Metronidazole for bacterial vaginosis. A comparison of vaginal gel vs. oral therapy

OBJECTIVE

To compare the efficacy and safety of 0.75% metronidazole vaginal gel with oral metronidazole for the treatment of bacterial vaginosis (BV).

STUDY DESIGN

Nonpregnant women with BV were enrolled in a multicenter, randomized, investigator-blind treatment trial. Patients were randomly assigned to either 0.75% metronidazole vaginal gel (5 g twice daily for five days) or oral metronidazole (500 mg twice daily for seven days). Follow-up visits occurred approximately two and five weeks after initiation of therapy.

RESULTS

BV was clinically eliminated at the first follow-up visit in 83.7% (36/43, 95% CI 72.3-95.1%) of the intravaginal group and 85.1% (40/47, 95% CI 74.6-95.6%) of the oral group. At the final visit, BV was eliminated in 70.7% (29/41, 95% CI 56.3-85.1%) of the intravaginal group and 71.1% (32/45, 95% CI 57.4-84.8%) of the oral group. Significantly more patients in the oral treatment group (51.8%) reported gastrointestinal complaints as compared to the intravaginal treatment group (32.7%, P = .04).

CONCLUSION

The efficacy of 0.75% metronidazole vaginal gel twice daily for five days in treating BV was similar to that of standard oral metronidazole treatment and was associated with fewer gastrointestinal complaints.

Comparative evaluation of three Tactylon(TM) condoms and a latex condom during vaginal intercourse: breakage and slippage

This study compared breakage and slippage rates of three male condom styles made of Tactylon(TM), a synthetic elastomer, to those of a marketed latex condom during vaginal intercourse. Safety and acceptability outcomes were also assessed. This two-center, prospective, crossover study enrolled 443 couples. Each couple was randomly assigned to use three condoms of each type in one of 24 use sequences. Couples completed questionnaires after using each condom, all of one condom type, and all four condom types. The percentage and standard error (SE, in parentheses) of latex condoms with clinical breakage was 0.86% (0.295). Percentages for Tactylon condoms were not equivalent to the latex study condom, ranging from 3.50% to 4.17%. The percentage and SE of latex condoms with complete slippage was 1.11% (0.328). Percentages for Tactylon condoms were equivalent to those for latex, ranging from 0.70% to 1.31%. The Low-Modulus Tactylon condom was the most preferred. Fewer medical events were reported with the Tactylon condoms than with the latex condom. It was concluded that Tactylon condoms were equivalent to the latex condom in terms of slippage but not breakage. However, safety and acceptability seemed to be better for Tactylon condoms. This may improve consistency of use and may attract new users.

New limit on CPT violation

A search for antiproton decay has been made at the Fermilab Antiproton Accumulator. Limits are placed on fifteen antiproton decay modes. The results are used to place limits on the characteristic mass scale m(X) that could be associated with CPT violation accompanied by baryon number violation.

Chemical and Sensory Characterization of Hydrolyzed Vegetable Protein, a Savory Flavoring

Three protein hydrolysates (HVPs) were produced from untoasted defatted soy by acidic hydrolysis (aHVP), enzymatic hydrolysis (eHVP), and enzymatic hydrolysis followed by a heat treatment with glucose (eHVPrea). The three HVPs were characterized by amino acid analysis, identification of volatile compounds, and sensory profiling. aHVP had a higher degree of hydrolysis compared with eHVP and eHVPrea which still contained peptides composed mainly of the smaller and the acidic amino acids. A total of 29 volatile compounds were identified by GC-MS. Furans and sulfides were primarily found in the acidic HVP, while alcohols and pyrazines primarily were found in eHVP/eHVPrea. Further Maillard reaction had occurred in eHVPrea compared to eHVP, but the sensory profile was not altered. The multivariate analysis of the sensory profile showed that the acidic HVP had increased intensity in the bouillon, soy, and lovage odor and taste characteristics compared with the two enzymatic HVPs.

Efficacy and tolerability of a topical NSAID patch (local action transcutaneous flurbiprofen) and oral diclofenac in the treatment of soft-tissue rheumatism

The efficacy and safety of local action transcutaneous flurbiprofen 40 mg [flurbiprofen LAT] patches and diclofenac sodium tablets, 50 mg b.d., were compared in an open, multicentre, randomized, parallel-group study in patients with soft-tissue rheumatism. Patches were replaced at 12-hourly intervals. Clinical assessments were performed after 7 and 14 days of treatment. Fifty-six patients were treated with flurbiprofen LAT and 53 with diclofenac. Six withdrawals (three from each group) occurred during the treatment period. A statistically significant difference was observed in favour of flurbiprofen LAT for the principal measure, namely the investigator's opinion of overall change in clinical condition: 49/53 (92%) patients treated with flurbiprofen LAT had improved by day 14 compared with 36/49 (73%) patients receiving diclofenac sodium (p = 0.03; eligible dataset). There were also statistically significant differences in favour of flurbiprofen LAT for the investigator's assessments of the overall severity of the clinical condition (p = 0.03; eligible dataset), for the severity of pain at the region treated (p = 0.04; intent-to-treat), and for the severity of tenderness (p < 0.001; intent-to-treat). Supplementary analgesia (paracetamol) was required by two patients in the flurbiprofen LAT group and by eight diclofenac-treated patients. The difference in favour of flurbiprofen LAT in the average daily consumption of paracetamol was significant (p = 0.04). The patients' assessment of severity of pain on movement also favoured flurbiprofen LAT (p = 0.049; eligible dataset), but there were no statistically significant differences in day or night pain or quality of sleep. For the patients' opinion of treatment there was, however, a statistically significant difference in favour of flurbiprofen LAT (p = 0.02). Of the patients receiving flurbiprofen LAT, 94% regarded it as a convenient form of treatment. With respect to tolerability 8/56 (14%) patients applying flurbiprofen patches reported a total of nine adverse effects (AEs) (mainly local, mild skin irritations), vs 9/52 (17%) patients receiving diclofenac, who reported 12 AEs. Most AEs in the enteric-coated diclofenac group were of a gastrointestinal nature (one of which was severe). In terms of the proportion of patients reporting AEs related to the digestive system, there was a statistically significant difference in favour of flurbiprofen LAT (p = 0.011). In conclusion, local treatment of soft-tissue rheumatism with flurbiprofen LAT was demonstrably superior to benchmark oral therapy with diclofenac sodium over a 2-week period in terms of both efficacy and gastrointestinal tolerability. Flurbiprofen LAT provided both an effective and convenient form of topical SAID treatment.

A case of systemic strongyloidiasis in an ex-coal miner with idiopathic colitis

An ex-coal miner was diagnosed with an idiopathic sigmoiditis compatible with colitis ulcerosa. He was treated with corticosteroids because of his deteriorating clinical condition, but his condition continued to worsen. He revealed to have a systemic Strongyloides stercoralis hyperinfection and Strongyloides colitis. A short time after diagnosis he died from septic shock despite therapy with thiabendazole and antibiotics. S. stercoralis is an opportunistic infection that is not uncommon and has high mortality in hyperinfection. It is prevalent in (sub)tropical areas, and also in coal mines because of the specific microclimate. However, the parasite is difficult to detect because eosinophilia can appear normal in chronic infection. Several stool examinations, duodenal aspiration or biopsies are necessary for a high diagnostic sensitivity. Serological diagnosis is the most sensitive and specific but is not always available.

Vaginal flora and pelvic inflammatory disease

Forty-one patients with acute pelvic inflammatory disease were evaluated for the coexistence of bacterial vaginosis. Because all patients had a copious purulent vaginal discharge, microscopic criteria could not be used and microbiologic criteria were employed. The vaginal bacterial flora were not consistent with that of bacterial vaginosis, because Lactobacillus and other gram-positive bacteria dominated with colony counts of 10(3) to 10(5) cfu/ml (colony-forming units per milliliter). Endocervical specimens yielded Neisseria gonorrhoeae from 20 patients and Chlamydia trachomatis from 11 patients. Anaerobes were not dominant in any site sampled. A total of 147 bacteria were isolated from the endometrium, 16 (11%) of which were anaerobes. Thus the endogenous bacterial flora were not consistent with that of the microbiologic definition of bacterial vaginosis. N. gonorrhoeae was the most common isolate from the endocervix and endometrium; it was isolated three times more frequently from the endocervix and two times more frequently from the endometrium than was C. trachomatis.

Subacromial impingement: open versus arthroscopic decompression

An analysis of the follow-up results of 53 patients treated by an arthroscopic decompression (AD) and 53 patients treated by an open decompression (OD) is presented. Patients were evaluated pre- and postoperatively with the UCLA Shoulder Rating Scale, which includes an assessment of pain, function, range of motion, strength, and patient satisfaction. After an average of 20.1 months for the AD group and 27.3 months for the OD group, good or excellent results were found in 83.1% in the AD group and in 81.1% in the OD group. Patient satisfaction was 88.3% (AD) compared with 94.3% (OD). Results of decompression in both groups were not influenced by associated pathologies (acromioclavicular degeneration, frozen shoulder, calcified tendinitis, rotator cuff lesions).

A right lower quadrant mass in cystic fibrosis: a diagnostic challenge

In a cystic fibrosis (CF) patient a right lower quadrant (RLQ) mass may be a difficult diagnostic problem. Most frequently it is due to a distal intestinal obstruction syndrome also called meconium ileus equivalent, but the possibility of intussusception and appendiceal abscess should also be considered. We describe three CF patients with an appendiceal abscess seen in a 4-year period. All three patients had a palpable RLQ mass. Chronicity and obliteration of the appendiceal lumen with abnormally viscid mucus may lead to concealed perforation and be responsible for the atypical presentation.

Ticarcillin/clavulanate for treatment of postpartum endometritis

Postpartum endometritis continues to be the leading cause of morbidity following cesarean section. This infection is commonly polymicrobial, involving aerobic, facultative, and obligate anaerobic gram-negative bacteria as well as gram-positive bacteria. The major risk factor for the development of post-cesarean section endometritis is duration of labor with ruptured amniotic membranes of greater than 6 hours. The most frequently utilized antibiotic regimen employed for treatment of postpartum endometritis is the combination of clindamycin and gentamicin. The combination ticarcillin/clavulanate has a spectrum of activity resembling that of clindamycin and gentamicin. In the data reported, cure rates among patients treated with ticarcillin/clavulanate were similar to the rates for those treated with clindamycin plus gentamicin as well as those for cefoxitin.

Bacteriologic findings with ectopic pregnancy

The fallopian tubes and peritoneum of 27 patients were cultured at the time of salpingotomy/salpingectomy to determine if active tubal infection was the cause of post-operative temperature elevations. Infection was documented in six patients (22%). Previous exposure to Chlamydia trachomatis was documented with 2 endocervical cultures and 17 serum specimens positive for IgG antibody. The culture results, however, did not correlate with the postoperative febrile morbidity.

Treatment of postpartum endometritis

In this study, cefoxitin alone (2 gm, every 8 hours) was generally sufficient to cure postpartum endometritis, even when the patient had received prophylaxis with a beta-lactam antibiotic. When single-agent therapy fails, addition of ampicillin usually results in a prompt clinical response.