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PubMed1976

Need for "counter-detailing" antibiotics.

Selected antibiotic advertisements in medical journals are discussed to illustrate the misleading information that is often disseminated to physicians by the pharmaceutical industry. Laboratory and clinical data are presented to question the validity of selected advertisements which (1) encourage the use of Keflex for severe respiratory infections in children, (2) recommend the use of Keflex for the treatment of bacterial bronchitis, (3) suggest that high tissue penetration is a unique property of Vibramycin, (4) present pooled susceptability data which do not reflect microbial resistance patterns in the patient's hospital, (5) recommend twice-daily administration of Ancef for urinary tract infections but do not clearly state the potential danger of this regimen for other infections, (6) suggest that gentamicin should be given to adults in only two dosage sizes for the treatment of serious Gram-negative infections, and (7) lead the reader to assume that only women need to be treated for Trichomonas infections. It is suggested that as antibiotics are marketed, hospital therapeutics committees should evaluate their advantages and permit formulary additions for only those agents demonstrating increased efficacy, decreased toxicity or decreased cost. Pharmacists who monitor drug therapy can provide information to the physician which will increase his awareness of optimal antibiotic therapy.

Advertising↗
PubMed1999

An outreach programme for sexually transmitted infection screening in street sex workers using self-administered samples.

Street sex workers represent an at-risk group of individuals who find it difficult to access mainstream health services. This was a cross-sectional study of street sex workers in Melbourne, Australia using a self-administered method to detect chlamydial, gonorrhoea and trichomonas infections. Of the 81 individuals approached, 63 (78%) (95% CI: 67-86%) agreed to participate. Overall, 87% of the participants obtained their results. Of the 63 participants, 53 (84%) had a past history of injecting drug use (95% CI: 73-92%), and 21 (33%) had a history of a sexually transmitted infection (STI) (95% CI: 22.0-46.3%). Neisseria gonorrhoeae was identified in 7 (11%) participants, Trichomonas vaginalis in 7 (11%), Chlamydia trachomatis in 1 (1.6%). None of the 19 (30%) participants who had been screened for an STI in the preceding 3 months were infected. Our results demonstrated that this method of testing for STIs was acceptable to the street sex workers, and demonstrated a disturbingly high proportion with infections.

Adolescent↗
PubMed1998

Clinical algorithms for the screening of pregnant women for STDs in Libreville, Gabon: which alternatives?

OBJECTIVE: Sexually transmitted diseases (STDs) remain one of the major public health problems in the developing world. To implement a systematic screening of STDs among pregnant women in Libreville, Gabon, a preliminary cross sectional study on STD prevalence and risk factors was performed in antenatal clinics. A score, integrating risk factors and elementary clinical signs for the screening of STDs, showed higher performances compared with hierarchical algorithms. The prospective validation of this score based on six criteria (risk factors and simple clinical signs) was done in 1994-5. The sensitivity (76.7%), compared with results from other studies, was acceptable for diagnosing cervical infection (Neisseria gonorrhoeae and/or Chlamydia trachomatis) but the specificity was low (50.6%). In addition, the diagnostic values for diagnosing vaginal infection (Trichomonas vaginalis and/or Candida albicans) were poor. We then proposed to evaluate an alternative flowchart for the screening of cervical and vaginal infections. METHODS: In this study, 646 pregnant women were enrolled. Each woman was interviewed and examined by a physician and then was subjected to reference laboratory examinations. An algorithm in two steps, combining a risk assessment score at the beginning of a hierarchical process, followed by a second step more specifically applied to a limited number of women, was developed and evaluated. RESULTS: The prevalence rate was 11.3% for cervical infection and 39.5% for vaginal infection. The first step of the algorithm, applied to all pregnant women, is based on four criteria (age, marital status, dyspareunia, coloured vaginal discharge). It allows classification of the women into three classes: high, low, and intermediate risk of cervical infection. Only the patients with intermediate risk were submitted to further investigations including speculum and microscopic examination, and subsequently chlamydial antigen detection. This flowchart was 83.6% and 81.2% sensitive and 63.4% and 62.7% specific for predicting cervical infection and vaginal infection, respectively. CONCLUSION: Similar strategies using simple rapid tests for chlamydial and gonococcal infection would certainly constitute a good diagnostic tool. This theoretical model needs to be evaluated prospectively, not only to confirm their diagnostic value but also to evaluate their feasibility, reliability and acceptability, as well as their cost effectiveness.

Algorithms↗
PubMed2003

Prevalence of selected reproductive tract infections among pregnant women attending an urban maternal and childcare unit in Dhaka, Bangladesh.

A cross-sectional study was conducted during May-December 2000 among pregnant women attending an urban maternal and childcare-delivery unit in Dhaka, Bangladesh, to assess the prevalence of bacterial vaginosis, Trichomonas vaginalis, and syphilis. All pregnant women at 16-24 weeks gestation attending the clinic for antenatal check-up irrespective of symptoms were enrolled. Sociodemographic information and obstetric history were obtained from each enrolled subject. High vaginal swabs and serum samples were tested for bacterial vaginosis, and T. vaginalis and syphilis respectively. In total, 284 pregnant women were enrolled. Of them, 17.7% had bacterial vaginosis, 1.4% had Trichomonas infection, and 3% had syphilis. The prevalence of bacterial vaginosis was higher in women with low socioeconomic status.

Adolescent↗
PubMed2005

Antibiotics for bacterial vaginosis or Trichomonas vaginalis in pregnancy: a systematic review.

OBJECTIVE: To determine whether antibiotic treatment for bacterial vaginosis or Trichomonas vaginalis during pregnancy decreases the risk of preterm birth and associated adverse outcomes. DATA SOURCES: Pre-MEDLINE and MEDLINE (1966-2003), EMBASE (1980-2003), and the Cochrane Library were searched using the keywords "bacterial vaginosis", "Trichomonas", "Trichomonas vaginalis", "Trichomonas vaginitis", "Trichomonas infections", "pregnancy", "pregnant", "antibiotics", and "antibiotic prophylaxis". METHODS OF STUDY SELECTION: The search produced 1,888 titles, of which 1,256 abstracts were reviewed further. Of these, 1,217 were ineligible. Inclusion criteria were the following: randomized controlled trials in which antibiotics were compared with no antibiotic or placebo, for women in the second or third trimester of pregnancy with symptomatic or asymptomatic bacterial vaginosis or Trichomonas vaginalis, intact membranes, and not in labor. Exclusion criteria were as follows: published in a language other than English, dropout rate of more than 20% of women in either group, and lack of usable outcomes. Of the 39 papers reviewed in detail, 14 studies were included in the meta-analysis. TABULATION, INTEGRATION, AND RESULTS: One of the authors reviewed titles obtained from the searches, and 2 reviewers independently reviewed the abstracts, excluded those that were ineligible, identified eligible papers, and abstracted the data. For women with bacterial vaginosis, antibiotics reduced the risk of persistent infection but did not reduce the risk of preterm birth or the incidence of associated adverse outcomes for the general population or for any subgroup analyzed. For women with Trichomonas vaginalis, metronidazole reduced the risk of persistent infection but increased the incidence of preterm birth. CONCLUSION: Contrary to the conclusions of 3 recent systematic reviews, we found no evidence to support the use of antibiotic treatment for bacterial vaginosis or Trichomonas vaginalis in pregnancy to reduce the risk of preterm birth or its associated morbidities in low- or high-risk women.

Anti-Bacterial Agents↗
PubMed2006

Comparison between secretory leukocytic protease inhibitor and reactive nitrogen intermediates levels in cervicovaginal secretions from symptomatic and asymptomatic trichomoniasis Egyptians patients.

Although trichomoniasis is one of the most widespread sexually transmitted diseases, limited information is known about the host and parasite factors which cause symptomatic versus asymptomatic infections. Both of Secretory Leukocytic Protease Inhibitor (SLPI) and Reactive Nitrogen Intermediates (RNI) are major effectors in the innate immune response against infection. This study aimed to compare the level of SLPI and RNI in relation to the vaginal complains among trichomoniasis Egyptian patients. Two groups of trichomonas infected patients were included. Group I included 30 symptomatic patients distributed in three equal subgroups mild, moderate and severe accordiing to degree of symptoms and Group II included 10 asymptomatic patients. Besides, control Group III included 10 healthy females. Cervicovaginal levels of SLPI & RNI were determined in all patients. The mean level of SLPI was less in symptomatic patients (187.75+/-11.61 ng/ml) than in asymptomatic ones (361.18+/-53 ng/ml), with statistically significant difference. Mean level of SLPI was markedly lower in severe symptomatic patients (173.97+/--4.64 ng/ml) when compared with moderate (188.60+/-2.47 ng/ml) and mild (200.69+/-3.01 ng/ml) subgroups respectively. This difference was statistically significant. In controversy, mean levels of RNI in symptomatic patients were significantly higher (39.4+/-7.15 microM) than asymptomatic (38.89+/-6.49 microM). The mean level of RNI was significantly low in severe symptomatic (30.07+/-1.79 microM) than moderate (41.83+/-1.01 microM) and mild (46.30+/-2.02 microM) symptomatic subgroups. This difference was statistically significant. Both of SLPI & RNI levels returned to normal levels in 93.4% & 80% of symptomatic patients respectively one week after metronidazole therapeutic course.

Animals↗