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Expert Review of Anti-infective Therapy Aug 2022Single-dose 2-g oral secnidazole (SEC), newly approved by the U.S. Food and Drug administration (FDA) for treatment of trichomoniasis, is a potent 5-nitroimidazole with...
INTRODUCTION
Single-dose 2-g oral secnidazole (SEC), newly approved by the U.S. Food and Drug administration (FDA) for treatment of trichomoniasis, is a potent 5-nitroimidazole with selective toxicity against various micro-organisms. It has been used internationally to treat trichomoniasis, bacterial vaginosis, and other infections for decades. Trichomoniasis is the most common non-viral sexually transmitted infection worldwide and is associated with significant morbidity. In comparison to the only other FDA-approved treatments for trichomoniasis in the United States - metronidazole and tinidazole - SEC has favorable pharmacokinetics, including a longer half-life and a lower minimal lethal concentration.
AREAS COVERED
This work summarizes the chemistry and pharmacology of SEC and reviews the evidence on its efficacy, tolerability, and safety for the treatment of trichomoniasis.
EXPERT OPINION
SEC is an efficacious, well tolerated, and safe treatment for patients aged ≥12 years with trichomoniasis. Single-dose administration makes it a favorable treatment option, especially in cases where adherence to multi-dose treatment regimens may be low.
Topics: Adolescent; Adult; Female; Humans; Metronidazole; Nitroimidazoles; Trichomonas Infections; Trichomonas Vaginitis; Trichomonas vaginalis; United States; Vaginosis, Bacterial
PubMed: 35642509
DOI: 10.1080/14787210.2022.2080656 -
Journal of the Association of Medical... Mar 2021Metronidazole-resistant trichomoniasis is a health burden for patients, and limited access to susceptibility testing and treatment is a challenge for Canadian...
Metronidazole-resistant trichomoniasis is a health burden for patients, and limited access to susceptibility testing and treatment is a challenge for Canadian clinicians. These cases emphasize the burden of metronidazole resistance in our population. Herein we describe two cases of metronidazole-resistant trichomoniasis. In one case, a patient underwent five courses of therapy to treat a persistent infection. International culture and susceptibility testing revealed resistance to metronidazole and susceptibility to tinidazole. The patient was subsequently lost to follow-up. In another case, a patient was treated with six courses of therapy before their infection had cleared. International culture and susceptibility testing indicated resistance to metronidazole and intermediate resistance to tinidazole. In both cases, metronidazole treatment, either alone or in addition to another therapy, was attempted an average of 3.5 times in escalating dose regimens before switching to tinidazole. Tinidazole proved to be an effective second-line therapy when tolerated by the patient. Until susceptibility testing is available in Canada, clinicians should be aware of access to international susceptibility testing of to appropriately identify metronidazole-resistant cases and make timely and informed decisions regarding treatment.
PubMed: 36340208
DOI: 10.3138/jammi-2020-0044 -
Iranian Journal of Pharmaceutical... 2017Co-administration of norfloxacin (NFX) and tinidazole (TNZ) has been used for the treatment of gastrointestinal and urinary tract infections. Concomitant oral...
Co-administration of norfloxacin (NFX) and tinidazole (TNZ) has been used for the treatment of gastrointestinal and urinary tract infections. Concomitant oral administration of NFX with TNZ may affect NFX absorption and consequently its blood concentration and pharmacological effect. The present study was undertaken to investigate the effect of TNZ at the usual clinical dosage on the pharmacokinetics of NFX in healthy volunteers. This study was conducted as an open-label, randomized, two-way crossover experimental design. After an overnight fast, subjects were randomized to receive a single oral dose of NFX 400 mg alone and the fixed-dose combination (FDC) of NFX /TNZ 400 mg/600mg on two different occasions separated by 1 week washout period between treatments. Blood samples were collected up to 24 h postdose, and plasma was analyzed for NFX concentrations by using HPLC. The pharmacokinetic properties of NFX after FDC administration were compared with NFX administered alone. Twelve healthy subjects were enrolled (6 in each part), and all subjects completed the study. None of the participants showed any sign of adverse drug reactions during or after the completion of the study. The 90% confidence interval (CI) between NFX alone and when co-administered with TNZ indicated the presence of an interaction between NFX and TNZ, which would significantly increase the systemic rate and exposure of NFX absorption. The co-administration of TNZ with NFX increased the AUC and C of NFX significantly compared with administration of NFX alone. The AUC and C of NFX alone were 6.0 µg.hr/mL (2.3-9.8) and 0.87 µg/mL (0.4-1.6), respectively whereas the corresponding AUC and C values after administration of FDC were 7.1 µg.hr/mL (4.0-10.6) and 0.97 µg/mL (0.4-1.7), respectively. The respective geometric mean ratios of NFX for AUC and C with TNZ were 1.197 [90% CI, 0.941-1.522] and 1.087 (90% CI, 0.807 -1.463) compared with NFX alone. Both T and Ka of NFX showed a significant decrease after administration of the combination compared to administration of NFX alone. The peak plasma concentration reached at 1.3 h (0.6-2.4) and 1.9 h (0.4-4.4) after oral administration of FDC and NFX alone, respectively. Both NFX and TNZ were well tolerated. The interaction of TNZ with fluroquinolones should be investigated to determine whether this interaction is limited to NFX or if other fluroquinolones have the same pharmacokinetic interactions. Further studies are necessary to determine the role of P-gp and other transporters on NFX disposition and pharmacokinetics. Additionally, the influence of TNZ on the physiological activity of GIT should be investigated.
PubMed: 29552066
DOI: No ID Found -
Iranian Journal of Parasitology 2023and are among the most common intestinal protozoa worldwide. Treatment of infection by metronidazole (MTZ) has some limitations. The objective of this study was to...
BACKGROUND
and are among the most common intestinal protozoa worldwide. Treatment of infection by metronidazole (MTZ) has some limitations. The objective of this study was to detect the prevalence of and among school-age children from December 2021 till March 2022 from Motoubes, Kafrelsheikh, Egypt, and determine the efficacy of nitazoxanide (NTZ), NTZ plus garlic and tinidazole (TIN) on and giardiasis infection.
METHODS
Stool samples were collected from 390 children and microscopically examined using formalin-ethyl acetate concentration and culturing on Jones' medium for . Those who tested positive for giardiasis (120 children, 30.7%) (Group I) or (180 children, 46.1%) (Group II) were equally divided into four subgroups. The first subgroup received NTZ orally, every 12 hours for three successive days. The second subgroup received NTZ in the same dose as the first subgroup plus dry garlic powder every 12 hours for three successive days. The third subgroup received TIN as a single oral dose, and a fourth control subgroup. Successful cure was considered if no or giardiasis stages were found in post-treatment faecal specimens.
RESULTS
Cure rate was significantly higher in TIN treated groups (75.5% and 96.6%) than NTZ (57.7% and 40%) or NTZ plus garlic treated groups (55.5% and 43%) in both and giardiasis, respectively (<0.05).
CONCLUSION
TIN, once, is more efficacious than NTZ or NTZ plus garlic in the treatment of and giardiasis in children.
PubMed: 37197063
DOI: 10.18502/ijpa.v18i1.12379 -
Journal of Parasitology Research 2022Chronic cough is a common problem in the setting of family physicians. Recently, was considered a cause of respiratory symptoms in children and adults.
BACKGROUND
Chronic cough is a common problem in the setting of family physicians. Recently, was considered a cause of respiratory symptoms in children and adults.
OBJECTIVE
This study is aimed at determining the effect of antiprotozoal treatment of in patients with a chronic cough in Mashhad during 2020-2021.
MATERIALS AND METHODS
This study was a randomized clinical trial. In this study, 60 patients with chronic cough and unremarkable imaging findings, who were unresponsive to three steps of standard treatment, were randomly assigned to the treatment, with 2 weeks of tinidazole and placebo. The tinidazole and placebo were prepared in a completely identical shape, and a random assignment was performed by a third party. The primary outcome was a complete resolution of cough. A follow-up of treatment was performed. Data were analyzed using the SPSS software version 25.
RESULTS
The basic demographic results showed no significant differences of sex and age between two groups. The results of this study showed a complete resolution of all respiratory symptoms in 40% (12), a complete improvement of cough in 40% (12), and a complete resolution of dyspnea in 50% (10) of the tinidazole group. The remaining showed significant improvement in the severity of cough and dyspnea. Postnasal drip, sputum, body temperature, and airway hyperresponsiveness were improved significantly. After tinidazole treatment, laboratory assessment of bronchial lavage and sputum revealed that 86 percent of smears were converted to negative.
CONCLUSION
Tinidazole effectively resolved the chronic cough and most of the respiratory symptoms. is a potential mechanism for chronic cough.
PubMed: 36387781
DOI: 10.1155/2022/2413941 -
Acta Crystallographica. Section F,... Feb 2022Giardiasis is the most prevalent diarrheal disease globally and affects humans and animals. It is a significant problem in developing countries, the number one cause of...
Giardiasis is the most prevalent diarrheal disease globally and affects humans and animals. It is a significant problem in developing countries, the number one cause of travelers' diarrhea and affects children and immunocompromised individuals, especially HIV-infected individuals. Giardiasis is treated with antibiotics (tinidazole and metronidazole) that are also used for other infections such as trichomoniasis. The ongoing search for new therapeutics for giardiasis includes characterizing the structure and function of proteins from the causative protozoan Giardia lamblia. These proteins include hypothetical proteins that share 30% sequence identity or less with proteins of known structure. Here, the atomic resolution structure of a 15.6 kDa protein was determined by molecular replacement. The structure has the two-layer αβ-sandwich topology observed in the prototypical endoribonucleases L-PSPs (liver perchloric acid-soluble proteins) with conserved allosteric active sites containing small molecules from the crystallization solution. This article is an educational collaboration between Hampton University and the Seattle Structural Genomics Center for Infectious Disease.
Topics: Catalytic Domain; Crystallography, X-Ray; Giardia lamblia; Models, Molecular; Protein Conformation; Protozoan Proteins
PubMed: 35102894
DOI: 10.1107/S2053230X21013595 -
Clinical Microbiology and Infection :... Jan 2018Giardia intestinalis is microaerophilic diarrhoea-causing protozoan common in countries with suboptimal sanitation. Standard treatment is with nitroimidazoles, but a... (Review)
Review
BACKGROUND
Giardia intestinalis is microaerophilic diarrhoea-causing protozoan common in countries with suboptimal sanitation. Standard treatment is with nitroimidazoles, but a growing number of refractory cases is being reported. Treatment failure has become increasingly prevalent in travellers who contract giardiasis in Asia. Clinicians are increasingly falling back on second-line and less well-known drugs to treat giardiasis.
AIMS
To review nitroimidazole-refractory G. intestinalis infection, examine the current efficacy of standard therapeutic agents, consider potential resistance mechanisms which could cause treatment failure and describe the practical aspects of managing this emerging clinical problem.
SOURCES
A PubMed search was conducted using combinations of the following terms: refractory, Giardia, giardiasis, resistance and treatment. Articles on the pharmacotherapy, drug resistance mechanisms and use of alternative agents in nitroimidazole-refractory giardiasis were reviewed.
CONTENT
We review the standard drugs for giardiasis, including their efficacy in initial treatment, mode of action and documented in vitro and in vivo drug resistance. We assess the efficacy of alternative drugs in nitroimidazole-refractory disease. Existing data suggest a potential advantage of combination treatment.
IMPLICATIONS
An optimal treatment strategy for refractory giardiasis has still to be determined, so there is no standard treatment regimen for nitroimidazole-refractory giardiasis. Further work on drug resistance mechanisms and the use of drug combinations in this condition is a priority.
Topics: Albendazole; Antiprotozoal Agents; Chloroquine; Drug Resistance; Drug Therapy, Combination; Giardia lamblia; Giardiasis; Humans; Metronidazole; Quinacrine; Tinidazole; Treatment Failure
PubMed: 28624613
DOI: 10.1016/j.cmi.2017.05.028 -
American Journal of Obstetrics and... Feb 2020Vaginitis is one of the most common causes of patient visits to gynecologists, primary care providers, and urgent care centers. However, many women leave without a clear... (Review)
Review
Vaginitis is one of the most common causes of patient visits to gynecologists, primary care providers, and urgent care centers. However, many women leave without a clear diagnosis or experience recurrent symptoms despite treatment. The 3 most common etiologies of vaginitis are trichomonas, bacterial vaginosis, and vulvovaginal candidiasis, which account for an estimated 70% of cases. The remaining 30% may be related to other causes of vaginitis, including atrophic vaginitis, desquamative inflammatory vaginitis, and vaginal erosive disease. The purpose of this review is to describe the noncandidal causes of acute and recurrent vaginitis, with the goal of improving the likelihood of accurate diagnosis as well as efficient and effective therapy. We excluded candidal vaginitis from our review because there was a recently published review on this topic in the Journal. The clinical presentation and evaluation of patients with symptoms of vaginitis can be triaged into 1 of 2 diagnostic pathways: noninflammatory and inflammatory vaginitis. The most common noninflammatory cause is bacterial vaginosis. Features such as irritation, purulent discharge, and the presence of polymorphonuclear neutrophils are more suggestive of an inflammatory process. Trichomoniasis is the most common cause of inflammatory vaginitis. Other well-described forms of inflammatory vaginitis include atrophic vaginitis, desquamative inflammatory vaginitis, and erosive disease. We present a review of the pathogenesis, symptoms, examination findings, diagnostic testing, and treatment for each of these causes of noncandidal vaginitis.
Topics: Administration, Intravaginal; Administration, Oral; Anti-Infective Agents; Anti-Inflammatory Agents; Atrophic Vaginitis; Candidiasis, Vulvovaginal; Clindamycin; Dehydroepiandrosterone; Diagnosis, Differential; Estrogen Replacement Therapy; Estrogens; Female; Humans; Hydrocortisone; Inflammation; Lichen Planus; Metronidazole; Pemphigoid, Benign Mucous Membrane; Pemphigoid, Bullous; Pemphigus; Tamoxifen; Tinidazole; Trichomonas Vaginitis; Vaginitis; Vaginosis, Bacterial
PubMed: 31513780
DOI: 10.1016/j.ajog.2019.09.001 -
The Cochrane Database of Systematic... Jan 2019Infection with the protozoan Entamoeba histolytica is common in low- and middle-income countries, and up to 100,000 people with severe disease die every year. Adequate... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Infection with the protozoan Entamoeba histolytica is common in low- and middle-income countries, and up to 100,000 people with severe disease die every year. Adequate therapy for amoebic colitis is necessary to reduce illness, prevent development of complicated disease and extraintestinal spread, and decrease transmission.
OBJECTIVES
To evaluate antiamoebic drugs for treating amoebic colitis.
SEARCH METHODS
We searched the available literature up to 22 March 2018. We searched the Cochrane Infectious Diseases Group Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, mRCT, and conference proceedings. We contacted individual researchers, organizations, and pharmaceutical companies, and we checked reference lists.
SELECTION CRITERIA
Randomized controlled trials of antiamoebic drugs given alone or in combination, compared with placebo or another antiamoebic drug, for treating adults and children with a diagnosis of amoebic colitis.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the eligibility and methodological quality of trials and extracted and analysed the data. We calculated clinical and parasitological failure rates and rates of relapse and adverse events as risk ratios (RRs) with 95% confidence intervals (CIs), using a random-effects model. We determined statistical heterogeneity and explored possible sources of heterogeneity using subgroup analyses. We carried out sensitivity analysis by using trial quality to assess the robustness of reported results.
MAIN RESULTS
In total, 41 trials (4999 participants) met the inclusion criteria of this review. In this update, we added four trials to the 37 trials included in the first published review version. Thirty trials were published over 20 years ago. Only one trial used adequate methods of randomization and allocation concealment, was blinded, and analysed all randomized participants. Only one trial used an E histolytica stool antigen test, and two trials used amoebic culture.Tinidazole may be more effective than metronidazole for reducing clinical failure (RR 0.28, 95% CI 0.15 to 0.51; 477 participants, eight trials; low-certainty evidence) and is probably associated with fewer adverse events (RR 0.65, 95% CI 0.46 to 0.92; 477 participants, 8 trials; moderate-certainty evidence). Compared with metronidazole, combination therapy may result in fewer parasitological failures (RR 0.36, 95% CI 0.15 to 0.86; 720 participants, 3 trials; low-certainty evidence), but we are uncertain which combination is more effective than another. Evidence is insufficient to allow conclusions regarding the efficacy of other antiamoebic drugs.
AUTHORS' CONCLUSIONS
Compared with metronidazole, tinidazole may be more effective in reducing clinical failure and may be associated with fewer adverse events. Combination drug therapy may be more effective for reducing parasitological failure compared with metronidazole alone. However, these results are based mostly on small trials conducted over 20 years ago with a variety of poorly defined outcomes. Tests that detect E histolytica more accurately are needed, particularly in countries where concomitant infection with other bacteria and parasites is common.
Topics: Amebicides; Animals; Drug Therapy, Combination; Dysentery, Amebic; Entamoeba histolytica; Humans; Metronidazole; Randomized Controlled Trials as Topic; Tinidazole
PubMed: 30624763
DOI: 10.1002/14651858.CD006085.pub3 -
Medical Sciences (Basel, Switzerland) Sep 2019Trichomoniasis is the most common non-viral sexually transmitted disease (STD) globally and yet is not a reportable disease. is an important source of reproductive...
Trichomoniasis is the most common non-viral sexually transmitted disease (STD) globally and yet is not a reportable disease. is an important source of reproductive morbidity and may increase risk of acquisition and transmission of human immunodeficiency viruses (HIV). The World Health Organization (WHO) and the Control Disease Center (CDC) recommend various regimens of nitroimidazole s for treatment. The common nitroimidazoles used for trichomoniasis are metronidazole and tinidazole, which vary in their cost, efficacy, and side effect profile. It is relevant to study these factors for better management of the patients. This study aimed to compare and study the efficacy, compliance of various treatment regimens, their outcomes, and side-effects for trichomoniasis, among STI clinic attendees in Trinidad. A clinical trial study was designed, and after obtaining the informed consent, a routine clinical examination was conducted and the swabs for trichomoniasis tests were collected for diagnosis from the 692 participants. Out of 692 participants, 82 patients with positive diagnosis of infection were treated according to the patient's choice, using different drug regimens. Compliance to treatment, side effects, and outcome were evaluated. The prevalence of trichomoniasis in the population attending our STI clinic is 11.9% and prevalence of HIV is 9%. Of the total 82 participants for the treatment, 80% were females; nearly 90% of the patients belonged to age group 15-45 years, and over 60% were below 30 years. Among those diagnosed for , 14.6% had coexistent HIV infection. The compliance with respect to single dose treatment was significantly better than the long-duration oral regimen and has a significant relation with side effects of the treatment. The outcome is generally better and comparable and shows no significant difference between different treatment regimens used in the study. Metronidazole and tinidazole are commonly used drugs in various regimens. Compliance is better with those treated with tinidazole and metronidazole single dose than with other groups. Outcome is comparable between these regimens, especially when combined with other important factors like abstinence and treatment of the partners. The treatment regimens mainly differed in the compliance side effects profile and duration of therapy, which suggests that to improve the compliance of the drugs with fewer side effects, short course regimen would be a preferred choice.
PubMed: 31547105
DOI: 10.3390/medsci7100097