• Title/Summary/Keyword: Metronidazole

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Atypical Metronidazole-Induced Encephalopathy in Anaerobic Brain Abscess

  • Jang, Han Jin;Sim, Sook Young;Lee, Jong Yun;Bang, Ji Hwan
    • Journal of Korean Neurosurgical Society
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    • v.52 no.3
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    • pp.273-276
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    • 2012
  • Metronidazole-induced encephalopathy is a very rare complication of the long standing use of metronidazole. The encephalopathy is bilateral and symmetric in nature. We report on the magnetic resonance imaging (MRI) and clinical course of metronidazole-induced encephalopathy in a 60-year-old female with a persistent anaerobic brain abscess after draining of the abscess. After 3 months of metronidazole administration, the patient complained of dysarthria, tingling sense of all extremities, and left hemiparesis. MRI revealed symmetric hyperintensity lesions in medulla, pons, dentate nuclei of cerebellum, and splenium of corpus callosum, all of which represent typical findings of metronidazole-induced encephalopathy. In addition, asymmetric lesions in midbrain, thalamus, putamen and cerebral subcortical white matter were noted. The patient recovered after discontinuation of metronidazole and the remaining abscess was successfully treated with meropenem and levofloxacine.

rdxA. Gene is an Unlikely Marker for Metronidazole Resistance in the Asian Helicobacter pylori Isolates

  • Lui, Sook-Yin;Ling, Khoon-Lin;Ho, Bow
    • Journal of Microbiology and Biotechnology
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    • v.13 no.5
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    • pp.751-758
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    • 2003
  • Mutations in the rdxA gene had been reported to be associated with metronidazole resistance in Helicobacter pylori. In this study, sensitivity to metronidazole, RAPD profiles, and DNA sequences of the rdxA gene of 32 local H. pylori isolates were analyzed. Of these, 13 were found to be resistant, while 19 were sensitive to metronidazole. Among the 32 isolates, 10 were paired isolates from the antrum and body of the stomach of individual patients. Interestingly, the RAPD profiles of isolates from individual patients were distinctly different from each other, whereas paired isolates from the same patient were identical regardless of their sensitivities to metronidazole. DNA sequences of the rdxA gene of all 32 isolates showed 95% to 97% homology when compared with the HP0954 locus of H. pylori 26695 genome. From the 19 metronidazole-sensitive strains, 10 (with $MIC{\le}0.5\;\mu\textrm{g}/ml$ metronidazole) were selected and induced to become metronidazole resistant by sequentially passaging through serial 2-fold increasing concentrations of metronidazole. Nine of the 10 induced paired isolates showed mutations in the rdxA sequences which resulted in truncated protein or changes in the translated amino acid sequences. However, the changes did not occur at any specific site in the DNA or amino acid sequences of the rdxA gene of all the isolates analyzed. The results show that the rdxA gene cannot be a definitive marker for metronidazole resistance in H. pylori isolates of an Asian population, and that other factors may contribute to resistance to metronidazole.

Metronidazole Reduced Ammonia Toxicity in Human Hep G2 cell and Rat Hepatocytes (Hep G2 세포와 rat 간세포에서 Metronidazole에 의한 암모니아 독성 감소)

  • Kim, Bo-Ae;Kim, Hyun-Jung;Kim, You-Young
    • KSBB Journal
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    • v.23 no.5
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    • pp.381-386
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    • 2008
  • Lipophilic ammonia is toxic gas and can easily diffuse across cell membranes. Excess ammonia is implicated in the pathogenesis of several metabolic disorders including hepatic encephalopathy and may result in the death. The purpose of this study was to clarify the inhibition effect of metronidazole on liver cell damage due to ammonia in human Hep G2 cell and rat hepatocytes. The effects of metronidazole were studied in ammonium chloride treated human Hep G2 cell (75 mM) and rat hepatocyte (100 mM) following $0.1{\mu}M$ metronidazole treatment. In MTZ+AC group, cell viabilities increased prominently and LDH activities decreased over 25% than AC group. Furthermore, ammonia level according to ammonium chloride treatment reduced over 30% and lipid peroxidation as an index of cell membrane damage decreased more than twice. By comparison with control, catalase activity showed more than 30% reduction in AC group while less than 10% reduction in MTZ+AC group, respectively. In addition, MTZ+AC group showed the similar cell structure as control in cell morphology study by using light microscope, and represented fluorescent intensity decrement compared with AC group in fluorescent microscopic study with avidin-TRITC fluorescent dye. And cleaved PARP expression due to ammonia reduced twofold or more in MTZ+AC group. As the results suggest, metronidazole may protect the liver cell by inhibiting cell damages due to ammonia and be used for an effective antagonist of ammonia in hyperammonemia.

A Comparison of Vancomycin and Metronidazole for the Treatment of Clostridium difficile-associated Diarrhea (CDAD) in Medical Intensive Care Unit (MICU) (내과계 중환자실 재원 성인 환자의 Clostridium difficile associated Diarrhea에 대한 Metronidazole과 Vancomycin의 치료효과 비교)

  • Cho, Eun Ae;Lee, Kyung A;Kim, Jae Song;Kim, Soo Hyun;Son, Eun Sun
    • Korean Journal of Clinical Pharmacy
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    • v.27 no.2
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    • pp.77-82
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    • 2017
  • Background: Clostridium difficile associated diarrhea (CDAD) is a leading cause of hospital-associated gastrointestinal illness. Risk factors for CDAD include advanced age, long-term admission, antibiotics, proton-pump inhibitor or $H_2$ blocker use and immunosuppression. The practice guideline of American Journal of Gastroenterology (2013) suggests metronidazole for the first-line therapy of mild-moderate CDAD as well as vancomycin for severe CDAD. MICU inpatients receiving stress ulcer prophylaxis and antibiotics are susceptible to nosocomial CDAD. Therefore, this study aimed to evaluate occurrence and treatment of CDAD in MICU. Methods: Patients who were admitted to the MICU and had CDAD from August 2012 to August 2015 were analyzed retrospectively. Results: Of the 90 patients with CDAD, 20 patients (2.22%) had mild-moderate CDAD (16 received metronidazole and 4 received vancomycin therapy) and 70 patients (77.8%) had severe CDAD(54 received metronidazole and 16 received vancomycin therapy). Among the patients with mild- moderate CDAD, treatment with metronidazole or vancomycin resulted in same clinical cure in 50% of the patients (p=1.00). Among the patients with severe CDAD, treatment with metronidazole or vancomycin resulted in clinical cure in 40.7% and 50.0% of the patients, respectively (p=0.511). Clinical symptoms recurred in 7.4% of the severe CDAD patients treated with metronidazole and 6.3% of those treated with vancomycin(p=0.875). Conclusion: Our findings suggest that metronidazole and vancomycin are equally effective for the treatment of mild-moderate CDAD; however, vancomycin demonstrated higher clinical cure rate and lower recurrence rate for severe CDAD, although the difference was not statistically significant. For better clinical outcomes, appropriate medication use by disease severity is needed.

Metronidazole Induced Encephalopathy in a Patient with Brain Abscess

  • Bahn, Yoo-Chang;Kim, Eun-Young;Park, Chon-Goon;Park, Hyung-Chun
    • Journal of Korean Neurosurgical Society
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    • v.48 no.3
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    • pp.301-304
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    • 2010
  • Metronidazole is commonly used for brain abscess but is not well known for its neurotoxic complications. Metronidazole-induced encephalopathy (MIEP) is toxic encephalopathy associated with the use of metronidazole. We experienced a case of brain abscess which developed reversible severe MIEP during treatment period. Although MIEP occurs in typical locations, it is not easy to differentiate from other conditions such as cerebral infarction, demyelinating diseases and metabolic diseases. Neurosurgeons should be aware that severe MIEP can occur during the use of metronidazole though it is not common.

Elution profiles of metronidazole from calcium sulfate beads

  • Burasarin Ithisariyanont;Saranya Poapolathep;Amnart Poapolathep;Pareeya Udomkusonsri
    • Journal of Veterinary Science
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    • v.24 no.6
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    • pp.74.1-74.15
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    • 2023
  • Background: Antibiotic beads are used to treat local bacterial infections by delivering high drug concentrations to infected tissue. Objectives: This study examined the elution characteristics of metronidazole from metronidazole-calcium sulfate (MCa) and metronidazole-calcium-potassium sulfate (MCaK) beads over 20 days and the antibacterial efficacy of the beads after storage. Methods: The MCa and MCaK beads were prepared by mixing 250 mg of metronidazole and 10 g of calcium sulfate hemihydrate with water and a 3% potassium sulfate solution, respectively. The beads were placed in phosphate-buffered saline for the elution study. The metronidazole eluents were determined using high-performance liquid chromatography. The microstructures were examined by scanning electron microscopy (SEM), and the antimicrobial activity was evaluated by a microbioassay. Results: For the 20-day study, the total amount of metronidazole released was greater in the MCa beads than in the MCaK beads by 6.61 ± 0.48 mg (89.11% ± 3.04%) and 4.65 ± 0.36 mg (73.11% ± 4.38%), respectively. The amounts of eluted drugs from the MCa and MCaK beads were higher than the minimum inhibitory concentration at 0.5 ㎍/mL against anaerobic bacteria at both 20 days and 14 days. SEM showed that calcium crystals on the outer surface had dissolved after elution, and thinner calcium crystals were prominent in the MCaK beads. The MCa and MCaK beads exhibited antibacterial activity after setting, followed by storage at room temperature or 4℃ for 21 days. Conclusions: The MCa beads could release more drug than the MCaK beads, but all eluted metronidazole amounts were effective in controlling bacterial infections. Both metronidazole beads could be stored at ambient temperature or in a refrigerator.

Reversible Metronidazole-induced Encephalopathy (메트로니다졸에 의해 유발된 가역적 뇌증 2례)

  • Ji, Ki-Hwan;Lee, Jeong;Yun, Chang-Ho;Ha, Choong-Kun
    • Journal of The Korean Society of Clinical Toxicology
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    • v.4 no.2
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    • pp.131-136
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    • 2006
  • Metronidazole is an antimicrobial drug widely used against various types of infectious agents, including protozoa, amoeba, Helicobacter pylori, and anaerobes. Metronidazole may produce some adverse effects on hematologic, immunologic, neurologic and other systems. We report a case of reversible metronidazole-induced encephalopathy. The toxic dose of metronidazole and the onset of encephalopathy were variable. Two patients showed abnormally high signal intensity in the bilateral dentate nucleus of cerebellum, and characteristic abnormalities were detected by brain magnetic resonance imaging (MRI) and T2-weighted images, fluid-attenuated inversion recovery images and/or diffusion weighted imaging (DWI). Discontinuation of metronidazole resulted in the improvement of the neurologic symptoms over a period of two to three weeks. We followed up the brain MRI with DWI in one case following obvious clinical improvement, and the previously detected lesion had disappeared.

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Seven-Day Bismuth-based Quadruple Therapy as an Initial Treatment for Helicobacter pylori Infection in a High Metronidazole Resistant Area

  • Vilaichone, Ratha-korn;Prapitpaiboon, Hatainuch;Gamnarai, Pornpen;Namtanee, Juraiwan;Wongcha-um, Arti;Chaithongrat, Supakarn;Mahachai, Varocha
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.14
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    • pp.6089-6092
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    • 2015
  • Background: The prevalence of metronidazole-resistant H. pylori is almost 50% in Thailand which severely limits the use of this drug for eradication therapy. The aims of this study were to evaluate the efficacy and safety profiles of 7-day bismuth-based quadruple therapy including metronidazole as an initial treatment for H. pylori infection in a high metronidazole resistance area. Materials and Methods: This study was performed at Thammasat University Hospital and King Chulalongkorn Memorial Hospital during January 2009 to October 2010. Patients with non-ulcer dyspepsia (NUD) with active H. pylori infection were assigned to receive seven days of quadruple therapy (pantoprazole 40 mg bid, bismuth subsalicylate 1,048 mg bid, amoxicillin 1 gm bid and metronidazole 400 mg tid). H. pylori infection was defined as positive H. pylori culture or two positive tests (rapid urease test and histology). Antibiotic susceptibility test for metronidazole by Epsilometer test (E-test) was performed in all positive cultures. At least four weeks after treatment, $^{13}C$ urea breath test ($^{13}C-UBT$) was performed to confirm H. pylori eradication. Results: A total of 114 patients were enrolled in this study, 50 males and 64 females with a mean age of 49.8 years. All 114 patients had a diagnosis of NUD. Overall eradication as confirmed by negative $^{13}C-UBT$ was achieved in 94 out of 114 patients (82.5%). 44 patients had positive cultures and success for E-test. In vitro metronidazole resistance was observed in 22/44 (50%) patients. Eradication rate in patients with metronidazole resistant strains was 16/22 (72.7%) and 20/22 (90.1%) with metronidazole sensitive strains (72.7% vs 90.1%, p-value=0.12; OR=3.75 [95%CI=0.6-31.5]). Minor adverse reactions included nausea, bitter taste, diarrhea and black stools but none of the patients dropped out from the study. Conclusions: Initial treatment with 7-day bismuth-based quadruple therapy including metronidazole, amoxycillin and pantoprazole is highly effective and well tolerated for metronidazole-sensitive H. pylori infections. However, the efficacy markedly decline with metronidazole resistance. Longer duration of this regimen might be required to improve the eradication rate and larger multi-center studies are needed to confirm this hypothesis.

Biological Effect of Metronidazole Resistance in Helicobacter Pylori (Helicobacter pylori에서 metronidazole 내성이 미치는 생물학적 영향)

  • Lee Gin Hyug;Lee Sun-Mi;Nam Won-Hee;Kim Eun Sil;Kim Jin Ho;Kang Ho Young;Jeong Jin-Yong
    • Journal of Life Science
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    • v.15 no.6 s.73
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    • pp.955-960
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    • 2005
  • Resistance to metronidazole, a key component of therapies against Helicobacter pylori, is common in clinical isolates. Resistance generally requires inactivation of rdxA (HP0954), and sometimes also frxA (HP0642), two related nitroreductase genes. Here we studied the effect of resistance to metronidazole on fitness of the gastric pathogen H. pylori. The effect of metronidazole resistance for H. pylori in culture was assessed first by looking at colonies formed by freshly constructed mutant derivatives of H. pylori strain 26695. Mutations resulting in metronidazole resistance caused premature death of H.pylori in stationary phase, but had no significant effect on early exponential growth. The effect of nitroreductase deficiencies on fitness in vivo was tested by infecting C57BL/6 mice with 1:1 mixtures of SS1 wild type and its isogenic metronidazole resistant derivatives. Inactivation of rdxA caused an inability to colonize mice in SS1 H. pylori strain. Derivatives of a metronidazole resistant strain that survived better in stationary phase, although remaining metronidazole resistant, could again colonize mice. In conclusion, metronidazole resistance diminishes H. pylori's fitness, but their costs can be suppressed by additional mutation.

Effects of Sub Minimal Inhibitory Concentration of Metronidazole and Penicillin on Morphology of Aggregatibacter actinomycetemcomitans: Scanning Electron Microscopy Observation

  • Kwon, Ye Won;Lee, Si Young
    • International Journal of Oral Biology
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    • v.40 no.1
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    • pp.35-39
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    • 2015
  • Minimal inhibitory concentration (MIC) is the lowest concentration of antibiotics that inhibits the visible growth of bacteria. It has been reported that sub-MIC of antibiotics may result in morphological alterations, along with the biochemical and physiological changes in bacteria. The purpose of this study was to examine morphological changes of Aggregatibacter actinomycetemcomitans, after the treatment with sub-MIC metronidazole and penicillin. The bacterial morphology was observed with scanning electron microscope, after incubating with sub-MIC antibiotics. The length of A. actinomycetemcomitans was increased after the incubation with sub-MIC metronidazole and penicillin. Sub-MIC metronidazole and penicillin inhibited bacterial division and induced long filaments. Our study showed that metronidazole and penicillin can induce the morphological changes in A. actinomycetemcomitans.