Quemadura genital por producto químico: reporte de caso / Genital burn by chemical product: case report

Resumen ANTECEDENTES: Las quemaduras son la forma más severa de estrés que el cuerpo puede sufrir; pueden generarse por diferentes agentes térmicos y químicos. CASO CLÍNICO: Paciente de 25 años, con dolor intenso en la región genital de 12 horas de evolución, secundario a la introducción en la vagina de una piedra de alumbre. Se le hicieron múltiples irrigaciones con solución salina al 0.9% sin obtener el resto de la piedra de alumbre. Se le aplicó sulfadiazina de plata en la cavidad vaginal cada 12 horas, óvulos vaginales de ketanserina, miconazol y metronidazol cada 8 horas, ketorolaco por vía oral 10 mg cada 8 horas. Durante su estancia hospitalaria tuvo buena evolución, con disminución de la inflamación en la zona genital, epitelización adecuada. Al tercer día se dio de alta del hospital con cita para valoración a los siete días. CONCLUSIÓN: El tratamiento de las quemaduras en el área genital, por agentes químicos, tiene como piedra angular la identificación del agente causante de la lesión que permita actuar de forma inmediata y evitar las secuelas físicas, sexuales y psicológicas mediante el lavado exhaustivo con solución o agua estéril para remover el agente causal y disminuir que continúe actuando en el sitio afectado.

Abstract BACKGROUND: Burns are the most severe form of stress that the body can suffer; they can be caused by various thermal and chemical agents. CLINICAL CASE: A 25-year-old female patient presented with severe genital pain of 12 hours' duration, secondary to the introduction of an alum stone into the vagina. She underwent several irrigations with 0.9% saline without obtaining the rest of the alum stone. She was given vaginal silver sulfadiazine every 12 hours, vaginal ketanserin, miconazole and metronidazole every 8 hours and oral ketorolac 10 mg every 8 hours. During her stay in hospital, she progressed well, with a decrease in genital inflammation and adequate epithelialisation. She was discharged on the third day with an appointment for a seven-day follow-up. CONCLUSION: The management of genital burns caused by chemical agents is based on the identification of the agent causing the lesion, which allows immediate action and prevents physical, sexual and psychological sequelae by thorough washing with sterile solution or water to remove the causative agent and reduce its continued action in the affected area.

Analysis of resistance and sensitivity of 1 200 strains of vulvovaginal candidiasis in China to five common antifungal drugs / 中华妇产科杂志

Objective:To test the antibiotic susceptibility of vulvovaginal candidiasis pathogenic strains to 5 antifungal drugs commonly used in clinic.Methods:A total of 1 200 vulvovaginal candida patients from 23 gynecological and family planning outpatient departments in China were enrolled. Their vaginal secretions were collected for candida strain isolation and species identification. According to Clinical and Laboratory Standards Institute (CLSI) M27-S3, the sensitivity of 1 200 strains to clotrimazole, fluconazole, miconazole, itraconazole and nystatin was tested.Results:(1) The sensitivity and resistance of 1 200 vulvovaginal candidiasis pathogens to 5 antifungal drugs were statistically different ( χ2=3 513.201, P<0.01). (2) All strains had higher sensitivity to nystatin [99.92% (1 199/1 200)], followed by miconazole [92.25% (1 107/1 200)] and clotrimazole [87.17% (1 046/1 200)]. All strains had higher resistance to fluconazole [69.17% (830/1 200)], while itraconazole was 50.83% (610/1 200). (3) There was no significant difference between candida albicans and non-candida albicans in drug sensitivity to nystatin ( P=0.315) and miconazole ( P=0.425). (4) Candida albicans and non-candida albicans showed different sensitivity to clotrimazole, fluconazole and itraconazole, respectively. Compared with non-candida albicans, candida albicans showed higher sensitivity to clotrimazole [susceptibility rate: 73.01% (165/226) vs 90.45% (881/974); P<0.001] and higher resistance to fluconazole [resistance rate: 50.88% (115/226) vs 73.41% (715/974); P<0.001]. Although the drug sensitivity of itraconazole was not high, the susceptibility rate of candida albicans to itraconazole was slightly higher than that of non-candida albicans [37.68% (367/974) vs 23.89% (54/226)], and the drug resistance rate was lower [49.28% (480/974) vs 57.52% (130/226)]. Conclusions:The sensitivity of 1 200 strains of candida to 5 antifungal drugs is significantly different, the sensitivity rate of nystatin, miconazole and clotrimazole are higher, but the resistance rate of fluconazole and itraconazole are higher. The sensitivity of candida albicans and non-candida albicans to the same drug is also significantly different. It is suggested that in clinical diagnosis and treatment, we should pay attention to the identification of candida and drug sensitivity test, so as to select antifungal drugs rationally.

Síntese e avaliação dos efeitos de um nanocarreador de miconazol sobre microrganismos orais / Synthesis and evaluation of the effects of a miconazole nanocarrier on oral microorganisms

A presente tese teve como objetivo geral preparar, caracterizar e avaliar os efeitos antimicrobianos de um nanocarreador de miconazol (MCZ) à base de nanopartículas magnéticas de óxido de ferro (NPsMOF) funcionalizadas com quitosana (QS). Assim, dois subprojetos (SP1 e SP2) foram desenvolvidos e apresentaram os seguintes objetivos específicos: SP1) Preparar, caracterizar e avaliar os efeitos do nanocarreador NPsMOF-QS-MCZ sobre células planctônicas e biofilmes simples e misto de Candida albicans e Candida glabrata; SP2) Avaliar o efeito do nanocarreador na composição de três diferentes modelos de biofilmes polimicrobianos patogênicos orais (gengivite, prótese total e cárie dentária). A primeira etapa do SP1 consistiu em revestir as NPsMOF com QS e carregar este core-shell com MCZ, a fim de caracterizar este nanocarreador por métodos físico-químicos. As concentrações inibitórias mínimas (CIMs) do nanocarreador foram determinadas pelo método da microdiluição em caldo, usando o índice da concentração inibitória fracionária a fim de avaliar se houve interação sinergística entre os compostos. Ainda, biofilmes simples e mistos de Candida foram formados no fundo de placas de 24 ou 96 poços por 48 h e, em seguida, tratados por 24 h com NPsMOF-QS-MCZ carreando MCZ a 31,2 e 78 µg/ml, na presença e ausência de um campo magnético externo. Os biofilmes foram avaliados quantitativamente por biomassa total, atividade metabólica, contagem de unidades formadoras de colônias (UFCs) e composição da matriz extracelular. Os dados foram analisados por ANOVA a dois fatores, seguida pelo teste de Holm-Sidak (p<0,05). Ainda, a estrutura dos biofilmes foi avaliada qualitativamente por microscopia eletrônica de varredura e microscopia confocal. Os resultados do SP1 mostraram que o nanocarreador apresentou diâmetro menor que 50 nm e valores de CIM menores do que aqueles encontrados para MCZ sozinho, com efeito sinérgico sobre C. albicans. NPsMOF-QS-MCZ a 78 µg/ml foi mais eficaz que MCZ sozinho na redução de UFCs e atividade metabólica de biofilmes misto e simples de C. albicans. A biomassa total dos biofilmes e a matriz extracelular não foram afetadas pelo nanocarreador, e a aplicação de um campo magnético externo não melhorou seu efeito antibiofilme. As imagens de microscopia confirmam que tratamentos com o nanocarreador, principalmente na maior concentração, apresentaram maior atividade antibiofilme. Com relação ao SP2, as CIMs de NPsMOF-QS-MCZ foram determinadas para diferentes espécies microbianas, e todos os biofilmes polimicrobianos foram desenvolvidos por 5 dias e tratados por 24 h com NPsMOF-QS-MCZ a 64 µg/ml. Após o tratamento, os biofilmes foram avaliados quanto à biomassa total, atividade metabólica, contagem de UFCs e análise composicional por PCR quantitativo. Microscopia eletrônica de varredura foi usada para analisar a estrutura do biofilme. As diferenças entre os grupos foram determinadas por teste t não pareado (p<0,05). Os resultados do SP2 mostraram que NPsMOF-QS-MCZ foi mais eficaz que MCZ sozinho contra a maioria das células fúngicas e bacterianas testadas. Ainda, este nanocarreador foi capaz de reduzir a atividade metabólica, biomassa total e UFCs (p<0,05) dos biofilmes, além de alterar a sua ultraestrutura. Por fim, NPsMOF-QS-MCZ afetou a composição dos três biofilmes polimicrobianos avaliados, reduzindo principalmente os números de Streptococcus spp. e alterando a prevalência das espécies nos biofilmes. Em suma, os resultados dos SP1 e SP2 permitiram concluir que o nanocarreador melhorou o efeito antimicrobiano do MCZ, dependendo da espécie e parâmetro de biofilme avaliados. O nanocarreador também mostrou potencial para interferir nas interações sinergísticas entre células fúngicas e bacterianas dentro de biofilmes polimicrobianos(AU)

The present thesis aimed to prepare, characterize and evaluate the antimicrobial effects of a miconazole (MCZ) nanocarrier based on iron oxide magnetic nanoparticles (IONPs) functionalized with chitosan (CS). Thus, two subprojects (SP1 and SP2) were developed and had the following specific objectives: SP1) To prepare, characterize and evaluate the effects of the IONPs-CS-MCZ nanocarrier on planktonic cells and singleand dual-species biofilms of Candida albicans and Candida glabrata; SP2) To evaluate the effect of IONPs-CS-MCZ on the composition of three different models of oral pathogenic biofilms (gingivitis, denture and dental caries). The first step of SP1 was to coat IONPs with CS and to load this core-shell association with MCZ, in order to characterize this nanocarrier by physicochemical methods. The minimum inhibitory concentrations (MICs) of the nanocarrier were determined by the microdilution method, using the fractional inhibitory concentration index in order to assess whether there was synergistic interaction between the compounds.. In addition, single- and dual-species biofilms of Candida species were formed at the bottom of 24- or 96-well plates for 48 h and, in sequence, treated for 24 h with IONPs-CS-MCZ carrying MCZ at 31.2 and 78 µg/ml, in both the presence and absence of an external magnetic field. Biofilms were quantitatively evaluated by total biomass, metabolic activity, counting of colony forming units (CFUs) and extracellular matrix components. Data were analyzed by twoway ANOVA, followed by Holm-Sidak test (p <0.05). In addition, the structure of biofilms was qualitatively evaluated by scanning electron microscopy and confocal microscopy. The results from SP1 showed that IONPs-CS-MCZ presented diameter smaller than 50 nm, and MIC values lower than those found for MCZ alone, with synergistic effect on C. albicans. Moreover, 78 µg/ml IONPs-CS-MCZ was more effective than MCZ alone in reducing CFUs and metabolic activity of single biofilms of C. albicans and dual-species biofilms. Total biofilm biomass and extracellular matrix were not affected by the nanocarrier, and the application of an external magnetic field did not improve the nanocarrier effects. Microscopy images confirm that treatments with the nanocarrier, mainly in the highest concentration, exhibited greater antibiofilm activity. Regarding SP2, the MICs of IONPs-CS-MCZ were determined for different microbial species, and all polymicrobial biofilms were developed for 5 days and treated for 24 h with IONPs-CS-MCZ at 64 µg/ml. After treatment, the biofilms were evaluated for total biomass, metabolic activity, counting of CFUs and quantitative PCR analysis. Scanning electron microscopy was used to analyze the biofilm ultrastructure. Differences between groups were determined by unpaired t-test (p<0.05). Results from SP2 showed that IONPs-CS-MCZ was more effective than MCZ alone against most fungal and bacterial cells tested. Moreover, this nanocarrier was able to reduce the metabolic activity, total biomass and CFUs (P<0.05) of the biofilms, besides altering their ultrastructure. Finally, IONPs-CS-MCZ affected the composition of the three evaluated biofilms, mainly reducing the numbers of Streptococcus spp. and changing the prevalence of species in the biofilms. From the results obtained by SP1 and SP2, it was possible to conclude that the nanocarrier improved the antimicrobial effect of MCZ, depending on the species and biofilm parameter evaluated. Nanocarrier also showed potential to interfere in the synergistic interactions among fungal and bacterial cells within polymicrobial biofilms(AU)

Efecto de miconazol sobre el recuento de levaduras en candidiasis asociada a estomatitis protésica / Effect of miconazole on the yeast count in candidiasis associated with denture stomatitis

RESUMEN: Introducción: Estomatitis Subprotésica, proceso inflamatorio crónico de la mucosa adyacente a prótesis removible. 71,4% de los sujetos con esta condición es portador de Candida y la severidad se relaciona con la presencia de esta levadura. Para su tratamiento se indica antimicóticos tópicos de la familia de polienos o de azoles. El propósito del estudio fue determinar el recuento de levaduras del género Candida en adultos mayores con candidiasis oral, antes y después de ser tratados con miconazol. Materiales y métodos: Se consignaron antecedentes sistémicos y locales en 32 adultos mayores con estomatitis subprotésica. Se determinó recuento de levaduras del género Candida en saliva, antes y después del tratamiento tópico con Miconazol 2%. Se aceptaron diferencias estadísticamente significativas con un error alfa igual o menor a 0.05%. Resultados: Los recuentos de levaduras del inicio del estudio disminuyeron significativamente a los días 8 y 15 después del tratamiento (mediana 6.800, 163, 60, respectivamente). 56,2% de los individuos presentó persistencia de levaduras después del tratamiento; 21,8% de ellos con recuentos superiores a 400 UFC/ml de saliva. Conclusiones: En el 56,2% de los individuos del estudio se observó persistencia de levaduras del género Candida luego de 2 semanas de tratamiento con miconazol al 2%.

ABSTRACT: Introduction: Denture stomatitis is a chronic inflammatory process of the mucosa adjacent to removable prosthesis. 71.4% of the subjects with this condition are carriers of Candida and the severity is related to the presence of this yeast. Topical antimycotics belonging to the polyene or azole family are indicated for its treatment. Efficacy of miconazole is reported to be from 80% to 100%, although resistance is described in isolates of Candida. The purpose of the study was to determine the count of Candida in older adults with oral candidiasis, before and after being treated with miconazole. Methodology: Systemic and local antecedents were recorded in 32 elderly adults with denture stomatitis. Differences in number of the colony forming units of Candida yeast, were determined before and after topical treatment with Miconazole 2%. Statistical significances were set at a value of p < 0.05. Results: Yeast counts at the start of the study significantly decreased 8 and 15 days after treatment (median 6,800, 163, 60, respectively). 56.2% of the subjects presented persistence of yeasts after treatment; 21.8% of them with counts higher than 400 CFU / ml saliva. Conclusion: In 56.2% of the study subjects, persistence of Candida yeasts was observed after 2 weeks of treatment with 2% miconazole.

Comparison of Therapeutic Efficacy and Safety between Chlorquinaldol-promestriene and Miconazole Nitrate for Simple Vulvovaginal Candidiasis / 中国药房

OBJECTIVE:To compare therapeutic efficacy and safety of chlorquinaldol-promestriene and miconazole nitrate for simple vulvovaginal candidiasis (VCC).METHODS:In retrospective analysis,a total of 231 patients with simple VCC were divided into observation group (116 cases) and control group (115 cases).Observation group was given Chlorquinaldol-promestriene vaginal tablet (0.2 g) every night.Control group was given Miconazole nitrate suppositories (200 mg) every night.Both groups received a course of treatment,lasting for 7 d.Clinical efficacies of 2 groups were observed at the first and second recheck.The symptom relief time recurrence and ADR of effective patients were observed.RESULTS:There was no statistical significance in the total response rates of 2 groups at the first reexamination,as well as total response rates of 2 groups and symptom relief time of effective patients at the second reexamination(P＞0.05).At the second reexamination,reoccurrence rate of observation group was significantly lower than that of control group,with statistical significance (P＜0.05).There was no statistical significance in the incidence of ADR between 2 groups(P＞0.05).CONCLUSIONS:Chlorquinaldol-promestriene is similar to miconazole nitrate for VCC in therapeutic efficacy and safety,but chlorquinaldol-promestriene is better than miconazole nitrate in reducing recurrence rate.

Comparison of Therapeutic Efficacy and Safety between Chlorquinaldol-promestriene and Miconazole Nitrate for Simple Vulvovaginal Candidiasis / 中国药房

OBJECTIVE:To compare therapeutic efficacy and safety of chlorquinaldol-promestriene and miconazole nitrate for simple vulvovaginal candidiasis (VCC).METHODS:In retrospective analysis,a total of 231 patients with simple VCC were divided into observation group (116 cases) and control group (115 cases).Observation group was given Chlorquinaldol-promestriene vaginal tablet (0.2 g) every night.Control group was given Miconazole nitrate suppositories (200 mg) every night.Both groups received a course of treatment,lasting for 7 d.Clinical efficacies of 2 groups were observed at the first and second recheck.The symptom relief time recurrence and ADR of effective patients were observed.RESULTS:There was no statistical significance in the total response rates of 2 groups at the first reexamination,as well as total response rates of 2 groups and symptom relief time of effective patients at the second reexamination(P＞0.05).At the second reexamination,reoccurrence rate of observation group was significantly lower than that of control group,with statistical significance (P＜0.05).There was no statistical significance in the incidence of ADR between 2 groups(P＞0.05).CONCLUSIONS:Chlorquinaldol-promestriene is similar to miconazole nitrate for VCC in therapeutic efficacy and safety,but chlorquinaldol-promestriene is better than miconazole nitrate in reducing recurrence rate.

Protective effect of miconazole on white matter damage induced by anoxia and ischemia in rats / 临床儿科杂志

Objective To explore the protective effect of miconazole on white matter damage (WMD) in neonatal rats. Methods Three-day-old neonatal SD rats were randomly divided into sham group, WMD model group, 10 mg/(kg·d) miconazole group and 40 mg/(kg·d) miconazole group with 15 rats each. Rats in WMD model group were subjected to the ligation of right carotid artery, and then kept in a chamber with 6% oxygen and 94% nitrogen for 80 min to establish the white matter damage model. The rats in miconazole group were intraperitoneally injected with different doses (10 and 40mg/kg) of miconazole, dissolved in dimethyl sulfoxide (DMSO), for five consecutive days, and rats in WMD model group were injected with the same volume of DMSO. Myelin basic protein (MBP) of white matter was detected by immunofluorescence staining and western blot. Myelin sheaths of corpus callosum were observed by transmission electron microscopy. Weight changes of rats were compared among groups. Results Immunofluorescence staining and western blot showed that, after treatment with miconazole, the MBP expression level of corpus callosum was higher than in WMD model group (P<0.05). In WMD model group, the myelin sheath of corpus callosum had loose structure and a large number of small vacuoles with decreased thickness of myelin sheath. After treatment with miconazole, myelinolysis induced by anoxia and ischemia could be improved significantly. The increase in weight of rats in WMD model group was significantly less than that in sham group. And after miconazole treatment, the rate of weight gain of rats was increased. Conclusion Miconazole can significantly reduce the brain white matter damage induced by anoxia and ischemia through promoting myelination, and then improves the growth and development in rats.

Penetration Enhancers Screening for Compound Ketoconazole Gel / 中国药师

Objective:To study the effect of caprylic/capric acid glycerides (Lab), propylene glycol (PG) and Azone on the transdermal behavior of ketoconazole and miconazole nitrate in compound ketoconazole gel, to screen appropriate penetration enhanc-ers. Methods:Using a RYJ-6A-type transdermal drug diffusion tester, the effects of Lab, PG and Azone at different concentrations on the transdermal behavior of ketoconazole and miconazole nitrate in compound ketoconazole gel were studied. Results:3% PG showed the most obvious penetration enhancement, which could increase the permeation of ketoconazole by 2. 004 times, and increase the pen-etration of miconazole nitrate by 1. 795 times, and the differences were statistically significant (P<0. 05). Conclusion:The penetra-tion effect of 3% PG is obvious, which can be applied in compound ketoconazole gel.

Preparation Technology Optimization of Ketoconazole and Miconazole Nitrate β- Cyclodextrin Inclusion Compound / 中国药师

Objective:To optimize the preparation technology of ketoconazole and miconazole nitrateβ-cyclodextrin inclusion com-pound. Methods: The weight ratio of β-cyclodextrin to ketoconazole, inclusion temperature and inclusion time as the testing factors, the optimal inclusion technology was screened by orthogonal experiments. Results:The optimum inclusion conditions were as follows:the weight ratio of β-cyclodextrin to ketoconazole was 8 ∶1, the inclusion temperature was 50℃, and the ultrasonic time was 50 min. Conclusion:The optimized β-cyclodextrin inclusion process is simple and convenient to carry out.

The efficacy of itraconazole and miconazole nitrate for recurrent monilial vaginitis / 中国基层医药

Objective To study the treatment effect of joint nitric acid imidazole and itraconazole on recurrent candida vaginitis.Methods 200 confirmed cases of patients with recurrent candida vaginitis in our hospital during October 2014 to June 2015 were selected and divided into research group and the control group with random indicator method,with 100 cases in each group.The control group were treated by nitric acid imidazole vaginal soft capsule,with vaginal drug delivery,which shoud put suppository in vaginal depths after washing,for one times a night and one soft capsule every time,and a week was a period of treatment.The patients in the research group received basis treatment of the control group adding itraconazole capsules(200mg per day,oral).8 weeks after treatment,the patients in this process were reviewed to analyzed clinical efficacy and adverse reactions occured.Results The total effective rate of the research group was 98%,which of the control group was 73%,the difference was statistically significant(χ2 =25.21,P 0.05 ).Conclusion The curative effect of itraconazole joint miconazole nitratet to recurrent monilial vaginitis is superior to the use of miconazole nitrate alone, with less adverse reaction,and is easy to use.It is worth clinical application.

Cytoprotective effect of rhamnetin on miconazole-induced H9c2 cell damage

BACKGROUND/OBJECTIVES: Reactive oxygen species (ROS) formation is closely related to miconazole-induced heart dysfunction. Although rhamnetin has antioxidant effects, it remained unknown whether it can protect against miconazole-induced cardiomyocyte apoptosis. Thus, we investigated the effects of rhamnetin on miconazole-stimulated H9c2 cell apoptosis. MATERIALS/METHODS: Cell morphology was observed by inverted microscope and cell viability was determined using a WelCount(TM) cell proliferation assay kit. Miconazole-induced ROS production was evaluated by fluorescence-activated cell sorting with 6-carboxy-2',7'-dichlorofluoroscein diacetate (H2DCF-DA) stain. Immunoblot analysis was used to determine apurinic/apyrimidinic endonuclease 1 (APE/Ref-1) and cleaved cysteine-aspartic protease (caspase) 3 expression. NADPH oxidase levels were measured using real-time polymerase chain reaction. RESULTS: Miconazole (3 and 10 microM) induced abnormal morphological changes and cell death in H9c2 cells. Rhamnetin enhanced the viability of miconazole (3 microM)-treated cells in a dose-dependent manner. Rhamnetin (1 and 3 microM) treatment downregulated cleaved caspase 3 and upregulated APE/Ref-1 expression in miconazole-stimulated cells. Additionally, rhamnetin significantly reduced ROS generation. CONCLUSIONS: Our data suggest that rhamnetin may have cytoprotective effects in miconazole-stimulated H9c2 cardiomyocytes via ROS inhibition. This effect most likely occurs through the upregulation of APE/Ref-1 and attenuation of hydrogen peroxide levels.

Metabolic analysis of miconazole-treated Candida albicans by GC-MS / 药学实践杂志

Objective To investigate the metabolism in miconazole-treated Candida albicans ,search for possible biomar-kers and discuss the mechanism of miconazole .Methods GC-MS was employed to determine the metabolic fingerprint of Can-dida albicans before and after treatment with miconazole ,and the difference based on multivariate was compared by statistical analysis ,the potential biomarkers were screened out and the mechanism of miconazole was discussed .Results Twenty three metabolites was screened out as potential biomarkers ,and they were primarily involved in amino acid metabolism ,citrate cycle , glycolysis and lipid metabolism .Conclusion The antifungal activity of miconazole was played by affecting a variety of metabolic pathways .

Ciclopirox olamine in treatment of vulvovaginal candidiasis: A randomized controlled study / 第二军医大学学报

Objective To investigate the efficacy of ciclopirox olamine vaginal cream for treatment of vulvovaginal candidiasis(VVC). Methods According to the inclusion and exclusion criteria, 605 patients were enrolled in the present study from Jan. 2012 to Oct. 2013. The patients were randomly assigned to experimental group and the control group. Patients in the experimental group were given ciclopirox olamine ointment 5 g/d (ciclopirox olamine 0.05 g/d) for 7 days by vaginal delivery, and those in the control group were given miconazole nitrate suppositories 200 mg/d for 7 days in the same manner. The clinical efficacies of the two groups were compared. Results A total of 586 patients completed the study and the two groups had a good balance. The symptom remission rates 24 h after medication in the experimental group and the control group were 78.25% (223/285) and 41.86% (126/301), respectively, showing significant difference (P<.01); and the total effective rates one week after treatment were 91.93% (262/285) and 85.05% (256/301), respectively, also showing significant difference between the two groups (P<.01). The recurrence rates in 204 patients of the experimental group at 3 and 6 months after discontinuation were 0.49% (1/204) and 3.92% (8/204), while in 205 patients of the control group were 7.32% (15/205) and 14.15% (29/205), respectively, showing significant differences between the two groups at both time points(P<.01). Conclusion Ciclopirox olamine vaginal cream is more effective than miconazole nitrate in treating VVC, and it can significantly reduce the recurrence rate.

Clinical Study of Synergistic Effect of Xianglian Suppository Combined with Miconazole Suppository in Treating Simple Vulvovaginal Candidiasis / 广州中医药大学学报

Objective To observe the antibacterial and synergistic effect of Xianglian Suppository with miconazole suppository for the treatment of simple vulvovaginal candidiasis ( VVC) , and to explore the advantages of integrative Chinese and western medicine for the treatment of simple VVC. Methods According to the principle of randomized trial, 65 simple VVC patients were divided into two groups, 35 cases in test group and 30 in control group. The test group was given Xianglian suppository and miconazole suppository, and the control group was treated with miconazole suppository, the medication lasting for 7 days. The changes of symptom scores before and after treatment were observed, and the therapeutic effect and safety were also evaluated in both groups. Results ( 1) After treatment for one course, the markedly effective rate and total effective rate were 60.00%, 88.57% in the test group, and were 23.33%, 60.00% in the control group, respectively, the differences being significant between the two groups ( P<0.01). ( 2) After treatment, symptom scores were decreased in both groups ( P<0.01 compared with those before treatment) , and the decrease in the test group was superior to that in the control group (P<0.01). (3) One case of the test group had the complaint of severer pruritus vulvae after medication, and the results of physical examination showed the case had vulvovaginal flush but had no edema, blister or other discomfort. The manifestations disappeared when the medication continued, indicating that the case had no allergic reaction. No case had allergic reaction in the control group. Conclusion For the treatment of simple VVC, Xianglian suppository combined with miconazole suppository can obviously relieve the clinical symptoms, and is effective and safe.

Randomized, single-blinded comparison of efficacy, safety and tolerability of metronidazole 750mg - miconazole 200mg vaginal suppository vs. metronidazole 500mg - nystatin 100, 000 IU vaginal suppository in the treatment of bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis, and mixed vaginal infections / Philippine Journal of Obstetrics and Gynecology

OBJECTIVE: This randomized, single-blind, two-arm controlled study compared the efficacy, safety, and tolerability of an intravaginal suppository preparation containing metronidazole 750mg + miconazole 200mg (Neopenotran Forte) with another vaginal preparation containing metronidazole 500 mg + nystatin 10000 IU (Flagystatin) in the treatment of bacterial vaginosis (BV), candidal and trichomonial vulvovaginitis (CVV, TV), mixed vaginitis and in the prevention of secondary candidal vulvovaginitis. MATERIALS AND METHODS: Women ages 18-45 years with chief complaints of abnormal vaginal discharge or vaginal/vulvar itching were examined and microbiologic confirmation of BV, VVC, TV or mixed infection was made. They were then randomly assigned to receive either treatment once daily (nightly) for 7 days. A total of 261 subjects had evaluable clinical and microbiological findings at the end of the study. Test of cure by Amsel criteria and Nugent score were performed twice after treatment. RESULTS: The overall test revealed that microbiological cure rate is significantly different between the two treatment groups. CONCLUSION: The odds of being cured microbiologically is 2.35 times more in the metronidazole 750mg + miconazole nitrate 200mg group compared to the metronidazole 500 mg + nystatin 10000 IU group. However, no significant difference in the clinical cure between the two groups was found. Both drugs are safe and convenient to use.

Neurocriptococosis crónica en un paciente inmunocompetente / Chronic neurocryptococcosis in an immunocompetent patient

Se presenta el caso de un paciente, sin antecedentes ni evidencias de alteraciones de inmunidad, con un cuadro de meningoencefalitis crónica. Este fue ingresado en tres ocasiones con diferentes diagnósticos en un período de 10 meses. Se le realizó el diagnóstico de neurocriptococosis, y corroboró con los estudios de tinta china y cultivo micológico del líquido cefalorraquídeo; no se detectó otra localización del hongo en el paciente. El egresado curado, después del tratamiento con anfotericin B y miconazol y el seguimiento inmunológico hasta el año 2014; se le dio recientemente de alta después de 10 años, excluyéndose definitivamente la inmunosupresión adquirida.

A patient having no history or evidences of immune disorders, presented chronic meningoencephalitis. This patient was admitted three times with different diagnosis in a 10-month period. The diagnosis of neurocryptococcosis was confirmed by means of studies with India ink stain and mycological culture of cerebrospinal fluid, no other localization of fungus was found. The patient was discharged after the treatment with Amphotericin B and miconazole along with immunological follow-up to 2014; he was recently discharged after 10 years, definitely excluding an acquired immunocompetence.

Evaluation of Efficacy, Safety and Tolerability of a Combination of Clobetasol, Neomycin and Miconazole Versus Betamethasone, Clotrimazole and Neomycin Versus Betamethasone, Gentamycin and Miconazole in Subjects with Eczematous Disorders Associated with underlying Tinea or Yeast Infections.

Lobate GM Neo, 15 mg is a triple drug combination of a steroid clobetasol with anti-fungal miconazole and antibacterial neomycin in treatment of Eczematous disorders associated with underlying Tinea or Yeast Infections. Aims and Objectives: The study was designed to evaluate the efficacy, safety and tolerability of a combinations of clobetasol, neomycin and miconazole (Group A) versus betamethasone, clotrimazole, neomycin (Group B) versus betamethasone, gentamicin, miconazole (Group C) in subjects with any type of eczematous disorder associated with underlying tinea or yeast infection. Materials and Methods: This was an open label, parallel group, randomized comparative study. The primary endpoint analyzed was improvement in clinical score from baseline at the end of day 7 and other primary endpoint like hyperpigmentation were analyzed by the visual analogue scale of 1 to 10 at the end of day 7. Results: Thirty-six subjects were randomized to three groups. The clinical score showed a significant reduction from baseline at the end of day 7 in all the groups, i.e. 82.9%, 81.3% and 85.6% in Group A, B and C respectively. However, the difference between the groups were not statistically significant. Mean hyper pigmentation score showed significant decrease of 82.9% in Group A, 81.6% in Group B and 92.2% in Group C from baseline at the end of day 7. Conclusion: The triple combination of antifungal, antibacterial and potent steroid was found to be efficacious, safe and tolerable in reducing signs and symptoms (scaling, inflammation, burning and itching) of eczematous disorder associated with underlying tinea/yeast infection.

Simultaneous Determination of Ketoconazole and Miconazole Mitrate in Compound Toconazole Gels by HPLC / 中国药师

Objective: To establish a method for the determination of ketoconazole and miconazole nitrate in compound ketocon-azole gels. Methods:An HPLC method was developed. A Hypersil BDS C18 column(416 mm × 200 mm,5μm) was used, the mobile phases consisted of 0. 5% ammonium acetate solution-methanol(containing 0. 2% triethanolamine) (20∶80), the flow rate was 1. 0 ml ·min-1 , the detection wavelength was set at 230nm, the column temperature was 30℃ and the injection volume was 20μl. Results:There was a good linear correlation within the range of 5. 1-510. 0 mg·L-1 for ketoconazole (r=0. 999 9) and 50. 0-500. 0 mg·L-1 for miconazole nitrate (r=0. 999 9), the average recovery for ketoconazole and miconazole nitrate was 100. 3%(RSD=0. 38%, n=6) and 99. 9%(RSD=0. 79%, n=6), respectively. Conclusion:The method is simple, rapid, accurate and sensitive, and can pro-vide a method for controlling the quality of compound ketoconazole gels.

Validación del método para control de la calidad del nitrato de miconazol en una nueva crema al 2 % / Validation of a quality control method of a new 2 percent miconazole nitrate cream

Objetivo: validar el método para control de la calidad del nitrato de miconazol en una nueva crema al 2 por ciento. Métodos: se realizó la validación según los parámetros exigidos para la categoría I y considerando la metodología y los criterios de aceptación vigentes en Cuba. Una vez validado, se aplicó al análisis de los tres lotes elaborados a escala piloto. Resultados: los resultados fueron satisfactorios, cumpliendo en todos los parámetros los límites establecidos. El método fue lineal, exacto y preciso en el rango de 10 a 30 mg/g y no hubo interferencias de ninguno de los componentes de la nueva formulación. Los lotes presentaron correcta dosificación, sin diferencias estadísticamente significativas entre las réplicas y los lotes analizados. Conclusiones: El método evaluado resulta válido para el objetivo con el cual se propuso(AU)

Objective: to validate a quality control method for a 2 percent new miconazole nitrate cream. Methods: the validation was made following the category I parameters and taking into account the methodology and acceptance criteria in force in Cuba. Once validated, the analysis of the three batches was applied on pilot scale. Results: the results were satisfactory since they fulfilled all the set parameters. The method was linear, accurate and precise in the 10-30 mg/g range. there was no interference from any of the components of the new formulation. The batches presented correct dosing, without any statistically significant differences between replicas and analyzed batches. Conclusions: the evaluated method proved to be valid for the stated purpose(AU)

Eficacia, tolerancia y seguridad de una combinación de metronidazol, miconazol, centella asiática, polimixina y neomicina en cápsula blanda para uso vaginal en el tratamiento de la vaginosis bacteriana / Efficacy, tolerability, and safety of a combination including metronidazole, miconazole, Gotu kola, polymixin, and neomycin in soft vaginal capsules for the treatment of bacterial vaginosis

Introducción: La vaginosis bacteriana (VB) es un síndrome polimicrobiano, en la cual la flora dominante de lactobacilos normales es sustituida por una flora polimicrobiana. La prevalencia de VB en Perú varía entre 27 y 43,7%. El Centro de Control y Prevención de Enfermedades (DCD) sugiere el tratamiento de VB en mujeres sintomáticas con metronidazol oral/gel o clindamicina crema. Se planteó en el presente estudio evaluar la eficacia, tolerancia y seguridad de la combinación de metronidazol, miconazol, centella asiática, polimixina y neomicina en cápsula blanda para el tratamiento de VB. Material y Métodos: El presente estudio de tipo abierto, observacional, prospectivo, permitió evaluar la eficacia, tolerancia y seguridad en la aplicación de la combinación de metronidazol, miconazol, centella asiática, polimixina y neomicina en cápsula blanda. Resultados: Se incluyó a 61 pacientes con edad promedio de 29.28 años (rango 18-48) de las cuales 93,4% tenía historia previa de flujo vaginal anormal. Se realizaron dos visitas durante el estudio, la primera para diagnóstico e inicio de tratamiento y la segunda de control post tratamiento. Tres pacientes no tuvieron segunda visita y 8 no tenían registrada toda la información para definir la respuesta terapéutica. La segunda visita se realizó a los 21 días en promedio. Los principales signos y síntomas en la primera visita de diagnóstico fueron flujo vaginal (100,0%), disconfort vaginal (85,2%), dispareunia (70,5%) y dolor abdominal bajo (57,4%), las cuales disminuyeron en forma significativa (p<0,05) a la segunda visita post tratamiento. La prueba de aminas resultó positiva en el 93,4% de los casos en la primera visita y en el 15,5% de los casos en la segunda visita (p<0,05). De la población inicial de estudio, solo 53 mujeres son evaluables para eficacia terapéutica...

Introduction: Bacterial vaginosis (BV) is a polymicrobial syndrome, in which the normal dominant flora consisting in Lactobacillus is replaced by polymicrobial flora. The prevalence of BV in Peru varies between 27 and 43.7%. The Centers for Disease Control and Prevention suggest therapy for BV in symptomatic women should include oral/gel metronidazole or clindamycin cream. We proposed in this study to evaluate the efficacy, tolerability and safety of the combination of metronidazole, miconazole, Gotu kola (Centella asiatica), polymixin, and neomycin in soft capsules, for the treatment of BV. Material and Methods: This investigation was an open, observational, and prospective study, which allowed us to evaluate the efficacy, tolerability and safety of the aforementioned combined therapy administered in soft capsules. Results: The study included 61 patients with a mean age of 29.28 years (range, 18-48) and 93.4% had a history of abnormal vaginal discharge. Two visits took place during the study, the first for making the diagnosis and initiating therapy, and the second was the post-treatment control. Three patients did not have a second visit and 8 did not record all the information required to define the therapeutic response. The second visit took place after 21 days on average. The main signs and symptoms at the first visit were vaginal discharge at diagnosis (100.0%), vaginal discomfort (85.2%), dyspareunia (70.5%) and lower abdominal pain (57.4%), which were significantly reduced (p <0.05) in the second visit after treatment. The amine test was positive in 93.4% of cases in the first visit and in 15.5% of cases in the second visit (p <0.05). From the initial population in the study, only 53 women are evaluable for efficacy. An overall response rate in 44 women (83.02%) was achieved with the soft capsule combination treatment. Adverse events were reported in only one case...