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Cureus Jan 2024Recent studies have discussed the role of antibiotic treatment in the conservative management of acute appendicitis and whether antibiotics are a safe option to replace... (Review)
Review
Recent studies have discussed the role of antibiotic treatment in the conservative management of acute appendicitis and whether antibiotics are a safe option to replace appendicectomy, which has been the gold standard treatment of acute appendicitis for many years. The bibliographic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, Medline, and PubMed comparing conservative versus surgical treatment of acute appendicitis were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-one studies consisting of systematic reviews and meta-analyses involving 44,699 participants were identified. At least 17,865 participants were treated with antibiotics. Our studies compare antibiotic versus appendicectomy among acute appendicitis patients ranging from 7 to 94 years of age. In most studies, patients received parenteral antibiotics for a total of one to three days, and oral antibiotics such as oral cephalosporin plus metronidazole, oral amoxicillin/clavulanate, oral fluoroquinolones plus Tinidazole upon hospital discharge for a total of 7 to 10 days. The total course of antibiotics for both parenteral and oral regimes ranged from 2 to 16 days, with 10 days being the commonest duration. The recurrence rate following initial antibiotic treatment at one-year follow-up ranged from 13% to 38%, while the mean duration of recurrence ranged from three to eight months. The majority of the patients with recurrence underwent appendicectomy, while some patients were either given a repeat or different course of antibiotics due to the possible presence of antibiotic resistance; however, only 2.4% of the patients were successfully treated upon completion of the second course of antibiotics. Most of the studies concluded that appendicectomy remains the gold standard treatment for uncomplicated acute appendicitis, given its higher efficacy and lower complication rates. Although antibiotic treatment cannot be routinely recommended, it can be considered an appropriate alternative in selected patients with uncomplicated appendicitis who wish to avoid surgery and also acknowledge the risk of recurrence and the potential need for subsequent surgery at the same time.
PubMed: 38384640
DOI: 10.7759/cureus.52697 -
International Journal For Parasitology.... Dec 2012Dientamoeba fragilis belongs to the trichomonad group of protozoan parasites and it has been implicated as a cause of gastrointestinal disease with world-wide... (Review)
Review
Dientamoeba fragilis belongs to the trichomonad group of protozoan parasites and it has been implicated as a cause of gastrointestinal disease with world-wide prevalences ranging from 0.5% to 16%. The majority of patients with dientamoebiasis present with gastrointestinal complaints. Chronic symptoms are common with up to a third of patients exhibiting persistent diarrhoea. Numerous studies have successfully demonstrated parasite clearance, coupled with complete resolution of clinical symptoms following treatment with various antiparasitic compounds. Treatments reported to be successful for dientamoebiasis include carbarsone, diphetarsone, tetracyclines, paromomycin, erythromycin, hydroxyquinolines and the 5-nitroimidazoles, including metronidazole, secnidazole, tinidazole and ornidazole. It is of note that most current treatment data is based only on small number of case reports. No large scale double blind randomised placebo controlled trials testing the efficacy of antimicrobial agents against D. fragilis has been undertaken highlighting the need for further study. In addition there is very little in vitro susceptibility data available for the organism making some current treatment options questionable. The aim of this review is to critically discuss all treatment options currently available for dientamoebiasis.
PubMed: 24533282
DOI: 10.1016/j.ijpddr.2012.08.002 -
International Journal of Dentistry 2021To compare the effectiveness of topical antibiotic mixtures used in noninstrumental endodontic treatment (NIET) of primary teeth. (Review)
Review
OBJECTIVE
To compare the effectiveness of topical antibiotic mixtures used in noninstrumental endodontic treatment (NIET) of primary teeth.
METHODS
Electronic databases including MEDLINE, the Cochrane Library, and Scopus database were searched. Randomized clinical trials evaluating the clinical and radiological outcomes of topical antibiotics used in NIET were selected. The revised Cochrane risk-of-bias tool (RoB 2.0) was used to assess the quality of the methodology of the included articles.
RESULTS
Five articles comparing the outcomes of four different drugs combination were included. Three studies conducted to evaluate the success rate of two combinations of antibacterial drugs consisting of ciprofloxacin-minocycline-metronidazole (3 Mix) in one group and ciprofloxacin-minocycline-ornidazole in the other group showed no statistically significant difference between both groups ( > 0.05). The ciprofloxacin-minocycline-ornidazole group showed better results compared with the 3 Mix group. One study conducted to compare the effectiveness of 3 Mix with ciprofloxacin-tinidazole-minocycline reported no significant difference between both groups, and one study that compared 3 Mix and ciprofloxacin-metronidazole-clindamycin mixture concluded that the overall success rates of both groups were 80.96% and 76.20%, respectively, with no statistically significant difference.
CONCLUSION
Based on the overall success rates, the ciprofloxacin-minocycline-ornidazole mixture was considered more effective than the 3 Mix which was more effective than the ciprofloxacin-tinidazole-minocycline and the ciprofloxacin-metronidazole-clindamycin groups. . Different antibiotic combinations, showing good clinical and radiographic success in treating necrotic primary teeth, can be used effectively in NIET and this technique can be considered effective for teeth with advanced root resorption and when conventional endodontic treatment is contraindicated.
PubMed: 34135965
DOI: 10.1155/2021/5518599 -
Tropical Medicine & International... Jul 1998To compare the effectiveness of various treatment strategies for trichomoniasis in women. (Comparative Study)
Comparative Study Review
OBJECTIVE
To compare the effectiveness of various treatment strategies for trichomoniasis in women.
DATA SOURCES
Medline from 1966 to 1996, Embase from 1986 to 1996, Science Citation Index from 1990 to 1996; reference lists of existing reviews; through the manufacturers of metronidazole and tinidazole in the UK, the Cochrane Controlled Trials Register until October 1997 and informal discovery.
STUDY SELECTION
Any randomized or quasi-randomized trial in nonpregnant women with trichomoniasis where different treatment strategies were compared. 45 of the 124 identified studies met the criteria and were included in the review.
DATA EXTRACTION
Settings, diagnostic methods, exclusions, loss to follow-up and partner treatment strategies were extracted. Outcomes sought were parasitological cure, clinical cure and side-effects of treatment.
RESULTS
Most trials were small, with only two trials containing more than 100 women in each comparison group. Only 11 trials followed up women for more than one month. Oral nitroimidazoles were effective in achieving parasitological cure. Fourteen trials compared different treatment strategies with the remainder comparing different doses or different drugs. Partner treatment was effective in decreasing longer-term re-infection rates in the one trial testing this.
CONCLUSIONS
Parasitological cure can be achieved by a single oral dose of nitroimidazoles. There is, however, very little data on partner treatment strategies and long-term cure rates after initial treatment. Further research should test various partner treatment strategies to prevent re-infections and reduce trichomoniasis prevalence.
Topics: Antitrichomonal Agents; Female; Humans; Randomized Controlled Trials as Topic; Research Design; Sexual Partners; Treatment Outcome; Trichomonas Vaginitis
PubMed: 9705189
DOI: 10.1046/j.1365-3156.1998.00273.x -
Journal of Analytical Methods in... 2013A simple, sensitive, and accurate RP-HPLC coupled with UV detector method was developed and validated for simultaneous determination of matrine and tinidazole in...
A simple, sensitive, and accurate RP-HPLC coupled with UV detector method was developed and validated for simultaneous determination of matrine and tinidazole in compound lotion. The chromatographic separation of the two compounds was carried out with a SinoChoom ODS-BP C18 column (5 μ m, 4.6 mm × 200 mm) analytical column, using a mobile phase consisting of 0.025 mol/L potassium dihydrogen phosphate (containing triethylamine 0.05%, v/v) and acetonitrile (80 : 20, v/v) at a flow rate of 1.0 mL/min. The detection was monitored at 210 and 310 nm for matrine and tinidazole, respectively. Total run time was 12 min, and the column was maintained at 25°C. The excipients in the compound lotion did not interfere with the drug peaks. The calibration curves of matrine and tinidazole were fairly linear over the concentration ranges of 10.0-100.0 μ g/mL (r = 0.9954) and 20.0-200.0 μ g/mL (r = 0.9968), respectively. The RSD of both the intraday and interday variations was below 1.5% for matrine and tinidazole. The proposed HPLC method was validated according to International Conference on Harmonisation and proved to be suitable for the simultaneous determination of matrine and tinidazole in compound lotion.
PubMed: 23971001
DOI: 10.1155/2013/185706 -
The British Journal of Venereal Diseases Oct 1979A 36-year-old woman with symptomatic metronidazole-resistant trichomonal vaginitis for 10 years had a total of 22 courses of treatment with either metronidazole or...
A 36-year-old woman with symptomatic metronidazole-resistant trichomonal vaginitis for 10 years had a total of 22 courses of treatment with either metronidazole or tinidazole according to different schedules. The minimum trichomonicidal concentration of metronidazole for the strain of Trichomonas vaginalis isolated from the patient was 160 microgram/ml compared with 1.25-10 microgram/ml for other freshly isolated strains. The former strain also showed a definitely decreased sensitivity to ornidazole and tinidazole (80 microgram/ml). The mechanisms behind the appearance of resistance in this clinical isolate are at present unknown and require further study from the theoretical as well as the therapeutic viewpoint.
Topics: Adult; Drug Resistance, Microbial; Female; Humans; Metronidazole; Tinidazole; Trichomonas Vaginitis; Trichomonas vaginalis
PubMed: 315809
DOI: 10.1136/sti.55.5.351 -
The Cochrane Database of Systematic... Jul 2007There can be a high rate of recurrence of disease after initial drug treatment for giardiasis. These drugs also have a range of adverse effects. (Review)
Review
BACKGROUND
There can be a high rate of recurrence of disease after initial drug treatment for giardiasis. These drugs also have a range of adverse effects.
OBJECTIVES
The objective of this review was to assess the effects of drug treatments for giardiasis.
SEARCH STRATEGY
We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, Current Contents, and reference lists of articles.
SELECTION CRITERIA
Randomised and quasi-randomised trials of drug therapy for giardiasis compared with placebo or another drug.
DATA COLLECTION AND ANALYSIS
Two reviewers independently assessed trial quality and extracted data.
MAIN RESULTS
Thirty-four trials were included. Only one trial was without serious methodological flaws. Compared with placebo, drug treatment was associated with an improved cure rate (odds ratio 11.51, 95% confidence interval 2.29 to 57.98). Metronidazole treatment longer than three days had a better parasitological cure rate than other long treatment courses (odds ratio 2.41, 95% confidence interval 1.31 to 4.44), but there was significant heterogeneity between the trials. Available evidence has not detected a difference in cure between single dose therapy and longer treatment courses (odds ratio 0.33, 95% confidence interval 0.08 to 1.34). Within the single dose regimens, the available evidence did not demonstrate a difference in parasitological cure rate between tinidazole and other short therapies (odds ratio 3.39, 95% confidence interval 0.95 to 12.04), but had a higher clinical cure rate (odds ratio 5.33, 95% 2.66 to 10.67).
AUTHORS' CONCLUSIONS
A single dose of tinidazole appears to give the highest clinical cure rate for giardiasis with relatively few adverse effects.
Topics: Antiprotozoal Agents; Furazolidone; Giardiasis; Humans; Metronidazole; Tinidazole
PubMed: 17636622
DOI: 10.1002/14651858.CD000217.pub2 -
The Brazilian Journal of Infectious... 2022Helicobacter pylori infection can cause gastritis, gastric ulcers, duodenal ulcers, and gastric cancer. Its treatment involves different medications, but resistance to...
BACKGROUND
Helicobacter pylori infection can cause gastritis, gastric ulcers, duodenal ulcers, and gastric cancer. Its treatment involves different medications, but resistance to these treatments is increasing. It is currently considered a public health problem.
AIMS
to identify regimens used for H. pylori eradication by age group, year of treatment and geographical region of Colombia.
METHODS
A cross-sectional study that identified regimens used H. pylori eradication in outpatient consultations over a 6-year period based on a medication dispensing database of 8.5 million people affiliated to the Colombian Health System. The appropriate regimens were those that included a proton pump inhibitor, associated with two antibiotics recommended by clinical practice guidelines (amoxicillin, clarithromycin, levofloxacin, moxifloxacin, tetracycline, doxycycline, metronidazole, tinidazole, and furazolidone).
RESULTS
A total of 12,011 patients with a diagnosis of acid-peptic disease and H. pylori infection were identified, who had undergone 12,426 eradication treatment courses. Of these, 98.0% used a proton pump inhibitor (PPI), and 91.1% used amoxicillin. A total of 56.1% of the regimens were considered adequate; of these, 42.0% were a combination of PPI, amoxicillin/clarithromycin. This regimen predominated between 2015 and 2017 for all age groups.
CONCLUSIONS
The management of H. pylori infection in the majority of patients is heterogeneous and inconsistent with current recommendations based on evidence of antimicrobial resistance.
Topics: Anti-Bacterial Agents; Clarithromycin; Colombia; Cross-Sectional Studies; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole
PubMed: 35182470
DOI: 10.1016/j.bjid.2022.102331 -
European Journal of Microbiology &... Jul 2021As therapy-refractory giardiasis is an emerging health issue, this review aimed at summarizing mechanisms of reduced antimicrobial susceptibility in Giardia duodenalis... (Review)
Review
INTRODUCTION
As therapy-refractory giardiasis is an emerging health issue, this review aimed at summarizing mechanisms of reduced antimicrobial susceptibility in Giardia duodenalis and strategies to overcome this problem.
METHODS
A narrative review on antimicrobial resistance in G. duodenalis was based upon a selective literature research.
RESULTS
Failed therapeutic success has been observed for all standard therapies of giardiasis comprising nitroimidazoles like metronidazole or tinidazole as first line substances but also benznidazoles like albendazole and mebendazole, the nitrofuran furazolidone, the thiazolide nitazoxanide, and the aminoglycoside paromomycin. Multicausality of the resistance phenotypes has been described, with differentiated gene expression due to epigenetic and post-translational modifications playing a considerable bigger role than mutational base exchanges in the parasite DNA. Standardized resistance testing algorithms are not available and clinical evidence for salvage therapies is scarce in spite of research efforts targeting new giardicidal drugs.
CONCLUSION
In case of therapeutic failure of first line nitroimidazoles, salvage strategies including various options for combination therapy exist in spite of limited evidence and lacking routine diagnostic-compatible assays for antimicrobial susceptibility testing in G. duodenalis. Sufficiently powered clinical and diagnostic studies are needed to overcome both the lacking evidence regarding salvage therapy and the diagnostic neglect of antimicrobial resistance.
PubMed: 34237023
DOI: 10.1556/1886.2021.00009 -
Antibiotics (Basel, Switzerland) Feb 2020The in vitro resistance of selected red/orange complex periodontal pathogens to tinidazole was compared with four other antibiotics. Subgingival biofilm samples from 88...
The in vitro resistance of selected red/orange complex periodontal pathogens to tinidazole was compared with four other antibiotics. Subgingival biofilm samples from 88 adults with severe periodontitis were anaerobically incubated on enriched Brucella blood agar with and without supplementation with tinidazole (16 mg/L), metronidazole (16 mg/L), amoxicillin (8 mg/L), doxycycline (4 mg/L), or clindamycin (4 mg/L). Growth of , , or on antibiotic-supplemented plates indicated their in vitro antibiotic resistance. Tinidazole inhibited all test species, except , , and in 3.8%, 10.2%, and 88.9% of species-positive patients, respectively. Significantly fewer patients yielded tinidazole-resistant test species, and had significantly lower subgingival proportions of tinidazole-resistant organisms, than patients with amoxicillin, doxycycline, or clindamycin-resistant species, but not those with metronidazole-resistant strains. Joint in vitro species resistance to tinidazole and amoxicillin, or metronidazole and amoxicillin, was rare. Tinidazole performed in vitro similar to metronidazole, and markedly better than amoxicillin, doxycycline, or clindamycin, against fresh clinical isolates of red/orange complex periodontal pathogens. As a result of its similar antimicrobial spectrum, and more convenient once-a-day oral dosing, tinidazole should be considered in place of metronidazole for systemic periodontitis drug therapy.
PubMed: 32046045
DOI: 10.3390/antibiotics9020068