[india-drug] Ornidazole in intestinal protozoal infections

["Sampada Patvardhan" <dicmspc@yahoo.co.in>]

Ornidazole in intestinal protozoal infections
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Dear Dr Anupam Aggarwal,
   
    Here is information in response to your query about: latest references on ornidazole in intestinal protozoal infections.

  Nitroimidazoles in the treatment of trichomoniasis, giardiasis, and amebiasis. 
Int J Clin Pharmacol Ther Toxicol. 1984 Feb;22(2):63-72.
  Rossignol JF, Maisonneuve H, Cho YW.

Nitroimidazoles have been extensively evaluated in the treatment of trichomoniasis, giardiasis, liver and intestinal amebiasis. The most widely used are metronidazole, tinidazole, ornidazole, and secnidazole. Tinidazole, ornidazole, and secnidazole have a much longer half-life than metronidazole, allowing single-dose or once daily administration. Nitro-5-imidazoles remain extremely effective drugs for treating protozoans, Trichomonas vaginalis, Entamoeba histolytica, and Giardia intestinalis. Although all are suspected of potential carcinogenicity, they are the drugs of choice for treating protozoal infections.
   
   
  Treatment of intestinal E. histolytica and G. lamblia with metronidazole, tinidazole and ornidazole: a comparative study.
J Trop Med Hyg. 1987 Feb;90(1):9-12.
  Bassily S, Farid Z, el-Masry NA, Mikhail EM.

Metronidazole, tinidazole and ornidazole were compared in patients treated for Entamoeba histolytica or Giardia lamblia intestinal infections. Only patients with three positive stool specimens for trophozoites and/or cysts of E. histolytica or G. lamblia by the merthiolate iodine formaldehyde (MIFC) technique were included. Criteria for cure were at least 10 negative stool specimens over 3 weeks after completing therapy. Fifty-three male patients (aged 9-65 years) had E. histolytica infection. Seventeen received metronidazole (1.5 g daily for 10 days), 18 tinidazole (1.5 g daily for 10 days) and 18 ornidazole (1 g daily for 10 days). Metronidazole yielded 88%, tinidazole 67% and ornidazole 94% cure rates. Side reactions were minor. Eighty patients had G. lamblia infection, of whom 20 received metronidazole (0.5 g daily for 10 days), 30 tinidazole (single 2 g dose) and 30 ornidazole (single 1 g dose). Cure rates were 95% for metronidazole, 90% for tinidazole and 97% for  ornidazole with no side reactions.   
  
THERAPY OF ENTAMEBIASIS.
J Chemother. 1989 Apr;1(2):113-22.
  Di Perri G, Strosselli M, Rondanelli EG.
Department of Infectious Diseases, University of Pavia, IRCCS Policlinico, San Matteo, Italy.

Therapy of entamebiasis is critical in that, if untreated, the disease can be fatal. Recently, a new method for differentiating pathogenic and non-pathogenic amebae has been standardized. This method relies upon the electrophoretic analysis of 4 isoenzymes which allow the identification of 20 different zymodemes. It is now widely accepted that non-pathogenic strains of Entamoeba histolytica are not a hazard for humans and therefore don't need therapy. As a consequence, treatment must be addressed only toward infections caused by pathogenic strains. As there are different drugs available for treating amebiasis, from a therapeutical point of view the disease must be divided into two forms: intestinal and extraintestinal. For the former, drugs which reach therapeutical levels in the gut are required. The mainstay for the treatment of asymptomatic carriage of pathogenic strains is DILOXANIDE FUROATE, a very well tolerated luminal amebicide. METRONIDAZOLE and other  5-nitroimidazole compounds such as ORNIDAZOLE are indicated for the treatment of symptomatic intestinal infections as they reach good concentrations in tissues, including the bowel where ulcerations develop. In order to ensure the clearance of amebae from the gut, a subsequent cycle with diloxanide furoate is advisable. Extraintestinal forms include amebic abscesses which can develop in many sites, but most commonly in the liver. Metronidazole and related compounds are the drugs of choice; in case of liver abscess, the addition of CHLOROQUINE is indicated because of its good concentration in tissues. A subsequent cycle with diloxanide furoate is also indicated.
 
  
Dr. (Mrs.) Sampada Patvardhan (Ph.D.Tech. Pharmacology)                                                
Director, Maharashtra State Pharmacy Council?s Drug Information Centre  E.S.I.S. Hospital Compound, L.B.S. Marg, Mulund (W), Mumbai-400 080   Phone: 25930607  Telefax: 25684291/25684418  
e-mail: dicmspc@yahoo.co.in  OR    dicmspc@hathway.com