Genital Organ Disease Case No 6.Vaginal Discharge-3

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Genital Organ Disease Case No 6.Vaginal Discharge-3

vaginal discharge

1.Bad smell + Intense itching= Trichomoniasis(yellow-green in colour.)

2.Bad smell + No itching= Bacterial vaginosis(greyish-white)

3.Only vaginal discharge + No bad smell+ no itching =Simple leucorrhoea.(milky or white)

4.Vaginal whitish discharge + intense itching+ irritation+ no bad smell= Vaginal candidiasis

5.Vaginal discharge + Bad smell + systemic features (Fever) + lower abdominal pain + low back pain = PID (yellow or green colour )

(Look for history of abortion, IUD, D&C, multiple sexual partners)

PID( Pelvic inflammatory disease). (PID) is defined as an inflammation of the upper genital tract due to an infection in women. The disease affects the uterus, Fallopian tubes, and/or ovaries. It is typically an ascending infection, spreading from the lower genital tract.

1.Bacterial Vaginosis Rx:

-Tab. Flamyd 500mg (AS A Metronidazole Amoebicides, Anti-diarrhoeal Antiprotozoal).

Indications of Tab. Flamyd 500mg (AS A Metronidazole Amoebicides, Anti-diarrhoeal Antiprotozoal).

Flamyd is indicated in the treatment of following diseases:

The prevention of post-operative infections due to anaerobic bacteria (particularly species of bacteroides and anaerobic streptococci).
The treatment of septicaemia, bacteraemia, peritonitis, brain abscess, pelvic abscess, pelvic cellulitis and post-operative wound infections caused by anaerobes.
In the treatment of urogenital trichomoniasis.
Bacterial vaginosis (also known as non-specific vaginitis).
All forms of amoebiasis (intestinal, extra-intestinal disease and that of symptomless cyst passers).
Giardiasis.
Acute ulcerative gingivitis.
Anaerobically infected leg ulcers and pressure sores.
Acute dental infections due to anaerobic organisms.
Antibiotic associated pseudomembranus colitis.

Pharmacology of Tab. Flamyd 500mg (AS A Metronidazole Amoebicides, Anti-diarrhoeal Antiprotozoal).

Metronidazole is a member of the imidazole class of antibacterial drug and is classified therapeutically as an antiprotozoal agent. The 5-nitro group of Metronidazole is reduced by anaerobes metabolically. Studies have demonstrated that the reduced form of this drug interacts with DNA and gives bactericidal action of Metronidazole.

Dosage & Administration of Tab. Flamyd 500mg (AS A Metronidazole Amoebicides, Anti-diarrhoeal Antiprotozoal).

Tablet and Suspension:

Trichomoniasis (Adults & Children over 10 yrs)-

200 mg tid or 400 mg bid for 7 days
800 mg in the morning and 1-2 gm at night for 2 days
2 gm as a single dose for 1 days

Trichomoniasis (Children)-

Children 7-10 yrs: 100 mg tid
Children 3-7 yrs: 100 mg bid
Children 1-3 yrs: 50 mg tid

Intestinal amoebiasis (Adults & Children over 10 yrs)-

800 mg tid for 5 days

Intestinal amoebiasis (Children)-

Children 7-10 yrs: 400 mg tid
Children 3-7 yrs: 200 mg qid
Children 1-3 yrs: 200 mg tid

Extra-intestinal & Asymptomatic amoebiasis (Adults & Children over 10 yrs)-

400-800 mg tid for 5-10 days

Extra-intestinal & Asymptomatic amoebiasis (Children)-

Children 7-10 yrs: 200-400 mg tid
Children 3-7 yrs: 100-200 mg qid
Children 1-3 yrs: 100-200 mg tid

Giardiasis (Adults & Children over 10 yrs)-

2 gm once daily for 3 days

Giardiasis (Children)-

Children 7-10 yrs: 1 gm once daily
Children 3-7 yrs: 600-800 mg once daily
Children 1-3 yrs: 500 mg once daily

Acute ulcerative gingivitis (Adults & Children over 10 yrs)-

200 mg tid for 3 days

Acute ulcerative gingivitis (Children)-

Children 7-10 yrs: 100 mg tid
Children 3-7 yrs: 100 mg bid
Children 1-3 yrs: 50 mg tid

Acute dental infections (Adults & Children over 10 yrs)-

200 mg tid for 3-7 days

Bacterial Vaginosis (Adults & Children over 10 yrs)-

400 mg bid for 7 days
2 gm as a single dose for 1 days

Leg ulcers and pressure sores (Adults & Children over 10 yrs)-

400 mg tid for 7 days

Anaerobic infections (Adults & Children over 10 yrs)-

800 mg initially and then 400 mg tid for 7 days

Anaerobic infections (Children)-

Children 1-10 yrs: 7.5 mg/kg tid

Surgical prophylaxis (Adults & Children over 10 yrs)-

400 mg tid started 24 hours before surgery for 1 days

Surgical prophylaxis (Children)-

Children 1-10 yrs: 7.5 mg/kg tid

Vaginal Gel:

The recommended dose is one applicator full of Metronidazole gel (approximately 5 grams containing approximately 37.5 mg of Metronidazole) intravaginally once or twice a day for 5 days. For once a day dosing, Metronidazole gel should be administered at bedtime.

Suppository:

Anaerobic Infections-

Adults: 1 g every 8 hours for 3 days, then 1 g every 12 hours.
Children: 5-10 years: 500 mg every 8 hours for 3 days, then every 12 hours, Over 10 years adult dose.

Surgical Prophylaxis-

Adults: 1 g 2 hours before surgery; up to 3 further doses of 1 g may be given every 8 hours for high risk procedures.
Children: 5-10 years: 500 mg 2 hours before surgery; up to 3 further doses of 500 mg may be given every 8 hours for high risk procedures.

IV Infusion:

Metronidazole intravenous infusion requires no dilution and should not be mixed with any other drugs prior to administration.

Adults and children over 12 years: Infuse 500 mg 8 hourly at a rate of 5 ml/minute and a maximum of 4 g should not be exceeded during a 24-hour period. Treatment for 7 days is sufficient for most patients, but treatment can be extended, especially for cases where reinfection is likely. For surgical prophylaxis, administration shortly before surgery should be followed by 8-hourly doses for the next 24 hours.
Children under 12 years: 7.5 mg/kg body weight/day every 8 hours at a rate of 5 ml/minute.

Contraindications of Tab. Flamyd 500mg (AS A Metronidazole Amoebicides, Anti-diarrhoeal Antiprotozoal).

Metronidazole is contraindicated in patients with a history of hypersensitivity to Metronidazole or other Nitroimidazole derivatives.

Side Effects

Metallic taste, nausea, vomiting, diarrhoea, drowsiness, rashes may be observed during treatment.

Pregnancy & Lactation of Tab. Flamyd 500mg (AS A Metronidazole Amoebicides, Anti-diarrhoeal Antiprotozoal).

US FDA Pregnancy Category of Metronidazole is B. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Metronidazole have been shown to be excreted in human milk. So, caution should be exercised when Metronidazole is administered to a nursing woman.

Therapeutic Class of Tab. Flamyd 500mg (AS A Metronidazole Amoebicides, Anti-diarrhoeal Antiprotozoal).

Amoebicides, Anti-diarrhoeal Antiprotozoal

১+১+১ ৫-৭দিন

-proper hygiene maintain

–কুসুম গরম পানি দিয়ে private parts wash করবে।

–use cotton undergraments

2. Trichomonas vaginalis:

Tab. Flamyd 500mg (AS A Metronidazole Amoebicides, Anti-diarrhoeal Antiprotozoal).

১+১+১ ৫-৭দিন

Itching থাকলে

Tab.Fexofenadine 120 mg

0+0+1

-proper hygiene maintain

–কুসুম গরম পানি দিয়ে private parts wash করবে।

–use cotton undergraments

3.Normal leucorrhoea :

সাধারণত ট্রিটমেন্ট লাগেনা

এমনেই ভাল হয়ে যায়।

Tab.vitamin B complex

0+0+1….3 months

proper hygiene maintain

Take proper protein enriched food

কুসুম গরম পানি দিয়ে private parts wash করবে।

–use cotton undergraments

4.Vaginal candidiasis

A)Non pregnant women:

Cap.Flugal 200mg

০+০+১ ৫ দিন

যাদের বারবার হয় তাঁরা প্রতি বুধবারে ৪ সপ্তাহে ৪ টা খাবে।

Itching থাকলে

Tab.Fexofenadine 120 mg

0+0+1

B)Pregnant women :

Afun VT 200mg

তিন রাতে তিনটা মাসিকের রাস্তায় দিবে।

যাদের repeatdly attack হয় তারা ৫ রাতে ৫ টি দিবে। তারপর প্রতি

সপ্তাহের একটা নির্দিষ্ট দিনে(যেমনঃসোমবার) ৪ সপ্তাহ দিবে।

Itching থাকলে

Tab.Fexofenadine 120 mg

0+0+1

proper hygiene maintain

–কুসুম গরম পানি দিয়ে private parts wash করবে।

–use cotton undergraments

N.B:উপরের সবগুলি Rx এর ক্ষেত্রেই

husband should be treated with Nystatin ointment locally after each act of coitus-5-7 days.

5.PID:Pelvic Inflamatory Disease,

Cap.Doxycycline 100 mg

Capsule 1:-Doxin 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Indications of Capsule :-Doxin 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Doxin is indicated in the following infections caused by susceptible microorganisms:

Respiratory tract infections: Pneumonia, influenza, sinusitis, bronchitis, tonsillitis, tracheitis.
Gastrointestinal tract infections: Cholera, traveler’s diarrhea, shigella dysentery, acute intestinal amebiasis.
Chlamydial infections: Lympho-granuloma venereum, psittacosis, trachoma.
Sexually transmitted diseases: Non gonococcal urethritis, acute pelvic inflammatory disease, uncomplicated urethral and endocervical or rectal infections, gonorrhoea, syphilis, pyelonephritis, cystitis.
Other infections: Impetigo, furunculosis, inclusion conjunctivitis, brucellosis, tularemia, cellulitis, acne and Q-fever.

Description of Capsule :-Doxin 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Doxin is a highly active broad-spectrum antibiotic of tetracycline group. It is effective against a wide range of Gram-positive and Gram-negative bacteria, spirochete, mycoplasma, rickettsia and mycobacteria. Doxin is used as an alternate to penicillin in the treatment of gonorrhoea and syphilis. Doxin has its main mechanism of action on protein synthesis. Inside the bacterial cell, it inhibits protein synthesis.

Pharmacology of Capsule :-Doxin 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Doxycycline Hydrochloride is a semisynthetic tetracycline antibiotic with broad spectrum activity. It is primarily a bacteriostatic antibiotic. It has a similar spectrum of activity to other tetracyclines but in particular is more active against Staphylococcus aureus and Nocardia. The drug is often active against penicillin-resistant strains of Staphylococcus aureus and against strains of those organisms that are resistant to other Tetracyclines. Certain Gram-negative strains of E. coli, Proteus mirabilis and Klebsiella, which are often resistant to Tetracycline, may be sensitive to Doxycycline. In addition, 70-90% of the various anaerobes are sensitive to Doxycycline and Bacteroides fragilis is more likely to be sensitive to Doxycycline than to other tetracyclines.

Doxycycline is active against most strains of Haemophilus influenzaeand is particularly useful for infections with H. ducreyi, Actinomyces, Brucella and Vibrio cholerae. It is also active against Nocardia, Chlamydia, Mycoplasma and a wide range of Rickettsiae. Doxycycline is active against spirochetes such as Borellia recurrentis, Treponema pallidum and Treponema pertenue. It is also active against Plasmodium falciparum.

Dosage of Capsule :-Doxin 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Usual dose: 200 mg on first day, then 100 mg daily for 7-10 days.
Severe infections (including refractory urinary tract infections): 200 mg daily for 10 days.
Acne: 100 mg daily.
Uncomplicated genital chlamydia, non-gonococcal urethritis: 100 mg twice daily for 7-21 days (14-21 days in pelvic inflammatory disease).

Contraindications of Capsule :-Doxin 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Doxycycline is contraindicated to the patients who have shown hypersensitivity to any of the tetracyclines. Doxycycline is contraindicated to the children under 8 years of age. It is also contraindicated to pregnant women and to the lactating mothers.

Side Effects of Capsule :-Doxin 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Nausea, vomiting, diarrhoea, skin rashes, hemolytic anaemia, eosinophilia may be reported.

Pregnancy & Lactation of Capsule :-Doxin 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Doxycycline should be avoided in pregnant women, because of the risk of both staining and effect on bone growth in the foetus. Doxycyclines enter breast milk, and mothers taking these drugs should not breastfeed their child.

Therapeutic Class of Capsule :-Doxin 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Tetracycline group of drugs

1+0+1……14 days

Tab.Metronidazole 400 mg

1+1+1…..5 days

Tab.Ornidazole 500 mg

Tablet 1.Robic 500mg (AS A Ornidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Indications of Tablet:-Robic 500mg (AS A Ornidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Robic is indicated for Amoebiasis (Intestinal and hepatic), Giardiasis, Trichomoniasis, Bacterial vaginosis, Treatment of susceptible anaerobic infections.

Pharmacology of Tablet:-Robic 500mg (AS A Ornidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Ornidazole is a 5-nitroimidazole derivative active against protozoa and anaerobic bacteria. It is converted to reduction products that interact with DNA to cause destruction of helical DNA structure and strand leading to a protein synthesis inhibition and cell death in susceptible organisms.

Dosage & Administration of Tablet:-Robic 500mg (AS A Ornidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Amoebiasis:

Adults: 500 mg twice a day for 5 days.
Children: 10-25 mg per kg body weight in two divided doses.

Amoebic dysentery:

Adults: 1.5 gm once a day for 3 days.
Children: 40 mg per kg body weight, once a day for 3 days.

Giardiasis:

Adults: 1.5 gm once daily for 1-2 days.
Children: 40 mg per kg body weight for 2 days.

Trichomoniasis: 1.5 gm once or 500 mg twice a day for 5 days. Sexual partner should also be treated at the same time.

Bacterial vaginosis: 3 tablets of 500 mg each as a single dose or one tablet of 500 mg once daily for 5-7 days.

Interaction of Tablet:-Robic 500mg (AS A Ornidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Like other imidazoles, Robic has a mild potential to cause disulfiramlike reactions. Concomitant administration of oral anticoagulants may increase the risk of haemorrhage due to diminished hepatic metabolism. Robic has been reported to decrease the clearance of 5-fluorouracil.

Contraindications of Tablet:-Robic 500mg (AS A Ornidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Previous hypersensitivity to Ornidazole and to other nitroimidazoles. Ornidazole is contraindicated in central nervous system disorders, particularly in epilepsy or in peripheral neuropathy.

Side Effects of Tablet:-Robic 500mg (AS A Ornidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Side effects of Robic have been mainly limited to the gastrointestinal tract (nausea, vomiting, epigastric pain) and central nervous system (dizziness, headache, lassitude). Unlike other nitroimidazoles, Robic does not interact with alcohol, although this requires further study.

Leukopenia has been described occasionally during therapy. Adverse central nervous system (CNS) effects of Robic have mainly included headache, dizziness, lassitude or somnolence, fatigue and weakness. Adverse CNS effects of Robic may be less than that happens with metronidazole. Seizures have not been reported with Robic in studies available to date.

Pregnancy & Lactation of Tablet:-Robic 500mg (AS A Ornidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Therapeutic Class of Tablet:-Robic 500mg (AS A Ornidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Amoebicides, Anti-diarrhoeal Antiprotozoal

Adequate clinical trials have not been conducted. Ornidazole should be prescribed only if the potential benefit justifies the potential risk to fetus/neonate.

1+0+1…..ভরা পেটে….. 5 days

Tab.Pantoprazole 20 mg

1+0+1…14 days….before 30 minutes of meal.

যদি pain থাকে-

Tab.Teimonium methyl sulphate 50 mg

1+1+1

জ্বর থাকলে-

Tab.paracetamol 665 mg

1+1+1….after meal

Husband also take

Cap.Doxycycline 100 mg

1+0+1……14 days

Tab.Metronidazole 400 mg

1+1+1…..5 days

E sara o amra multi drug hisebe ar akta drug dite pari

seta holo

General Quaries:

1 Amra to gynomix/ v cap vaginal suppository o sathe suggest kori tai na?

Answer is: Yes pari use Korte .

Vaginal suppository 1: Gynomix (As A Metronidazole+Neomycin sulfate+Polymyxin B+Nystatin As A drugs used in vaginal and Vulval condition.)

Indications:-

Gynomix is indicated in-

Vaginal trichomoniasis

Vaginal leucorrhoeas

Mixed vaginal infections (Fungal or Bacterial).

Raiyyan Tahsan Date:-22-01-2025 Wednesday Time:9-35-45 PM

Raiyyan Tahsan

Raiyyan Tahsan