Table 2.
Evidence for alternative treatment regimens outside of the 5-nitroimidazole drug class for T. vaginalis-infected patients with 5-nitroimidazole hypersensitivity
| Authors/DatePublished | Case Presentation | Treatment (Duration) | Outcome | Follow-Up |
|---|---|---|---|---|
| Nyirjesy, et al.37(1998) | 9 women totala, 5 with hypersensitivity to MTZ | Intravaginal paromomycin 250mg per 4g applicator QD (2 weeks) | 9 of 9 symptomatic cureb | 4-6 weeks post treatment |
| Aggarwal, et al.38(2008) | 58-year-old woman with Type I hypersensitivity to MTZ | Intravaginal clotrimazole daily alternating nightly with intravaginal boric acid 600mg capsules (5 months) | Symptomatic and microbiological (culture) cure | Timeframe of TOC not specified |
| Helms, et al.39(2008) | 17 women with 5-nitroimidazole hypersensitivity | Betadine douchesc Intravaginal paromomycinc Intravaginal clotrimazolec Intravaginal furazolidone Intravaginal acetarsol |
Symptomatic and microbiological cured in: 3 of 4 with Betadine douches 1 of 4 with intra-vaginal paromomycin 1 of 3 with intra-vaginal clotrimazole 0 of 2 with intra-vaginal furazolidonee 0 of 1 with intra-vaginal acetarsol |
Timeframe of TOC not specified |
| Muzny, et al.40(2012) | 37-year-old black woman Type I hypersensitivity to MTZ | Intravaginal boric acid 600mg capsules BID (2 months) | Symptomatic and microbiological (wet mount and culture) cure | TOC 60 days post end of treatment |
| Keating, et al.41(2015) | Woman with severe 5-nitroimidazole allergy | Intravaginal paromomycin 6.25% cream, 5g daily (14 days) | Symptomatic and microbiological (OSOM® rapid test, NAAT, or culture) cure | Timeframe of TOC not specified |
| Backus, et al.42 (2017) | 67-year-old white woman with Type I hypersensitivity to MTZ | Intravaginal boric acid 600mg capsules BID (60 days) | Symptomatic and microbiological (NAAT) cure | Timeframe of TOC not specified |
| Thomas, et al.43 (2018) | 27-year-old woman with Type I hypersensitivity to MTZ | Intravaginal paromomycin 6.25% BID (8 days) | Symptomatic and microbiological (wet mount and culture) cure | 26 days post end of treatment |
Results did not differentiate between MTZ resistant and hypersensitive patients
8 of 9 women had negative wet mounts and 6 of those 8 had negative T. vaginalis cultures. One patient with a negative culture relapsed within 4 weeks of treatment
Dose and duration of treatment were not specified and varied amongst patients
Follow-up data available for 12 of 17 patients
One of these two patients was subsequently cured with betadine douches (dose and duration not specified)
Abbreviations: BID, twice daily; MTZ, metronidazole; NAAT, nucleic acid amplification test; PO, orally; QD, daily; TOC, test of cure