Metronidazole-Resistant Trichomoniasis: Beneficial Pharmacodynamic Relationship With High-Dose Oral Tinidazole and Vaginal Paromomycin Combination Therapy

Henien, Mira; Nyirjesy, Paul; Smith, Katharine

doi:10.1097/olq.0000000000000903

Cited by 11 publications

(7 citation statements)

References 6 publications

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“…The first is high-dose oral TIN 2–3 grams daily (in divided doses) plus intravaginal TIN 500 mg twice daily for 14 days 67 . The second is high-dose oral TIN (1 gram three times daily) plus intravaginal paromomycin (4 g of 6.25% intravaginal paromomycin cream nightly) for 14 days 68, 69 . Paromomycin is an aminoglycoside with a different mechanism of action (destruction of ribosomal RNA) than MTZ (inhibition of nucleic acid synthesis by DNA disruption) 70 ; successful treatment of MTZ-resistant trichomoniasis with both high-dose oral TIN and intravaginal paromomycin may suggest a synergistic effect.…”

Section: Managementmentioning

confidence: 99%

Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection

Gerwen

Muzny

2019

F1000Res

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Trichomonas vaginalis is the most common, curable non-viral sexually transmitted infection (STI) worldwide. Despite this burden of disease, it is not currently a reportable disease in the United States. Recent advances in the epidemiology, diagnosis, and management of T. vaginalis infection are described in this article. This includes updated global and U.S. prevalence data in women and men as well as recent epidemiological data in HIV-infected individuals and pregnant women. Advances in molecular diagnostics are also reviewed, as are data from recent clinical trials regarding the treatment of trichomonas in women.

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Section: Managementmentioning

confidence: 99%

Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection

Gerwen

Muzny

2019

F1000Res

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“…New approaches for trichomoniasis treatment tested in humans can also be found in articles, as case reports or randomized controlled trials (RCT). The treatments and follow-ups of individual patients observed in case reports are described, with the following approach: (a) intravaginal paromomycin, 5.0 g of a 5.0% cream with concomitant oral tinidazole 1.0 g, three times daily for 14 days; (b) high-dose oral tinidazole (1.0 g, three times daily) and 4.0 g of 6.25% intravaginal paromomycin cream nightly for 2 weeks; (c) intravenous MTZ 500 mg, intravaginal boric acid 600 mg daily and liquid tinidazole 2.0 g daily for 14 days; (d) intravenous MTZ 500 mg plus MTZ vaginal gel for one week [48,49,63,64]. In addition, tinidazole has been investigated for patients with MTZ allergies, demonstrating success in desensitization protocols, with doses ranging from 3.3 to 1000 mg [111].…”

Section: Articles: Synthetic Compoundsmentioning

confidence: 99%

Novel Treatment Approaches to Combat Trichomoniasis, a Neglected and Sexually Transmitted Infection Caused by Trichomonas vaginalis: Translational Perspectives

et al. 2022

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The multistep translational science behind new drugs comprehends the entire process through laboratory, clinical, and community observations turned into health interventions. The development of new drug options from discovering targets and leading compounds in basic research for implementing therapeutic guidelines contributes to the emergence of health policies essential for infection control. This review updates the translational research in the scenario of the most common non-viral sexually transmitted infection (STI), trichomoniasis. Paradoxically to its high occurrence, it is considered neglected since notification is not mandatory. It turns into a stable disease with health complications, and receives little emphasis from public health programs to control STI. Although related to curable STIs, the current drugs, metronidazole and tinidazole, present therapeutic failures. The need for new options to treat trichomoniasis is established by basic research studies and patents revealing novel synthetic compounds and natural products presenting anti-Trichomonas vaginalis activities, mainly based on in vitro findings. Clinical trials are still focused on new routes of administration for conventional drugs. In addition, nanotechnology approaches are in their infancy, shedding light on potential possibilities for creating more effective, targeted, and safe delivery systems. Overall, the novel proposed approaches need, in addition to pharmaceutical development and efficacy assessments, to ensure that the quality requirements for their use as medicines are met. It is essential to overcome these issues to cross the “Death Valley” of drug discovery and to advance in the translational science criteria in the trichomoniasis drug development field.

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“…74 .• There have been four published cases of women who had failed multiple treatments for TV who were cured with a combination of very high dose tinidazole plus intravaginal paromomycin cream daily for 14 days. 73,75,76 Two of the four had received the individual components separately but with treatment failure of each. However, the infections cleared when given in combination suggesting possible additive or synergistic effect between the two drugs.…”

Section: Treatmentmentioning

confidence: 99%

British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management ofTrichomonas vaginalis2021

et al. 2022

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The main objective of this guideline is to assist practitioners in managing individuals diagnosed with Trichomonas vaginalis (TV). It offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of TV. It covers the management of the initial presentation, as well as how to prevent transmission and future re-infection. It is aimed primarily at people aged 16 years or older presenting to health care professionals, working in departments offering specialist care in sexually transmitted infection (STI) management within the United Kingdom. However, the principles of the recommendations are applicable across all levels of STI care providers (N.B. non-specialist services may need to develop, where appropriate, local care pathways).

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Metronidazole-Resistant Trichomoniasis: Beneficial Pharmacodynamic Relationship With High-Dose Oral Tinidazole and Vaginal Paromomycin Combination Therapy

Cited by 11 publications

References 6 publications

Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection

Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection

Novel Treatment Approaches to Combat Trichomoniasis, a Neglected and Sexually Transmitted Infection Caused by Trichomonas vaginalis: Translational Perspectives

British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management ofTrichomonas vaginalis2021

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