticaria, while the other 2 suffered from vertigo and nausea. The results of this study show that ornidazole as a single dose can be used as an alternative protocol for treating giardiasis. Further studies should be done to determine the safest effective total single dose.

["Single shot" prevention in abdominal surgery. Antibiotics with long half-life (ceftriaxone, ornidazole) vs. antibiotics with short half-life (cefazolin, metronidazole, clindamycin)]

Single-shot antibiotic prophylaxis is well established in abdominal surgery. There is evidence suggesting that it prevents wound infections and some authors report also prevention against postoperative urinary tract infection and pneumonia. From April 1988 to December 1990 we randomly assigned 429 patients with gastro-intestinal operations to a defined protocol: 210 patients (5 drop-outs) with elective operations of the upper GI-tract were given Ceftriaxone (half-life 8 hours, 102 patients) or Cefazolin (half-life 2 hours, 103 patients). 117 (12 drop-outs) patients with operations of the lower GI-tract were given Ceftriaxone/Ornidazole (half-life 13 hours, 50 patients) or Cefazolin/Metronidazole (half-life 8 hours, 55 patients). 102 (20 drop-outs) patients with appendicitis were given Ornidazole (40 patients) or Clindamycin (42 patients). There were no differences in sex, age or type of operation in the different groups. The overall postoperative infection-rate was low. In the upper GI-tract we found one wound infection in both groups, in the lower GI-tract two wound infections in the Ceftriaxone/Ornidazole-group vs. nine in the Cefazolin/Metronidazole-group (p < 0.05). In patients with appendicitis there were three infections in the Ornidazole-group and four in the Clindamycin-group. There was no statistically significant difference in pulmonary or urinary tract infections in all groups. Although the protocol for antibiotics with a short half-life included a second dose of antibiotics in cases of operations with a duration of more than four hours, this was forgotten in 19 of 39 concerned patients (49%!).(ABSTRACT TRUNCATED AT 250 WORDS)

[Prophylactic and therapeutic use of Avrazor in abdominal surgery]

The authors investigated in a group of 30 patients the prophylactic and therapeutic action of ornidazole (the Czech preparation Avrazor) injections for infusion produced by Léciva Co. Prophylactically Avrazor was used most frequently in elective colorectal surgery, therapeutically in peritonitis. In a control group comprising 30 patients with the same indications the commonly used Metronidazole was administered and the results in the two groups were compared. Avrazor was administered most frequently combined with aminoglycosides. The authors did not observe side-effects after Avrazor administration and the preparation was very well tolerated. Because of its antimicrobial effect in the prophylaxis and therapy of intraabdominal infections the preparation can be recommended for clinical use.

Cardiac arrest: an unusual side-effect of intravenous ornidazole

Nitroimidazoles have been used alone or in combination with other antibacterial agents in the treatment of brain abscess. They are associated with certain adverse reactions related primarily to the gastrointestinal tract and central nervous system. But, as far as we know, cardiac arrest due to ornidazole has not been reported in the literature. In this study, we presented a case in which cardiac arrest occurred as an unusual side-effect of intravenous ornidazole administered to a ten-year-old girl suffering from brain abscess.

[Dangerous hypoprothrombinemic hemorrhage in antibiotic therapy]

Antibiotics can be associated with hypoprothrombinaemic haemorrhages in risk patients. Risk factors are: poor nutrition, impaired liver- or renal function, coagulation depleting medical therapy or illness. Pathogenetically there is a vitamin K deficiency with reduction of vitamin K dependent clotting factors; mainly by decreased vitamin K synthesis in intestinal bacterias. In consequence every risk patient under antibiotics should receive vitamin K prophylactically and in a parenteral way, because of unreliable resorption in gastrointestinal tract. Prothrombin-time-monitoring is essential to recognize the hypoprothrombinemia in every risk patient under antibiotics.

Use of ornidazole in fractionated radiotherapy: dose tolerance, serum and tumour tissue concentration

Sensitizing and neurotoxic effect of ornidazole, was tested in a double-blind randomized study in patients with carcinoma of the cervix and larynx. Ornidazole or placebo were given orally, two times weekly, for 3 weeks. Dose was 2.5 g/m2 for each administration. Total dose given was 15 g/m2. Radiation therapy was given 3 h after the drug administration. Ornidazole was well tolerated in the majority of the patients. No neurotoxic side effects, such as peripheral neuropathy or convulsion, were observed with a total dose of up to 30 g. Dizziness, somnolence and nausea were the prominent acute side effects, seen mostly (70%) in women. In the placebo group this rate was 17% (p less than 0.01). No important side effect was observed in men receiving ornidazole. Serum concentration of ornidazole reached the maximum level in 2-4 h after oral administration and ranged (23 patients) from 65.1 to 139.8 micrograms/ml. Mean half-life was 15.6 +/- 2.8 h. Peak concentration in tumour tissue was achieved 1-3 h after the administration, ranging from 13.0 to 78.0 micrograms/g. Tumour concentration of ornidazole ranged from 14 to 93% of the serum concentration at the time of irradiation.

Current clinical applications and dose regimens of metronidazole and related nitroimidazoles

Metronidazole, in particular, and the other nitroimidazoles (tinidazole, ornidazole) available in Australia are well established drugs for the treatment of protozoal (trichomonal or amoebic) infections; recent data testify to their efficacy in the prevention and therapy of anaerobic infections. Administration by oral and rectal routes is indicated rather than by the intravenous route on the basis of efficacy, safety and cost; this recommendation is applicable to both loading and maintenance dosing. Intravenous administration should be restricted to emergency preoperative loading (single 500-mg dose); to patients with proven anaerobic infections; patients with serious sepsis associated with an unidentified organism; patients who are unable to take medication by mouth and those without a functional rectum or with diarrhoea; and patients with leukaemia who are vomiting. These drugs are remarkably safe under conditions of acute use if the intravenous route is avoided. However, extreme caution in their long-term use and use in obstetric and paediatric patients should be exercised until toxicological issues are resolved. It is concluded that the nitroimidazoles are effective, cheap and safe drugs for the short-term treatment of protozoal and bacterial (anaerobic) infections.

[Peripheral neuropathy during treatment with ornidazole]

The case is reported of an 18 year old patient who developed a peripheral neuropathy after being given 1.5 g ornidazole daily for 6 days and 2 g daily for 16 days (total dose: 41 g). Bilateral radial paralysis was noted clinically, whilst electrical investigations showed diffuse motor and sensitive anomalies. Three months after the drug had been stopped, all symptoms and signs had disappeared. The pathogenesis of this complication is discussed. The part played by ornidazole is suggested but cannot be proved because of the multiple disorders presented by the patient.

Single oral dose of ornidazole in women with vaginal trichomoniasis

Fifty-nine women with trichomonal vaginitis were randomly allocated to receive treatment with a single oral dose of either 0.5, 1.0, or 1.5 g of ornidazole. One week after treatment, a parasitologic cure was observed in 100% of patients treated with 1.5 g, in 95% of patients treated with 1.0 g, and in 65% of patients given 0.5 g. At the one-month follow-up visit, the cure rate remained at 100% for the 1.5-g dose group but dropped to 85 and 45% in the 1.0- and 0.5-g dose groups, respectively. The disappearance of symptomatic complaints was also dose related: the clinical cure was 100, 85, and 40% at the first follow-up visit and 89, 80, and 30% at the second follow-up visit. Adverse effects of mild or moderate severity were reported by 13 patients. These were encountered mostly in the 1.5- and the 1.0-g dose groups. The most frequent adverse effects were dizziness and gastrointestinal distress. Laboratory safety test did not reveal any significant toxicity. This study confirms that single-dose treatment of trichomoniasis with an oral dose of 1.5 or 1.0 g of ornidazole is effective and well tolerated.

Ornidazole compared to phenoxymethylpenicillin in the treatment of orofacial infections

A double blind, randomized study comprising 60 patients was undertaken to compare the efficacy of ornidazole to that of phenoxymethylpenicillin in the treatment of orofacial infections. Thirty patients received ornidazole 500 mg orally every 12 h for seven days and were all cured in less than seven days. Five of the 30 patients receiving penicillin, 800 mg orally every 12 h for seven days, did not respond satisfactorily to the treatment given. In two of these instances, beta-lactamase-producing penicillin-resistant Bacteroides strains were isolated. In the present study, ornidazole was found to be more efficient than penicillin in the treatment of orofacial infections. Anaerobes were isolated from all specimens except four that yielded no growth. Anaerobes only were isolated from 65% of the specimens. Since ornidazole was efficient in all cases when given, it is concluded that anaerobic bacteria are the causal pathogens in most orofacial infections.

Ornidazole and anaerobic bacteria: in vitro sensitivity and effects on wound infections after appendectomy

The sensitivities of 68 clinical isolates of Bacteroides fragilis, 18 of Clostridium perfringens, and 11 of other Clostridium species were tested against ornidazole alone and in combination with ampicillin and gentamicin. A concentration of 3.1 microgram of ornidazole/ml inhibited 98% of the strains of B. fragilis, with greater sensitivity when ampicillin and gentamicin were also present. A concentration of 6.2 microgram of ornidazole/ml inhibited 16 of 18 strains of C. perfringens and all 11 strains of other Clostridium species. Concentrations in serum and tissue were determined after intravenous infusion of 500 mg of ornidazole 15 min prior to appendectomy. During the operation the concentration in serum was 7.90 +/- 0.57 microgram/ml, and in appendix tissue, 5.26 +/- 0.60 microgram/g. In the series of 200 patients undergoing appendectomy, six patients treated with ornidazole and 12 patients treated with placebo developed a wound infection. In patients with perforated appendix, the rate of wound infection was 7.1% in those given ornidazole and 63.6% in those given placebo (P = 0.004). Not a single B. fragilis was isolated from appendix swabs or wound exudates after prophylaxis with ornidazole.

[Therapy of Cronh's disease in the acute stage, using ornidazole (Tiberal). Preliminary results]

9 patients with acute exacerbations of Crohn's disease were treated over 2.5 months or longer with ornidazole (nitroimidazole). While 3 patients showed no response at all to 5 cycles of ornidazole treatment, 6 patients improved markedly within 2-3 months. In all but 1 patient, the improvement lasted during long-term therapy (average 9 months). Therapy was discontinued in 5 of these patients after 2.5-14 months; 2 patients had severe recurrences within 2-10 weeks, while 3 patients remained well during the follow-up (average 4.7 months). Ornidazole appears to be a promising alternative to steroid therapy in acute exacerbations of Crohn's disease and to deserve further evaluation by a double-blind study.