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de Sousa ALM, Rizaldo Pinheiro R, Furtado Araujo J, Mesquita Peixoto R, de Azevedo DAA, Cesar Lima AM, Marques Canuto K, Vasconcelos Ribeiro PR, de Queiroz Souza AS, Rocha Souza SC, de Amorim SL, Paula Amaral G, de Souza V, de Morais SM, Andrioli A, da Silva Teixeira MF. In vitro antiviral effect of ethanolic extracts from Azadirachta indica and Melia azedarach against goat lentivirus in colostrum and milk. Sci Rep 2023; 13:4677. [PMID: 36949145 PMCID: PMC10031174 DOI: 10.1038/s41598-023-31455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 03/13/2023] [Indexed: 03/24/2023] Open
Abstract
This study aimed to evaluate, in vitro, the use of leaf extracts of Azadirachta indica (A. indica) and Melia azedarach (M. azedarach) as antivirals against caprine lentivirus (CLV) in colostrum and milk of goat nannies. These were collected from eight individuals and infected with the standard strain of CLV. Samples were then subdivided into aliquots and treated with 150 µg/mL of crude extract, and with ethyl acetate and methanol fractions for 30, 60, and 90 min. Next, somatic cells from colostrum and milk were co-cultured with cells from the ovine third eyelid. After this step, viral titers of the supernatants collected from treatments with greater efficacy in co-culture were assessed. The organic ethyl acetate fractions of both plants at 90 min possibly inhibited the viral activity of CLV by up to a thousandfold in colostrum. In milk, this inhibition was up to 800 times for the respective Meliaceae. In conclusion, the ethanolic fraction of ethyl acetate from both plants demonstrated efficacy against CLV in samples from colostrum and milk when subjected to treatment, which was more effective in colostrum.
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Affiliation(s)
- Ana Lidia Madeira de Sousa
- Laboratory of Virology (LABOVIR), State University of Ceará (UECE), Fortaleza, CE, Brazil.
- Faculdade Educar da Ibiapaba, Ípu, CE, Brazil.
| | | | | | - Renato Mesquita Peixoto
- Vale do Salgado University Center (UNIVS), Icó, CE, Brazil
- Terra Nordeste College (FATENE), Caucaia, CE, Brazil
| | | | - Ana Milena Cesar Lima
- Scholarship for Regional Scientific Development of the National Council for Scientific and Technological Development (DCR-CNPq/FUNCAP), Level C, Embrapa Goats and Sheep, Sobral, CE, Brazil
| | - Kirley Marques Canuto
- Multiuser Laboratory of Natural Products Chemistry, Embrapa Tropical Agroindustry, Fortaleza, CE, Brazil
| | | | | | | | - Sara Lucena de Amorim
- Department of Veterinary Medicine, Federal University of Rondônia, Rolim de Moura, RO, Brazil
| | | | - Viviane de Souza
- Laboratory of Microbiology, Embrapa Goats and Sheep, Sobral, CE, Brazil
| | - Selene Maia de Morais
- Laboratory of Chemistry and Natural Products (LQPN), Ceará State University, Fortaleza, CE, Brazil
| | - Alice Andrioli
- Laboratory of Virology, Embrapa Goats and Sheep, Sobral, CE, Brazil
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Notario-Pérez F, Ruiz-Caro R, Veiga-Ochoa MD. Historical development of vaginal microbicides to prevent sexual transmission of HIV in women: from past failures to future hopes. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:1767-1787. [PMID: 28670111 PMCID: PMC5479294 DOI: 10.2147/dddt.s133170] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Infection with human immunodeficiency virus (HIV) remains a global public health concern and is particularly serious in low- and middle-income countries. Widespread sexual violence and poverty, among other factors, increase the risk of infection in women, while currently available prevention methods are outside the control of most. This has driven the study of vaginal microbicides to prevent sexual transmission of HIV from men to women in recent decades. The first microbicides evaluated were formulated as gels for daily use and contained different substances such as surfactants, acidifiers and monoclonal antibodies, which failed to demonstrate efficacy in clinical trials. A gel containing the reverse transcriptase inhibitor tenofovir showed protective efficacy in women. However, the lack of adherence by patients led to the search for dosage forms capable of releasing the active principle for longer periods, and hence to the emergence of the vaginal ring loaded with dapivirine, which requires a monthly application and is able to reduce the sexual transmission of HIV. The future of vaginal microbicides will feature the use of alternative dosage forms, nanosystems for drug release and probiotics, which have emerged as potential microbicides but are still in the early stages of development. Protecting women with vaginal microbicide formulations would, therefore, be a valuable tool for avoiding sexual transmission of HIV.
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Affiliation(s)
- Fernando Notario-Pérez
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain
| | - Roberto Ruiz-Caro
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain
| | - María-Dolores Veiga-Ochoa
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain
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Tun W, Katzen LL, Abbott SA, Srikrishnan AK, Kelly CA, Sarna A, Friedland BA, Solomon S, Mensch BS. Using a 2-stage strategy with respondent-driven sampling to recruit a hard-to-reach population for a placebo microbicide gel clinical trial in Nellore, Andhra Pradesh (India). AIDS Behav 2015; 19:369-79. [PMID: 25384905 DOI: 10.1007/s10461-014-0938-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Traditional recruitment methods for microbicide efficacy trials are labor intensive and may fail to reach high-risk hard-to-reach populations. We report duration of recruitment and lessons learned from a two-stage process to recruit female sex workers (FSWs) into a placebo microbicide trial, and examined characteristics associated with successful recruitment of peers who screened for and enrolled in the trial. FSWs were first recruited via respondent-driven sampling (RDS) to complete a survey and subsequently invited to screen for enrollment into a placebo microbicide trial taking place at a local clinic. It took 6 months to enroll 267 participants into the trial. Successful recruiters of peers who enrolled were more likely to have enrolled themselves (AOR 2.0, CI 1.3-2.9) and less likely to visit Nellore city (AOR 0.5, CI 0.3-0.9). Recruitment of FSWs via a two-stage recruitment strategy with RDS can be a good option for future clinical trials.
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Affiliation(s)
- Waimar Tun
- HIV and AIDS Program, Population Council, 4301 Connecticut Avenue, NW, Suite 80, Washington, DC, 20008, USA,
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Prabhughate A, Sarna A, Brady M. Tenofovir gel for HIV prevention for women: Perspectives of Key Opinion Leaders from India. HEALTH POLICY AND TECHNOLOGY 2014. [DOI: 10.1016/j.hlpt.2013.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pharmacokinetic and safety analyses of tenofovir and tenofovir-emtricitabine vaginal tablets in pigtailed macaques. Antimicrob Agents Chemother 2014; 58:2665-74. [PMID: 24566178 DOI: 10.1128/aac.02336-13] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Vaginal rapidly disintegrating tablets (RDTs) containing tenofovir (TFV) or TFV and emtricitabine (FTC) were evaluated for safety and pharmacokinetics in pigtailed macaques. Two separate animal groups (n = 4) received TFV (10 mg) or TFV-FTC (10 mg each) RDTs, administered near the cervix. A third group (n = 4) received 1 ml TFV gel. Blood plasma, vaginal tissue biopsy specimens, and vaginal fluids were collected before and after product application at 0, 0.5, 1, 4, and 24 h. A disintegration time of <30 min following vaginal application of the RDTs was noted, with negligible effects on local inflammatory cytokines, vaginal pH, and microflora. TFV pharmacokinetics were generally similar for both RDTs and gel, with peak median concentrations in vaginal tissues and vaginal secretions being on the order of 10(4) to 10(5) ng/g (147 to 571 μM) and 10(6) ng/g (12 to 34 mM), respectively, at 1 to 4 h postdose. At 24 h, however, TFV vaginal tissue levels were more sustained after RDT dosing, with median TFV concentrations being approximately 1 log higher than those with gel dosing. FTC pharmacokinetics after combination RDT dosing were similar to those of TFV, with peak median vaginal tissue and fluid levels being on the order of 10(4) ng/g (374 μM) and 10(6) ng/g (32 mM), respectively, at 1 h postdose with levels in fluid remaining high at 24 h. RDTs are a promising alternative vaginal dosage form, delivering TFV and/or FTC at levels that would be considered inhibitory to simian-human immunodeficiency virus in the macaque vaginal microenvironment over a 24-h period.
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Abstract
Microbicides are topically applied, user controlled dosage forms that are being developed to prevent the transmission of HIV during coitus. Early candidates focused on coitally dependent dosage forms such as gels and creams. More recent development has focused on broadening the coitally dependent options through the introduction of films and fast dissolving tablets. Additionally, it has become important to have longer acting products to minimize the burden of user compliance and thus vaginal rings have been developed providing sustained delivery of antiretroviral drugs. This chapter discusses the history of microbicides along with a detailed description of coitally dependent products, gels, films, tablets diaphragms, as well as coitally independent dosage forms such as vaginal rings and the introduction of a new technology, electrospun fibers.
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Affiliation(s)
- L C Rohan
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh Magee Women's Research Institute, Pittsburgh, PA, USA,
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Abstract
Human immunodeficiency virus (HIV), causative agent of acquired immunodeficiency syndrome (AIDS), is a global health concern. To control its transmission, safe sex has been proposed as one of the strategies. Microbicides- intravaginal/intrarectal topical formulations of anti-HIV agents have also been proposed to prevent HIV transmission. Microbicides would provide protection by directly inactivating HIV or preventing the attachment, entry or replication of HIV in susceptible target cells as well as their dissemination from target cells present in semen or the host cells lining the vaginal/rectal wall to other migratory cells. Microbicides must be safe, effective following vaginal or rectal administration, and should cause minimal or no genital symptoms or inflammations following long-term repeated usage. However, a safe and efficacious anti-HIV microbicide is not yet available despite the fact that more than 60 candidate agents have been identified to have in vitro activity against HIV, several of which have advanced to clinical testing. Nonetheless, proof-of-concept of microbicides has been established based on the results of recent CAPRISA 004 clinical trials. In this article, the trends and challenges in the development of effective and safe microbicides to combat HIV transmission are reviewed.
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Affiliation(s)
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- Reproductive Cell Biology Laboratory, National Institute of Immunology, Aruna Asaf Ali Marg,New Delhi, India
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Pillay V, Mashingaidze F, Choonara YE, Du Toit LC, Buchmann E, Maharaj V, Ndesendo VM, Kumar P. Qualitative and Quantitative Intravaginal Targeting: Key to Anti-HIV-1 Microbicide Delivery from Test Tube to In Vivo Success. J Pharm Sci 2012; 101:1950-68. [DOI: 10.1002/jps.23098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/27/2011] [Accepted: 02/09/2012] [Indexed: 12/20/2022]
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Paranjape RS, Thakar MR, Ghate MV, Godbole SV. Current Status of Research on HIV Epidemic, Pathogenesis, Management and Prevention in India. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s40011-011-0013-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Joglekar N, Joshi S, Deshpande S, Parkhe A, Katti U, Mehendale S. Acceptability and adherence: findings from a Phase II study of a candidate vaginal microbicide, ‘Praneem polyherbal tablet’, in Pune, India. Trans R Soc Trop Med Hyg 2010; 104:412-5. [DOI: 10.1016/j.trstmh.2009.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 12/15/2009] [Accepted: 12/15/2009] [Indexed: 11/17/2022] Open
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Abstract
HIV infection rates in the developing world remain a serious problem. One potential approach to reduce infection rates is to use products known as microbicides, referred to herein as microbicide drug products (MDPs). These are drugs capable of, when administered topically to the vagina (or rectum), interfering with infection by one or more mechanisms. This review article covers the latest pharmaceutical developments in the area of microbicides dosage forms and delivery systems. These products are principally designed for use in the developing world and must therefore address cultural and societal issues generally unknown in the developed world. The first-generation microbicides evaluated clinically were principally polyanions. These drugs, administered intravaginally as gels, were found to be ineffective in preventing transmission of HIV from men to women. Second-generation drugs such as tenofovir, dapivirine, and UC781 are reverse transcriptase inhibitors developed as gels formulations and intravaginal rings (IVRs). Gels are considered coitally-related products while IVRs are coitally-independent systems designed to release the drug over a four-week period or possibly longer (up to 3 or 4 months). Other dosage forms under development include fast dissolving films, tablets/capsules, and possibly vaginal sponges. Dual protection systems are also under development. These systems include formulations capable of preventing HIV infection along with a second drug capable of preventing conception or other viral infections such as HSV.
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Salhan S, Tripathi V, Sehgal R, Kumar G, Talwar GP, Chatterjee A. A phase II randomized controlled trial to evaluate the safety and efficacy of Praneem polyherbal vaginal tablets compared with betadine vaginal pessary in women with symptoms of abnormal vaginal discharge. Asia Pac J Public Health 2009; 21:461-8. [PMID: 19783561 DOI: 10.1177/1010539509344610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abnormal vaginal discharge (AVD) caused by a variety of reproductive tract infections is a widespread syndrome among women in India and in other developing countries. The purpose of this study was to determine whether a polyherbal formulation, Praneem, can be used for the regression of the syndrome. A phase IotaIota randomized controlled study was carried out with Praneem polyherbal tablets and Betadine vaginal pessary in 99 women with AVD. The authors found that 92% of women using Praneem were relieved of their symptoms of AVD as against 81.6% women using Betadine. Significant reduction was also seen with both treatments in lower abdominal pain, vaginal itching, and dysuria. Thus, the study indicates the efficacy of Praneem for the treatment of AVD and provides a rationale for planning a further Phase III study on a larger sample size for definitive conclusions.
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Affiliation(s)
- Sudha Salhan
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Shukla S, Bharti AC, Hussain S, Mahata S, Hedau S, Kailash U, Kashyap V, Bhambhani S, Roy M, Batra S, Talwar GP, Das BC. Elimination of high-risk human papillomavirus type HPV16 infection by 'Praneem' polyherbal tablet in women with early cervical intraepithelial lesions. J Cancer Res Clin Oncol 2009; 135:1701-9. [PMID: 19526249 DOI: 10.1007/s00432-009-0617-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 05/27/2009] [Indexed: 01/17/2023]
Abstract
PURPOSE 'Praneem', a polyherbal formulation developed by us, has successfully completed Phase II efficacy study for treatment of abnormal vaginal discharge due to reproductive tract infections that act as co-factors for HPV persistence. In the present study we evaluated potential anti-HPV activity of Praneem in women infected with high risk HPV type 16. METHODS Twenty women molecularly diagnosed positive for HPV16 infection without or with low grade squamous intraepithelial lesion (LSIL) or inflammation were assigned to receive intra-vaginal, topical application of either Praneem tablet or placebo for 30 days excluding the days of menstrual period and were evaluated for persistence of HPV infection using HPV L1 consensus and HPV type 16-specific PCR as primary outcome. RESULTS One course of Praneem treatment resulted in elimination of HPV in 6 out of 10 (60%) cases. A repeat treatment of four patients with persisting HPV infection resulted in clearance of HPV in two additional cases resulting in an overall 80% clearance of HPV 16 as against a spontaneous clearance of 10% (1/10) seen in the placebo arm. The elimination of HPV DNA was found to be accompanied by marked improvement in clinical symptoms and cytological abnormalities of Praneem-treated patients. CONCLUSION Our results showed for the first time that a 30-day intra-vaginal application of the Praneem can result in elimination of HPV infection from the uterine cervix.
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Affiliation(s)
- Shirish Shukla
- Division of Molecular Oncology, Institute of Cytology and Preventive Oncology (ICMR), Noida, India
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Sharma R, Mathur A, Chandhiok N, Datey S, Saxena N, Gopalan S, Sharma S, Mittal S, Sehgal R, Sumandal B, Chanda A, Salvi V, Mutalik N, Coyaji K, Gibsson A, Hazari K, Kalgutkar S, Talwar G. Phase II clinical trial with Praneem polyherbal tablets for assessment of their efficacy in symptomatic women with abnormal vaginal discharge (an ICMR task force study). Trans R Soc Trop Med Hyg 2009; 103:167-72. [DOI: 10.1016/j.trstmh.2008.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 09/16/2008] [Accepted: 09/16/2008] [Indexed: 11/28/2022] Open
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Cutler B, Justman J. Vaginal microbicides and the prevention of HIV transmission. THE LANCET. INFECTIOUS DISEASES 2008; 8:685-97. [PMID: 18992405 DOI: 10.1016/s1473-3099(08)70254-8] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Worldwide, nearly half of all individuals living with HIV are now women, who acquire the virus largely by heterosexual exposure. With an HIV vaccine likely to be years away, topical microbicide formulations applied vaginally or rectally are being investigated as another strategy for HIV prevention. A review of preclinical and clinical research on the development of microbicides formulated to prevent vaginal HIV transmission yielded 118 studies: 73 preclinical and 45 clinical. Preclinical research included in-vitro assays and cervical explant models, as well as animal models. Clinical research included phase I and II/IIb safety studies, and phase III efficacy studies. Whereas most phase I and phase II clinical trials have found microbicide compounds to be safe and well tolerated, phase III trials completed to date have not demonstrated efficacy in preventing HIV transmission. Topical microbicides are grouped into five classes of agents, based on where they disrupt the pathway of sexual transmission of HIV. These classes include surfactants/membrane disruptors, vaginal milieu protectors, viral entry inhibitors, reverse transcriptase inhibitors, and a fifth group whose mechanism is unknown. The trajectory of microbicide development has been toward agents that block more specific virus-host cell interactions. Microbicide clinical trials face scientifically and ethically complex issues, such as the choice of placebo gel, the potential for viral resistance, and the inclusion of HIV-infected participants. Assessment of combination agents will most likely advance this field of research.
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Affiliation(s)
- Blayne Cutler
- Department of Medicine, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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Ndesendo VMK, Pillay V, Choonara YE, Buchmann E, Bayever DN, Meyer LCR. A review of current intravaginal drug delivery approaches employed for the prophylaxis of HIV/AIDS and prevention of sexually transmitted infections. AAPS PharmSciTech 2008; 9:505-20. [PMID: 18431651 PMCID: PMC2976928 DOI: 10.1208/s12249-008-9073-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 02/04/2008] [Indexed: 12/26/2022] Open
Abstract
The objective of this review is to describe the current status of several intravaginal anti-HIV microbicidal delivery systems these delivery systems and microbicidal compounds in the context of their stage within clinical trials and their potential cervicovaginal defence successes. The global Human Immuno-Deficiency Virus (HIV) pandemic continues to spread at a rate of more than 15,000 new infections daily and sexually transmitted infections (STIs) can predispose people to acquiring HIV infection. Male-to-female transmission is eight times more likely to occur than female-to-male transmission due to the anatomical structure of the vagina as well as socio-economic factors and the disempowerment of women that renders them unable to refuse unsafe sexual practices in some communities. The increased incidence of HIV in women has identified the urgent need for efficacious and safe intravaginal delivery of anti-HIV agents that can be used and controlled by women. To meet this challenge, several intravaginal anti-HIV microbicidal delivery systems are in the process of been developed. The outcomes of three main categories are discussed in this review: namely, dual-function polymeric systems, non-polymeric systems and nanotechnology-based systems. These delivery systems include formulations that modify the genital environment (e.g. polyacrylic acid gels and lactobacillus gels), surfactants (e.g. sodium lauryl sulfate), polyanionic therapeutic polymers (e.g. carageenan and carbomer/lactic acid gels), proteins (e.g. cyanovirin-N, monoclonal antibodies and thromspondin-1 peptides), protease inhibitors and other molecules (e.g. dendrimer based-gels and the molecular condom). Intravaginal microbicide delivery systems are providing a new option for preventing the transmission of STIs and HIV.
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Affiliation(s)
- Valence M. K. Ndesendo
- />Department of Pharmacy and Pharmacology, University of the Witwatersrand, 7 York Road, Parktown 2193 Johannesburg, South Africa
| | - Viness Pillay
- />Department of Pharmacy and Pharmacology, University of the Witwatersrand, 7 York Road, Parktown 2193 Johannesburg, South Africa
| | - Yahya E. Choonara
- />Department of Pharmacy and Pharmacology, University of the Witwatersrand, 7 York Road, Parktown 2193 Johannesburg, South Africa
| | - Eckhart Buchmann
- />Department of Gynecology and Obstetrics, Chris Hani Baragwanath Hospital, Bertsham, Johannesburg, 2013 South Africa
| | - David N. Bayever
- />Department of Pharmacy and Pharmacology, University of the Witwatersrand, 7 York Road, Parktown 2193 Johannesburg, South Africa
| | - Leith C. R. Meyer
- />Brain Function Research Group, School of Physiology, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
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Patel Y, Gopalan S, Bagga R, Sharma M, Chopra S, Sethi S. A randomized trial comparing a polyherbal pessary (a complementary and alternative medicine) with Ginlac-V pessary (containing clotrimazole, tinidazole and lactobacilli) for treatment of women with symptomatic vaginal discharge. Arch Gynecol Obstet 2008; 278:341-7. [PMID: 18236058 DOI: 10.1007/s00404-008-0568-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2007] [Accepted: 01/08/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most women with abnormal vaginal discharge have infection due to candida species, bacterial vaginosis or trichomoniasis and often seek treatment without laboratory confirmation. In this context, a single agent effective against these infections would be useful. AIM To compare the efficacy of two such agents: Praneem polyherbal pessary; a complementary and alternative medicine (CAM) with Ginlac-V pessary (containing clotrimazole, tinidazole and lactobacilli) for treatment of abnormal vaginal discharge. SETTINGS AND DESIGN A randomized study in a tertiary care hospital in North India. METHODS One hundred women were randomized for treatment with either of the two pessaries. Clinical examination and laboratory evaluation was done before and after treatment. STATISTICAL ANALYSIS Mc-Nemar test and Chi-square test. RESULTS Overall, 82% (82/100) reported symptomatic relief; 78% (39/50) with Praneem and 86% (43/50) with Ginlac-V. Only 36% (18/50 in each group) had laboratory-confirmed infection; 18% (18/100) candidosis, 17% (17/100) bacterial vaginosis, 1% (1/100) both; none had trichomoniasis. Among these, symptomatic improvement was seen in 72% (13/18) and laboratory cure in 78% (14/18) with Praneem; symptomatic improvement in 78% (14/18) and laboratory cure in 78% (14/18) with Ginlac-V. Clinical or laboratory criteria could assess treatment efficacy equally. Neither drug was efficacious in candidosis. Ginlac-V was efficacious in bacterial vaginosis (100%) and though Praneem showed a similar trend, it was not statistically significant. Vaginal irritation was more frequent with Praneem (16% vs 4% with Ginlac-V). CONCLUSION Both Praneem and Ginlac-V provided symptomatic relief in most of the women. Either clinical or laboratory criteria could assess treatment efficacy of both drugs. Ginlac-V was efficacious for treating bacterial vaginosis.
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Affiliation(s)
- Yamal Patel
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
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Bhattachar N, . MC, . SS. Neem (Azadirachta indica A. Juss), a Potent Biopesticide and Medicinal Plant: A Review. ACTA ACUST UNITED AC 2007. [DOI: 10.3923/jps.2007.251.259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Joshi M, Ali SW, Rajendran S. Antibacterial finishing of polyester/cotton blend fabrics using neem (Azadirachta indica): A natural bioactive agent. J Appl Polym Sci 2007. [DOI: 10.1002/app.26323] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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21
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Bagga R, Raghuvanshi P, Gopalan S, Das SK, Baweja R, Suri S, Malhotra D, Khare S, Talwar GP. A polyherbal vaginal pessary with spermicidal and antimicrobial action: evaluation of its safety. Trans R Soc Trop Med Hyg 2006; 100:1164-7. [PMID: 16750546 DOI: 10.1016/j.trstmh.2006.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2005] [Revised: 01/17/2006] [Accepted: 01/18/2006] [Indexed: 11/30/2022] Open
Abstract
A polyherbal vaginal pessary (Praneem) has been formulated that has antimicrobial properties against genital pathogens in addition to spermicidal action. Thus, it has dual potential as a barrier method for contraception and for providing protection against some sexually transmitted infections. The present study reports the findings of a multicentre trial that was conducted to evaluate the safety of this product. Trials were carried out in 23 women in three centres in India: the Postgraduate Institute of Medical Education and Research, Chandigarh; Safdarjang Hospital, New Delhi; and Kamla Nehru Memorial Hospital, Allahabad. Thorough clinical and pelvic examinations were carried out as well as cervical cytology, blood biochemistry and haematology before and after use of the polyherbal pessary intravaginally once daily for 7 consecutive days. No toxicity was observed on clinical examination or by laboratory investigations. Daily intravaginal use of this pessary for 7 days had no adverse effects on cervical cytology or on metabolic and organ functions.
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Affiliation(s)
- R Bagga
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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McGowan I. Microbicides: a new frontier in HIV prevention. Biologicals 2006; 34:241-55. [PMID: 17097303 DOI: 10.1016/j.biologicals.2006.08.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 08/24/2006] [Indexed: 01/01/2023] Open
Abstract
Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections (STIs) including HIV-1. Despite more than two decades of HIV-1 vaccine research, there is still no efficacious HIV-1 vaccine, and the scientific community appears skeptical about the short or long-term feasibility of developing a vaccine that has the ability to induce sterilizing immunity against HIV-1. In this setting, microbicide research has gathered momentum. Currently, 16 candidate microbicides are in clinical development and five products are being evaluated in large-scale Phase 2B/3 effectiveness studies. Initial data from these trials will be available within the next 2-3 years, and it is feasible that there could be one or more licensed microbicides by the end of the decade. The first generation of surfactant microbicides had a non-specific mechanism of action. However, subsequent candidate microbicides have been developed to target specific steps in the process of viral transmission. The purpose of this article is to provide an overview of microbicide development and an update on the candidate pipeline.
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Affiliation(s)
- Ian McGowan
- Center for Prevention Research, David Geffen School of Medicine at UCLA, Los Angeles, 10940 Wilshire Boulevard, Suite 1250, Los Angeles, CA 90025, USA.
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Microbicides for the prevention of HIV infection in women: an overview of recent trials. Curr Opin HIV AIDS 2006; 1:514-9. [DOI: 10.1097/01.coh.0000247386.62743.b4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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