Management of metronidazole-resistant Trichomonas vaginalis--a new approach.
Metronidazole-resistant trichomoniasis is an infrequent but challenging problem with no universally successful treatment. Since 1994, we have been using a combination regimen consisting of high-dose tinidazole plus a broad-spectrum antibiotic, i.e. doxycycline or ampicillin, and clotrimazole pessaries, for 7--14 days in this condition. A retrospective case review identified 11 cases of resistant trichomonas between 1994 and 2002. In the absence of resistance testing, resistance was defined clinically. Nine of the 11 patients were cured; one patient did not attend follow-up. In the women who attended for follow-up, the cure rate was 90%. We have found the combination of tinidazole, a broad-spectrum antibiotic, and clotrimazole pessaries to be a tolerable and effective treatment for metronidazole-resistant Trichomonas vaginalis. Although a variety of total doses of tinidazole were used in our patients, based on our findings, and those of others, we would recommend giving tinidazole 2 g twice daily for 14 days (total dose 56 g).
Mammen-Tobin
A
A
Department of Genitourinary Medicine, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK. AmyMt@doctors.org.uk
Wilson
J D
JD
D000667:Ampicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000818:Animals; D000994:Antitrichomonal Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D003022:Clotrimazole / Q000008:administration & dosage / Q000627:therapeutic use; D004318:Doxycycline / Q000008:administration & dosage / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008795:Metronidazole / Q000494:pharmacology*; D012189:Retrospective Studies; D014011:Tinidazole / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014247:Trichomonas Vaginitis / Q000188:drug therapy* / Q000469:parasitology; D014246:Trichomonas vaginalis / Q000187:drug effects*
D000994:Antitrichomonal Agents; D014011:Tinidazole; D008795:Metronidazole; D000667:Ampicillin; D003022:Clotrimazole; D004318:Doxycycline