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Background Much controversy exists regarding the role of antibiotics in the development of fistula in-ano after incision and drainage. We evaluated the role of postoperative antibiotics in the prevention of fistula in-ano after incision and drainage of perianal abscess. Methods In a randomized single blind clinical trial study, 307 patients were randomly selected from those referring for incision and drainage of perianal abscess at Shahid Faghihi Hospital, Shiraz, Iran, during September 2013 to September 2014. Patients were allocated randomly either to receive 7 days of oral metronidazole and ciprofloxacin in addition to their standard care or to only receive standard care without any antibiotics after they were discharged from the hospital. Patients were followed for 3 months and final results were evaluated. The study was registered at the clinical trial registry ( www.irct.ir ; Irct201311049936n7). Results Seven patients were lost to follow-up. Those who used prophylactic antibiotics ( n = 155) had significantly lower rates of fistula formation compared with those who did not use any medication ( n = 144; P < .001). Men had higher rates of fistula formation ( P = .002). Patients who used more cigarettes had higher rates of fistula development ( P = .001). In the univariate analysis, only postoperative antibiotic use showed a protective role against fistula formation (odds ratio = 0.426; confidence interval, 0.206–0.881). In the regression analysis postoperative antibiotic use remained protective against fistula development (odds ratio = 0.371; confidence interval, 0.196–0.703), furthermore male sex presented as a risk factor for developing fistula in-ano (odds ratio = 3.11; confidence interval, 1.31–7.38). Conclusion Postoperative prophylactic antibiotic therapy including ciprofloxacin and metronidazole play an important role in preventing fistula in-ano formation. Considering the complications of fistula in-ano formation and the minor side effects of antibiotic therapy, based on our results, a 7–10 course of postoperative antibiotics is advised after incision and drainage of perianal abscess. [ABSTRACT FROM AUTHOR]

Introduction Considering the known pharmacological effects of Allium iranicum and the use of this herb in traditional Persian medicine (TPM) as an antihemorrhoid agent, we evaluated the efficacy of A. iranicum leaf extract cream for management of hemorrhoids in a double blind randomized placebo control trial. Methods Eighty patients with symptomatic hemorrhoids were randomly allocated to three groups to receive topical leek cream or placebo cream or routine cream for the management of hemorrhoids (antihemorrhoid) for a period of 3 weeks. Bleeding severity (primary), pain, defecation discomfort, anal itching severity, and overall subjective improvement (secondary) were assessed as outcomes of this study. Results A significant reduction was observed in the bleeding severity, anal pain, defecation discomfort and anal itching of all patients. The leek cream group had significantly less bleeding severity than standard antihemorrhoid and placebo groups at the end of the study (0.26 ± 0.75, 0.83 ± 1.09, 0.35 ± 0.93, respectively P = 0.04). The number of patients with more than 50% subjective improvement was also significantly more in the leek cream group compared to other groups (12, 5, 6, respectively P = 0.04). The mean reductions in pain, defecation discomfort and anal itching showed no significant difference between the three groups ( P = 0.07, 0.39, 0.33, respectively). Conclusion The current study showed significantly better outcomes for the leek group compared to the standard antihemorrhoid and placebo groups for bleeding severity and overall subjective improvement. However, there was no difference among topical use of leek, routine antihemorrhoid and placebo creams symptomatic relief of pain, defecation discomfort and itching. This trial was registered by Iranian Registry of Clinical Trials with the code: IRCT2014010816143N1 and also registered in ClinicalTrials.gov with identifier: NCT02301052 . [ABSTRACT FROM AUTHOR]

Anal fissure which is an ischemic ulcer in the lining of the anus, is a common challenging problem in current medicine. This study was designed to evaluate the benefits of a Persian Medicine cerate containing wallflower (Erysimum cheiri) and damask rose (Rosa × damascena) oil (WDC) on anal fissure. This randomized, controlled clinical trial was conducted on 64 acute anal fissure patients. In each group, patients were given either 0.5 g of WDC or 2.5 cm of Diltiazem 2% gel twice daily for 2 weeks. Anal pain, itching and inflammation were primary outcomes. The recurrence rate and statistical analyses were performed on a per protocol and intention-to-treat basis. Fifty-three patients completed the study. The symptoms decreased significantly (p < 0.05) in all patients after 2 weeks. Comparison of responses between groups reveals no significant differences (p > 0.05) in pain, itching, and inflammation. There was no significant difference (p > 0.05) in recurrence rate of the disease, but the trend of healing in WDC group was better than Diltiazem 2% gel after six weeks. No serious adverse events were observed. The results suggest that topical application of the cerate containing wallflower and damask rose oil can be considered as a potential herbal medicine for the treatment of anal fissure. It exerts comparable clinical effects to current routine treatment. Further studies with long-term follow-ups and larger sample sizes are necessary to have a comprehensive overview of the safety and efficacy of this natural preparation. [ABSTRACT FROM AUTHOR]