Search

Metronidazole is an antiprotozoal drug which is also effective against anaerobic bacteria. It exhibits pronounced in-vitro and in-vivo activity against Trichomonas vaginalis and E. histolytica. Many different brands and dosage forms of Metronidazole are available in the gulf countries that place physicians and pharmacists in a dilemma of drug substitution in case of non availability of a particular brand. The present study was aimed to evaluate the pharmaceutical equivalence of four brands of 250 mg Metronidazole tablets marketed in Middle East countries. Four brands of Metronidazole tablets were purchased locally from the retail pharmacy outlets in Muscat, Oman and their solubility, partition coefficient (log P) and pharmaceutical quality were assessed by using in-vitro tests as per the United States Pharmacopoeia (USP) and unofficial standards as recommended by the manufacturers. Selected brands of Metronidazole were found to be highly soluble, highly permeable and also passed all the official and unofficial in- vitro quality control tests prescribed for the tablets except hardness test. All brands of Metronidazole tablets released more than 70% of their drug content within 45 minutes. Thus, based on the above results, it can be concluded that tested brands of Metronidazole tablets being eligible for biowaiver, are pharmaceutically equivalent and therefore can be considered for drug substitution for each other. [ABSTRACT FROM AUTHOR]

Importance: The use of perioperative, prophylactic, intravenous antibiotics is standard practice to reduce the risk of surgical site infection after oncologic resection and complex endoprosthetic reconstruction for lower extremity bone tumors. However, evidence guiding the duration of prophylactic treatment remains limited., Objective: To assess the effect of a 5-day regimen of postoperative, prophylactic, intravenous antibiotics compared with a 1-day regimen on the rate of surgical site infections within 1 year after surgery., Design, Setting, and Participants: This randomized clinical superiority trial was performed at 48 clinical sites in 12 countries from January 1, 2013, to October 29, 2019. The trial included patients with a primary bone tumor or a soft tissue sarcoma that had invaded the femur or tibia or oligometastatic bone disease of the femur or tibia with expected survival of at least 1 year who required surgical management by excision and endoprosthetic reconstruction. A total of 611 patients were enrolled, and 7 were excluded for ineligibility., Interventions: A 1- or 5-day regimen of postoperative prophylactic intravenous cephalosporin (cefazolin or cefuroxime) that began within 8 hours after skin closure and was administered every 8 hours thereafter. Those randomized to the 1-day regimen received identical saline doses every 8 hours for the remaining 4 days; patients, care providers, and outcomes assessors were blinded to treatment regimen., Main Outcomes and Measures: The primary outcome in this superiority trial was a surgical site infection (superficial incisional, deep incisional, or organ space) classified according to the criteria established by the Centers for Disease Control and Prevention within 1 year after surgery. Secondary outcomes included antibiotic-related complications, unplanned additional operations, oncologic and functional outcomes, and mortality., Results: Of the 604 patients included in the final analysis (mean [SD] age, 41.2 [21.9] years; 361 [59.8%] male; 114 [18.9%] Asian, 43 [7.1%] Black, 34 [5.6%] Hispanic, 15 [2.5%] Indigenous, 384 [63.8%] White, and 12 [2.0%] other), 293 were randomized to a 5-day regimen and 311 to a 1-day regimen. A surgical site infection occurred in 44 patients (15.0%) allocated to the 5-day regimen and in 52 patients (16.7%) allocated to the 1-day regimen (hazard ratio, 0.93; 95% CI, 0.62-1.40; P = .73). Antibiotic-related complications occurred in 15 patients (5.1%) in the 5-day regimen and in 5 patients (1.6%) allocated to the 1-day regimen (hazard ratio, 3.24; 95% CI, 1.17-8.98; P = .02). Other secondary outcomes did not differ significantly between treatment groups., Conclusions and Relevance: This randomized clinical trial did not confirm the superiority of a 5-day regimen of postoperative intravenous antibiotics over a 1-day regimen in preventing surgical site infections after surgery for lower extremity bone tumors that required an endoprosthesis. The 5-day regimen group had significantly more antibiotic-related complications., Trial Registration: ClinicalTrials.gov Identifier: NCT01479283.