Recently, a novel Helicobacter pylori stool antigen test (Testmate pylori antigen EIA) using monoclonal antibodies against H. pylori catalase has been developed commercially. This study assessed the diagnostic usefulness of the stool antigen test compared with a polyclonal enzyme immunoassay (HpSA test) after H. pylori eradication.
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In a study to determine secondary resistance among Helicobacter pylori isolates, gastroenterologists from several German cities submitted over a 3-year period to centre A (Regensburg) or centre B (Freiburg) gastric biopsies from patients in whom one or more therapies to eradicate Helicobacter pylori had failed. Rates of resistance among the collections of 302 (centre A) and 252 (centre B) isolates were, respectively, as follows: to metronidazole, 75% and 66%; to clarithromycin, 58% and 49%; to amoxicillin, 0%; to ciprofloxacin, 9%; to doxycycline, 0%; and to rifampin, 0%. Resistance to clarithromycin was associated with metronidazole resistance in 89% and 85% of the isolates in centre A and centre B, respectively.
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Nitroimidazoles (metronidazole and tinidazole) are the only recommended drugs for treating Trichomonas vaginalis infection, and previous samples that assessed resistance of such isolates have been limited in geographic scope. We assessed the prevalence of in vitro aerobic metronidazole and tinidazole resistance among T. vaginalis isolates from multiple geographic sites in the United States. Swab specimens were obtained from women who underwent routine pelvic examinations at sexually transmitted disease clinics in 6 US cities. Cultured T. vaginalis isolates were tested for nitroimidazole resistance (aerobic minimum lethal concentration [MLC] >50 µg/mL). Of 538 T. vaginalis isolates, 23 (4.3%) exhibited low-level in vitro metronidazole resistance (minimum lethal concentrations 50-100 µg/mL). No isolates exhibited moderate- to high-level metronidazole resistance or tinidazole resistance. Results highlight the possibility that reliance on a single class of antimicrobial drugs for treating T. vaginalis infections may heighten vulnerability to emergence of resistance. Thus, novel treatment options are needed.
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Women from hospitals throughout 13 countries received a 14 day course of either oral moxifloxacin, 400 mg once daily (n = 384), or oral ofloxacin, 400 mg twice daily plus oral metronidazole, 500 mg twice daily (n = 365).
The transformation studies in vitro indicated that the CMNa transformation rate and metronidazole generation rate in whole blood at 90 min were 91.8% and 67.3%, respectively. After single i.v. doses of 57.3, 171.9 and 515.7 mg.kg-1 CMNa in mice, the T1/2 beta of the parent drug was 0.5, 0.8 and 1.0 min, the T1/2 beta of metronidazole was 63.2, 68.2 and 64.3 min. After a single i.v. dose of 171.9 mg.kg-1 CMNa in rats, the levels of CMNa and metronidazole in various tissues were higher at 2 and 5 min. The urinary excretion of the parent drug and metronidazole were 8.4% and 16.7% of the dose, the biliary excretion were 11.5% and 5.1% and the fecal excretion were 0.14% and 0.03%, respectively. The average plasma protein binding ratio (PPBR) of CMNa was 14.2%.
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A dissolution method for benzoyl metronidazole (BMZ) oral suspensions was developed and validated using a high-performance liquid chromatography (HPLC) method. After determination of sink conditions, dissolution profiles were evaluated using different dissolution media and agitation speeds. The sample insertion mode in dissolution media was also evaluated. The best conditions were obtained using a paddle, 50 rpm stirring speed, simulated gastric fluid (without pepsin) as the dissolution medium, and sample insertion by a syringe. These conditions were suitable for providing sink conditions and discriminatory power between different formulations. Through the tested conditions, the results can be considered specific, linear, precise, accurate, and robust. The dissolution profiles of five samples were compared using the similarity factor (f 2) and dissolution efficiency. The dissolution kinetics were evaluated and described by the Weibull model. Whereas there is no monograph for this pharmaceutical formulation, the dissolution method proposed can be considered suitable for quality control and dissolution profile comparison of different commercial formulations.
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Employees engaged in traditional Chinese medicinal materials are one of the groups at the highest risk of pulmonary acariasis. Metronidazole is effective in treating the infection.
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Intermittent courses of oral metronidazole might be as effective as continuous treatment in reducing gut propionate production in children with disorders of propionate metabolism.
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The purpose of this study was to examine the effect of a pulpal revascularization procedure for immature necrotic teeth with apical periodontitis.
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In our search for new antiprotozoal chemotherapy, we collected a selection of 26 plants used in Mexican traditional medicine for the treatment of gastrointestinal disorders. Methanolic extracts of these species were screened for their antiprotozoal activity against Entamoeba histolytica and Giardia lamblia trophozoites using in vitro tests. Among the tested extracts, the derivates of following species showed selectivity and significant antiprotozoal activity: Chiranthodendron pentadactylon, Annona cherimola and Punica granatum were the most active on Entamoeba histolytica with IC50 < 30 microg/ml. Dorstenia contrajerva, Senna villosa and Ruta chalepensis were the most active toward Giardia lamblia with IC50 < 38 microg/ml. The potency of Chiranthodendron pentadactylon (IC50 2.5 microg/ml) on Entamoeba histolytica was close that of to emetine, but far less than metronidazole, drugs used as control. The results of the antiprotozoal screening support the popular uses of the studied species for the treatment of diarrhoea and dysentery in Mexican traditional medicine.
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CDI is increasingly being recognized within the medical departments, and should be considered in hospitalized adults with diarrhea, fever, or abdominal distension alone, or in combination.
A review of the literature was conducted with the use of MEDLINE.
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The intention-to-treat (ITT) and per-protocol (PP) eradication rates were 62.2% (95% CI 54.8-69.6%) and 76.0% (95% CI 68.5-83.5%) in the standard triple group, and 77.8% (95% CI 71.4-84.2%) and 87.9% (95% CI 82.3-93.5%) in the sequential group, respectively. The eradication rate was significantly higher in the sequential group compared with the standard triple group in both the ITT and PP populations (P = 0.002 and P = 0.013 respectively), whereas the incidence of adverse events was similar.
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Enterococci are frequently isolated from intra-abdominal infections of non-appendiceal origin and are often involved in postoperative infectious complications, particularly peritonitis. Empirical antibiotic therapy covering Enterococcus faecalis should be contemplated in some circumstances.
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Triple therapy regimens including two antibiotics plus acid suppression have become the new standard therapy in Helicobacter pylori eradication because of success rates of about 90%. However, these regimens are still costly, duration is about one week or less, and side-effects are not negligible. We therefore evaluated a new quadruple therapy, because theoretically a shorter duration of treatment may result in reduced costs, fewer side-effects, and possibly in a lower potential for antibiotic resistances.
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Under optimal conditions, the effective separation of ceftriaxone sodium, metronidazole, and levofloxacin was achieved. A good linearity with the correlation coefficients more than 0.999 was demonstrated. The detection limits of ceftriaxone sodium, metronidazole, and levofloxacin were 0.05, 0.01, and 0.25 μg/ml, respectively, and the average recoveries in human urine were in the range from 97.73 to 100.7% with the average relative standard deviation (RSD) in the range of 2.5% and 3.0%.
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The eradication rate (intention-to-treat analysis) was 77% (95% CI: 69-86). No clinical factor was found to be different between eradicated and non-eradicated patients. Clarithromycin-resistant strains were found in 10 (10%; CI: 5-17) patients. The eradication rate was 20% (CI: 3-56) in these patients vs. 83% (CI: 75-91) in patients harbouring clarithromycin-sensitive strains (P < 0.001). A logistic-regression analysis confirmed clarithromycin resistance as the only factor associated with treatment failure.
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Four labrador male puppies were confirmed for the Isospora spp infection by direct smear and flotation method following complains of anorexia, haematemesis and haematochezia. The puppies were treated with trimethoprime and sulphamethoxazole @ 40 mg/kg body weight in combination with metronidazole @ 10 mg/kg body weight twice daily for 5 days which was supported with fluid therapy, aniemetics and plasma expanders. All the animals showed completed clinical recovery along with clearing of faecal oocyst.
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Recurrent Clostridium difficile-associated disease (RCDAD) is a difficult treatment problem--once a patient has one recurrence of the disease the likelihood of further recurrences is markedly increased. Repeat antibiotics are usually indicated, either metronidazole or vancomycin. Tapering and pulsing the antibiotic dose after a 10-day standard course decreases the incidence of recurrences compared with abruptly stopping antibiotics after a simple 10-day course. If recurrences continue after two courses of metronidazole, vancomycin may be preferable to avoid the risk of neurotoxicity that is associated with prolonged metronidazole use. There is also a role for probiotics in the treatment of RCDAD; Saccharomyces boulardii has been shown to decrease recurrences by about 50%, especially when combined with high-dose vancomycin. Other microbiologic approaches include the restoration of normal colonic flora by fecal enema or by nasogastric tube, but these have not been studied in controlled trials. In addition, there are numerous new treatment approaches that are under development, including a vaccine, which promise to aid the future treatment of RCDAD as well as prevention of initial CDAD.
The aim of this review is to establish the efficacy of antibiotic therapy for C. difficile-associated diarrhea (CDAD), to identify the most effective antibiotic treatment for CDAD in adults and to determine the need for stopping the causative antibiotic during therapy.
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There was a significant change in PD (P=0.0001), CAL (P=0.00001), PI (P<0.05), and BI (P<0.05) in the T group compared to the placebo group after therapy. Parallel to the clinical changes, treatment significantly reduced the number of Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and P. intermedia (Pi) compared with baseline in the T group (P=0.003, 0.021 and 0.0001, respectively). However, in the P group only the Pi colony count was reduced significantly (P=0.0001). After therapy, there was a significant difference between the T and P groups in the number of patients negative for Aa, Pg, and Pi (Pv = 0.033).
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Faecal microbiota transplantation (FMT) from a healthy donor has become the gold standard treatment for patients suffering from recurrent Clostridium difficile infection where antibiotic treatment (with vancomycin, metronidazole or fidaxomicin) has failed. FMT eradicates C. difficile and helps restore the recipient's intestinal flora, but its mechanism of action remains unclear. Since FMT's complex and highly variable composition cannot be easily characterized - nor its quality routinely assessed - FMT as a sui generis biologic drug cannot conform to existing standards for preparation. Clearly, donors must be carefully selected and the raw material prepared under close microbiological control, but FMT should also conform to manufacturing and laboratory practice standards for which international consensus can only be achieved with further experience. The objective should be to engage biomedical research to develop protocols that help elucidate the mechanism of action of FMT and support the production of safe and efficacious products.
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The presence of infection in the lower genital tract at the time of induced abortion has been associated with an increased risk of postabortion pelvic inflammatory disease (PID). The present study investigated the prevalences of Neisseria gonorrhoeae, Chlamydia trachomatis, and bacterial vaginosis among 1672 women undergoing induced abortion at four Scottish hospitals in 1995-96. It further compared the effectiveness of two clinical management strategies for minimizing the risk of postabortion infection. Women were randomly assigned to receive either 1 g of metronidazole rectally before abortion and 100 mg/day of doxycycline for 7 days (n = 826) or treatment only if screening was positive for infection (n = 846). Preabortion lower genital tract screening indicated 3 women (0.2%) were positive for N. gonorrhoeae, 91 (5.6%) for C. trachomatis, and 282 (17.5%) for bacterial vaginosis. A review of the rates of general practitioner consultations, antibiotic prescriptions, and hospital readmissions in the 8 weeks postabortion showed that symptoms were minor and similar in duration and intensity among women in both treatment groups. The postabortion PID/endometriosis rate was 4.6% among women in the prophylaxis group and 6.8% in the screen-and-treat group. Women in these two groups who were initially positive for 1 or more infection had significantly higher rates of postabortion PID/endometriosis (7.7% and 7.4%, respectively) than those who were initially negative (3.1% and 5.7%, respectively). Antibiotics had to be prescribed postabortion to 13.1% of women initially positive for 1 or more infection compared with 7.8% of those initially negative. The cost of universal prophylaxis (8.17 pounds) was less than half that of screening with treatment and follow up of positive cases.
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The objective of the present study is to compare the effect of systemic adjunctive use of azithromycin with amoxicillin/metronidazole to scaling and root planing (SRP) in a clinical study.
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For the therapeutic management of Helicobacter pylori infection, the Maastricht 2-2000 Consensus Report have introduced the concept of the 'treatment package' that considers first- and second-line eradication therapies together. According to this consensus statement, the first-line therapy for H. pylori eradication is a combination of the proton pump inhibitors (PPI) or ranitidine bismuth citrate (RBC) and claritromycin plus either amoxicillin or metronidazole. The second-line treatment is suggested to be PPI-quadruple therapy for a minimum of 7 days. If bismuth compounds are not available, PPI-based triple therapy will have to be used as a second-line treatment only after susceptibility testing. Since no considerable progress has been made during the past year in treatment regimens, there is still a need for new compounds that are specific for H. pylori, which could constitute future therapies.
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In this study, the application of thermotropic liquid crystals embedded in cellulose nitrate membranes as on-off drug permeation control in response to temperature changes is described. Two low-molecular-weight liquid crystals, n-pentyl-cyanobiphenyl (K15) and n-heptyl-cyanobiphenyl (K21), with nematic-to-isotropic phase transition temperatures (T(n-i)) of 36.3 °C and 43.3 °C, respectively, were used to modulate drug permeation through the membrane. Liquid crystal-embedded membranes composed of appropriate blends of K15 and K21 were prepared by vacuum filtration. The permeation of pyrazinamide and metronidazole as drug models with different hydrophilicity and molecular weights through the liquid crystal-embedded membrane was examined. It was found that the drug permeation through the membrane could be modulated by changing the temperature below and above the T(n-i) of liquid crystals. The permeation of pyrazinamide, the hydrophilic drug with smaller molecular weight, was more temperature-dependent than metronidazole, the hydrophobic drug with higher molecular weight. These experiments were also repeated with thermal cycling between 25 °C and 45 °C. The permeation profiles were reversible and followed zero-order kinetics.
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The results of previous studies on the effectiveness of antibiotics in ulcerative colitis (UC) seem more effective when used orally. In this retrospective, multicenter study, we aimed to report our experience of using a combination of 3-4 antibiotics in children with moderate-severe refractory UC and IBD-unclassified including metronidazole, amoxicillin, doxycycline, and if during hospital admission, also vancomycin (MADoV).
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A combined transplant consisting of bone flour plus the sorption-antimicrobial complex polymethylsiloxane + furazolidone + metronidazole is proposed to be grafted into the bone periodontal pockets in patients with generalized parodontitis. Effects were studied of the above transplant on the experimental defects of the lower jaw--of albino rats (n = 36). Morphologic changes in the immediate periods of follow-up (at day 7, 14, and 21) were characterized by a poorly manifest and short-term reactive inflammatory process in the paratransplant tissues as well as by an earlier development of the osteoid tissue and early formation of the bone regenerate.
It is concluded that, in this patient, the cervical resorptions were likely the result of an osteoclastic response extending into the roots because the root-protective role of the junctional epithelium did not develop. We hypothesize that this was due to the combined effects of a periodontopathogenic microflora and a dietary confounding factor.
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Antimicrobial resistance of Helicobacter pylori is a growing problem in clinical practice, particularly clarithromycin resistance. The aim of the present study was therefore to investigate the prevalence of H. pylori resistance to antimicrobial agents in Japanese children.