Metronidazole in Smelly Tumours

Ashford, Richard; Plant, Gordon T.; Maher, Jane; Pickering, D.; Coe, Manuela; Drury, A.; Goold, M.; Teare, E.L.

doi:10.1016/s0140-6736(80)91368-9

Cited by 42 publications

(17 citation statements)

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“…In 1980, other authors (9) proposed the use of metronidazole for odor control in neoplastic wounds for the first time, to publish a case report in which the wound had offensive and putrid odor -characteristic of infection by anaerobes. They proposed a local treatment with 200 mg of metronidazole three times a day, with no description of the form of administration (oral, intravenous or topical).…”

Section: Discussionmentioning

confidence: 99%

Controlling wound odor with metronidazole: a systematic review

Castro

Santos

2015

Rev. esc. enferm. USP

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Objective: Verifying the evidence of therapeutic efficacy in the topical application of metronidazole for controlling wound odor. Methods: A systematic literature review, according to the Cochrane Collaboration recommendations. Results: 329 articles were identified in the Cochrane, LILACS, SciELO, CINAHL and PubMed databases, with 14 of them being included in the final sample. Two of the studies were double-blind randomized clinical trial studies. Conclusion: The actual effectiveness of metronidazole in controlling wound odor cannot yet be evidenced due to the absence of strong evidence from studies on the subject, despite clinical practice recommending its benefits.

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Section: Discussionmentioning

confidence: 99%

Controlling wound odor with metronidazole: a systematic review

Castro

Santos

2015

Rev. esc. enferm. USP

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“…The role of anaerobes in the emergence of symptoms has already been characterized. That is why the use of specific antibiotics is a common practice, such as metronidazole, which could also have an impact on facultative anaerobic floras because its action is not restricted to strict anaerobes (7,25,26,27). Proliferation of anaerobes in tumoral wounds is directly linked to the presence of superficial or deep tumor-induced ischemic tissues.…”

Section: Discussionmentioning

confidence: 99%

Bacterial Floras and Biofilms of Malignant Wounds Associated with Breast Cancers

et al. 2013

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The risk of infections and the appearance of symptoms (e.g., odors) represent the main troubles resulting from malignant wounds. The aim of this study was to characterize the balance of bacterial floras and the relationships between biofilms and bacteria and the emergence of symptoms. Experimental research was carried out for 42 days on malignant wounds associated with breast cancer. Investigations of bacterial floras (aerobes, aero-anaerobes, and anaerobes), detection of the presence of biofilms by microscopic epifluorescence, and clinical assessment were performed. We characterized biofilms in 32 malignant wounds associated with breast cancer and bacterial floras in 25 such wounds. A mixed group of floras, composed of 54 different bacterial types, was identified, with an average number per patient of 3.6 aerobic species and 1.7 anaerobic species; the presence of strict anaerobic bacterial strains was evidenced in 70% of the wounds; biofilm was observed in 35% of the cases. Odor was a reliable indicator of colonization by anaerobes, even when this symptom was not directly linked to any of the identified anaerobic bacteria. Bacteria are more likely to be present during myelosuppression and significantly increase the emergence of odors and pain when present at amounts of >10 5 · g ؊1 . The presence of biofilms was not associated with clinical signs or with precise types of bacteria. No infections occurred during the 42-day evaluation period. This study provides a dynamic description of the bacterial floras of tumoral wounds. The study results highlight the absolute need for new therapeutic options that are effective for use on circulating bacteria as well as on bacteria organized in biofilm.

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“…Volatile sulfides and volatile fatty acids produced by anaerobic bacteria (such as Bacteroides fragilis) that have infected sites of ulceration are suggested to contribute to malodor. [2][3][4][5] The application of topical metronidazole (MTZ) preparations has been reported to be effective against cancerous malodor, 2,3,6) but because topical MTZ preparations are not sold in Japan, many hospitals prepare these agents in-house. A survey of the literature conducted by the Japanese Society of Hospital Pharmacists 7) in 2010 reported that topical MTZ preparations were prepared at standards between 0.75% and 1%, with an average one-time dose of 70 g. The plasma MTZ concentration of 32 ng/mL has been reported when 1 g of 1% MTZ gel was applied to the face once daily for 7 d. 8) Cancerous tissue with ulcer-like symptoms is likely to have a higher capacity to absorb drugs than normal skin, due to the fact that the protective mechanisms have been compromised.…”

Section: Investigation Of the Safety Of Topical Metronidazole From A mentioning

confidence: 99%

Investigation of the Safety of Topical Metronidazole from a Pharmacokinetic Perspective

Iida

Kudo

Shimada

et al. 2013

Biological & Pharmaceutical Bulletin

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Metronidazole (MTZ) ointment has been used widely as a hospital preparation against cancerous malodor. Although cancerous tissue with ulcer-like symptoms is likely to have a higher capacity to absorb drugs than normal skin, the extent to which MTZ is absorbed when a topical preparation is applied to cancerous tissue remains unclear. Furthermore, few studies have investigated the drug interactions involving MTZ despite its long use in clinical practice. In the present study, plasma concentration of MTZ was measured in a breast cancer patient using MTZ ointment for cancerous malodor and basic research was also conducted with the objective of investigating the safety of topical MTZ from a pharmacokinetic perspective. 4.75 µg/mL (27.8 µm) of MTZ was detected in the patient's plasma, which was close to the plasma concentration after oral dosage of MTZ. In a metabolic inhibition study using human liver microsomes, cytochrome P450 (CYP) 2C9-mediated hydroxylation of S-warfarin was almost unaffected by MTZ at the corresponding concentrations. In addition, 3-d repeated oral administration of MTZ (200 mg/kg/d) to rats did not show any significant effects on the hepatic mRNA levels of various CYP isozymes and CYP2C protein levels. These results suggest that the reported interaction of oral MTZ and S-warfarin was not due to CYP2C9 inhibition and that drug interactions via inhibition of CYP2C9 is unlikely to occur when MTZ ointment is applied to ulcerous skin. This information should be valuable for assessing the safety of MTZ ointment used for mitigating cancerous malodor.Key words metronidazole; cytochrome P450; drug interaction; cancerous malodor Invasion and metastasis of malignant tumors to the skin (continuous, hematogenous, lymphogenous metastasis to the skin), complicated by the infection of ulcerated skin cancer tissue, results in the emission of an intense malodor.1-3) Malodor causes discomfort to the patient, of course, but also to people in the vicinity of the patient, such as family members and healthcare workers, and can make it difficult to maintain human relationships, damage the self-esteem of the patient, and cause a decrease in quality of life. Volatile sulfides and volatile fatty acids produced by anaerobic bacteria (such as Bacteroides fragilis) that have infected sites of ulceration are suggested to contribute to malodor.2-5) The application of topical metronidazole (MTZ) preparations has been reported to be effective against cancerous malodor, 2,3,6) but because topical MTZ preparations are not sold in Japan, many hospitals prepare these agents in-house. A survey of the literature conducted by the Japanese Society of Hospital Pharmacists 7) in 2010 reported that topical MTZ preparations were prepared at standards between 0.75% and 1%, with an average one-time dose of 70 g. The plasma MTZ concentration of 32 ng/mL has been reported when 1 g of 1% MTZ gel was applied to the face once daily for 7 d. 8) Cancerous tissue with ulcer-like symptoms is likely to have a higher capacity to absorb drugs than norma...

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Metronidazole in Smelly Tumours

Cited by 42 publications

References 1 publication

Controlling wound odor with metronidazole: a systematic review

Controlling wound odor with metronidazole: a systematic review

Bacterial Floras and Biofilms of Malignant Wounds Associated with Breast Cancers

Investigation of the Safety of Topical Metronidazole from a Pharmacokinetic Perspective

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