Journal of Antimicrobial Chemotherapy (1977) 3, 347-353
Treatment with metronidazole of 48 patients with serious anaerobic infections
H. Giamarellon, K. Kanellakopoulou, D. Pragastis, N. Tagaris and G. K. Daikos
Forty-eight patients in whom 50 serious anaerobic infections were diagnosed, were treated with metronidazole either orally (33) or rectally (15). Complete recovery occurred in 38 infections, while in 9 there was a satisfactory response, and 3 were considered as treatment failures. Thirteen of the 15 patients treated with suppositories had a complete recovery, while the other patients had a satisfactory response. Serum levels for metronidazole were obtained in 19 patients as well as in 12 volunteers. Similar peak levels, ranging between 10 to 30 mg/1 were found after either the oral or rectal route. Sustained high levels were obtained when using the rectal route. Introduction Since the observation by Shinn in 1962 of the efficacy of metronidazole in the treatment of anaerobic infections, other reports have substantiated the use of this drug in the prophylaxis and treatment of such infections. Many of these reports are limited to a small number of patients. Three large series describing the role of metronidazole mainly in the prophylaxis against anaerobic infections have been published (Study Group, 1974; Study Group, 1975; Willis, et al., 1976). To our knowledge 27 cases are reported, by different groups (Tally, Sutter & Finegold, 1972; Mitre & Rotheran, 1974; Study, Group, 1975; Tally, Sutter & Finegold, 1975; Baron, Drugeon, Nicolas & Courtien, 1975; Ingham et al., 1976; George & Bint, 1976), where this drug was administered as a therapeutic agent. We are aware of only 6 patients that received metronidazole in the form of rectal suppositories in these series and this route of administration was discontinued in favour of the oral route when the patients condition permitted. In the communication are described the clinical, laboratory and pharmacological experience in 48 patients diagnosed as suffering from a variety of serious anaerobic infections. Thirty-three of these patients received the drug orally. In the remaining 15, because of gastric irritation, prolonged paralytic ileus and the patients' general condition, rectal suppositories were administered throughout therapy. Materials and methods The 48 patients in this study were admitted to units of Athens School of Medicine. In 37 patients, despite surgical drainage, the persistance of post-operative fever necessitated 347
Downloaded from http://jac.oxfordjournals.org/ at University of California, San Fransisco on April 9, 2015
Athens University School of Medicine, 1st Department of Propedeutic Medicine Kind Paul's Hospital, Athens 609, Greece
348
H. Giamarellou, K. Kanellakopoulou, D. Pragastis, N. Tagaris and G. K. Daikos
Results Seventeen patients were male and 31 female, the average age was 54-3 years (range 18 to 79). Fifty infections occurred in the 48 patients. Thirty of the infections were purely anaerobic, while the remaining 20 were mixed aerobic/anaerobic. Site of infection, corresponding therapy and culture results are given in Table I. Underlying conditions are shown in Table II. Duration of therapy depending on severity and general response of the patient's condition ranged between 7 and 45 days. Twenty-six patients were treated for
Treatment with metronidazole of 48 patients with serious anaerobic infections
H. Giamarellon, K. Kanellakopoulou, D. Pragastis, N. Tagaris and G. K. Daikos
Forty-eight patients in whom 50 serious anaerobic infections were diagnosed, were treated with metronidazole either orally (33) or rectally (15). Complete recovery occurred in 38 infections, while in 9 there was a satisfactory response, and 3 were considered as treatment failures. Thirteen of the 15 patients treated with suppositories had a complete recovery, while the other patients had a satisfactory response. Serum levels for metronidazole were obtained in 19 patients as well as in 12 volunteers. Similar peak levels, ranging between 10 to 30 mg/1 were found after either the oral or rectal route. Sustained high levels were obtained when using the rectal route. Introduction Since the observation by Shinn in 1962 of the efficacy of metronidazole in the treatment of anaerobic infections, other reports have substantiated the use of this drug in the prophylaxis and treatment of such infections. Many of these reports are limited to a small number of patients. Three large series describing the role of metronidazole mainly in the prophylaxis against anaerobic infections have been published (Study Group, 1974; Study Group, 1975; Willis, et al., 1976). To our knowledge 27 cases are reported, by different groups (Tally, Sutter & Finegold, 1972; Mitre & Rotheran, 1974; Study, Group, 1975; Tally, Sutter & Finegold, 1975; Baron, Drugeon, Nicolas & Courtien, 1975; Ingham et al., 1976; George & Bint, 1976), where this drug was administered as a therapeutic agent. We are aware of only 6 patients that received metronidazole in the form of rectal suppositories in these series and this route of administration was discontinued in favour of the oral route when the patients condition permitted. In the communication are described the clinical, laboratory and pharmacological experience in 48 patients diagnosed as suffering from a variety of serious anaerobic infections. Thirty-three of these patients received the drug orally. In the remaining 15, because of gastric irritation, prolonged paralytic ileus and the patients' general condition, rectal suppositories were administered throughout therapy. Materials and methods The 48 patients in this study were admitted to units of Athens School of Medicine. In 37 patients, despite surgical drainage, the persistance of post-operative fever necessitated 347
Downloaded from http://jac.oxfordjournals.org/ at University of California, San Fransisco on April 9, 2015
Athens University School of Medicine, 1st Department of Propedeutic Medicine Kind Paul's Hospital, Athens 609, Greece
348
H. Giamarellou, K. Kanellakopoulou, D. Pragastis, N. Tagaris and G. K. Daikos
Results Seventeen patients were male and 31 female, the average age was 54-3 years (range 18 to 79). Fifty infections occurred in the 48 patients. Thirty of the infections were purely anaerobic, while the remaining 20 were mixed aerobic/anaerobic. Site of infection, corresponding therapy and culture results are given in Table I. Underlying conditions are shown in Table II. Duration of therapy depending on severity and general response of the patient's condition ranged between 7 and 45 days. Twenty-six patients were treated for
