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Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Antibiotics are frequently used in the treatment of CD. Particularly, metronidazole is useful in the treatment of perianal complications such as fistulae or abscesses. Metronidazole is pregnancy category B. A number of studies have demonstrated that metronidazole is not associated with an increased risk of birth defects or cancer in humans (103,104). However, long-term use in pregnancy remains controversial due to its teratogenic and carcinogenic potential. Breast-feeding should be withheld for 12 to 24 hours if a single dose of metronidazole is given. Long-term use of metronidazole should be avoided during breast-feeding due to potential toxic effects.
Antiprotozoal Effects of Wild Plants
Published in Mahendra Rai, Shandesh Bhattarai, Chistiane M. Feitosa, Ethnopharmacology of Wild Plants, 2021
Muhammad Subbayyal Akram, Rao Zahid Abbas, José L. Martinez
Until recently, metronidazole, and its derivatives secnidazole and tinidazole, was the only drug of choice for the treatment of trichomoniasis (Wendel and Workowski 2007). However, it’s not safe to use metronidazole in pregnancy as it may result in fetal malformation, and increase the risk of preterm birth, specifically when used in the first trimester (Klebanoff et al. 2001). Persistent and overuse of metronidazole and its derivatives result in the development of drug-resistant strains of T. vaginalis; chiefly, parasite develops resistance against 5-nitomidazole derivatives, which was observed in up to 20% of patients (Krashin et al. 2010). The resistance of metronidazole and tinidazole in T. vaginalis were 9.6% and 0.56%, respectively (Schwebke and Barrientes 2006). In this scenario, development and research of new drugs is a necessity and wild plants’ extracts show promising results against resistant strains of T. vaginalis.
Nanotechnology and Delivery System for Bioactive Antibiofilm Dental Materials
Published in Mary Anne S. Melo, Designing Bioactive Polymeric Materials for Restorative Dentistry, 2020
Jin Xiao, Yuan Liu, Marlise I. Klein, Anna Nikikova, Yanfang Ren
The biofilm bacteria and their toxins perturb gingival epithelial cells as the first stage in a cascade of inflammatory and immune processes that lead to the destruction of gingival tissues and ultimately, in susceptible patients, alveolar bone loss and tooth loss as a result of periodontal disease (Gorr and Abdolhosseini 2011). Mixed biofilms are communities of bacteria that communicate by quorum sensing to change the bacteria’s physiology. The biofilm contains channels to aid nutrient transport and is typically encapsulated by an extracellular polysaccharide matrix (ten Cate 2006). These features combine to make antibiotic treatment difficult. Traditional antibiotics were often selected against metabolically active bacteria in a planktonic state and are therefore less effective against the physiologically dormant bacteria encapsulated in a biofilm (ten Cate 2006). Meanwhile, the abuse of antibiotics in recent years has led to the emerging of drug-resistant bacterial strains (Chastre 2008). Currently, the first-line treatment for periodontitis is metronidazole. However, the beneficial effects of metronidazole are accompanied by undesirable side effects, including diarrhea, vomiting, metallic taste, headache, and dizziness. CHX is another potent antiplaque chemical agent, but its clinical application is limited by bitter taste and teeth stain (Eley 1999, Addy and Moran 1997).
ALSUntangled #66: antimycobacterial antibiotics.
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2023
Ellen S. Pierce, Paul Barkhaus, Morgan Beauchamp, Mark Bromberg, Gregory T. Carter, Jill Goslinga, David Greeley, Sky Kihuwa-Mani, Gleb Levitsky, Isaac Lund, Christopher McDermott, Gary Pattee, Kaitlyn Pierce, Meraida Polak, Dylan Ratner, Paul Wicks, Richard Bedlack
Rifabutin can cause leukopenia, neutropenia, thrombocytopenia, and hepatitis requiring laboratory monitoring (57). Rifabutin at the high dose of 600 mg/day, especially in combination with a macrolide antibiotic such as clarithromycin, can result in reversible anterior uveitis in a significant proportion of patients depending on their immune status (58,59). The treatment of drug-induced uveitis “occasionally” involves hospitalization (60). Clarithromycin can cause a metallic taste, 10% of patients may have nausea, diarrhea, abdominal pain, and/or headache (61), and there is an increased rate of sudden cardiac death compared to other antibiotics of 37/million clarithromycin doses (62). Clofazimine almost always causes brownish skin discoloration, and sometimes abdominal pain, but these side effects led to discontinuation of treatment in only 0.1% of patients (63). Nausea, vomiting, diarrhea, and abdominal pain are common side effects of metronidazole (64). Encephalopathy (65) and optic neuropathy (66) are rare side effects of metronidazole and are usually reversible with discontinuation of the drug. Based on these rare but potentially serious side effects, we assign a TOE “risks” grade of D (Table 1). Of additional interest, one case-control study suggests that any antibiotic use might increase the risk of developing ALS as well (67).
Potential applications of drug delivery technologies against radiation enteritis
Published in Expert Opinion on Drug Delivery, 2023
Dongdong Liu, Meng Wei, Wenrui Yan, Hua Xie, Yingbao Sun, Bochuan Yuan, Yiguang Jin
RE induces the microbial dysbiosis in the gut, causing intestinal infections, which would aggravate the symptoms including abdominal pain, distension, rectal bleeding, diarrhea [65]. Bactericide metronidazole has the ability to kill anaerobic and microaerobic bacteria, as well as immunoregulation, reducing the entry of pathogenic bacteria into the intestinal mucosa. As a result, metronidazole reduces the risk of rectal bleeding and contributes to the treatment of radiation proctitis [51]. Combinations of multiple drugs would take some advantages for the therapy of RE. The combination of oral metronidazole and mesalazine, as well as betamethasone enema, significantly decreases the symptoms including rectal bleeding and diarrhea in the chronic radiation proctitis patients, better than the treatment without metronidazole [66]. In addition to alleviation of rectal bleeding and frequency of diarrhea in radiation proctitis, rectal irrigation with 4% formalin in combination with oral metronidazole and ciprofloxacin is effective by reducing diarrhea and tenesmus in the patients with hemorrhagic radiation proctitis [67]. Moreover, early metronidazole intervention is effective by reducing the duration of RE, and prevents long-term complications and avoids hospitalization [52]. Therefore, antimicrobial drugs are necessary against local infections though their long-term utilization may lead to new intestinal flora imbalance.
Clostridioides difficile: innovations in target discovery and potential for therapeutic success
Published in Expert Opinion on Therapeutic Targets, 2021
Tanya M Monaghan, Anna M Seekatz, Benjamin H Mullish, Claudia C. E. R Moore-Gillon, Lisa F. Dawson, Ammar Ahmed, Dina Kao, Weng C Chan
The mainstay of treatment for CDI is antibiotics, which may worsen dysbiosis, contributing to CDI recurrence. The conventional first-line therapy for CDI is vancomycin, a glycopeptide antibiotic targeting mainly Gram-positive bacteria. An alternative is fidaxomicin, a narrow spectrum macrolide antibiotic, which is superior to vancomycin in preventing CDI recurrence, although it is not currently commonly used as first-line therapy due to its high cost. Although the Infectious Diseases of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) recently recommended the use of fidaxomicin rather than standard course of vancomycin as the preferred therapy for an initial episode of CDI, its implementation will clearly depend upon available resources [17]. Metronidazole may still be used in a primary episode in younger patients with mild to moderate infection, although resistance is increasing [18].