Treating odontogenic infections of the head, neck and oral cavity requires the understanding of surgical and pharmacotherapeutic interventions as they apply to single and multispace infections. Three clinical cases are presented where Prevotella species were significant opportunistic pathogens. Since Prevotella can become virulent under conditions including post-extraction wound healing of an extraction site adjacent to an intact dentition, excessive plaque and calculus, nearby gingivitis or periodontitis, or an immunocompromised host, Metronidazole administration was deemed necessary in the cases described here. This intervention mitigated or resolved these odontogenic infections that were refractory to conservative surgical therapy that included source control. The involvement of Prevotella in odontogenic infections and pericoronitis, and the antibiotics used to treat common oral and maxillofacial infections with this bacterium are reviewed. Prevotella is susceptible to Metronidazole (Flagyl), and the antibiotic is effective in mitigating the disease process when basic principles of the treatment of odontogenic infections are employed.

After 29 years of clinical practice treating odontogenic infections of the head, neck and oral cavity, my co-contributors and I sought to determine by a review of the literature and three clinical cases if Prevotella species were significant opportunistic pathogens in odontogenic infections of all kinds in the oral and maxillofacial region. We performed a PubMed review of 40 articles using terms associated with odontogenic infections, pericoronitis, Prevotella and antibiotics used to treat common oral and maxillofacial infections. Three cases were reported, and the treatment was discussed. An additional 26 articles were reviewed to describe the pathogenesis of Prevotella. Given the opportunity to become virulent—such as post-extraction wound healing of an extraction site adjacent to an intact dentition, excessive plaque and calculus, nearby gingivitis or periodontitis, or an immunocompromised host—we wondered if Prevotella could be targeted with antimicrobials mitigating, or even resolving, odontogenic infections in those cases refractory to conservative surgical therapy that includes source control. We found that Prevotella is a significant opportunistic pathogen in odontogenic infections. Prevotella is susceptible to Metronidazole (Flagyl), and it is effective in mitigating the disease process when basic principles of the treatment of odontogenic infections are employed. Infections not responsive to this empiric therapy should be cultured to determine the opportunistic organism’s sensitivity and susceptibility to specific antibiotic therapy.

An easy and short-time TLC-densitometric method was developed for the separation of metronidazole, secnidazole, ornidazole, tinidazole, and 2-methyl-5-nitroimidazole and for the determination of metronidazole and tinidazole in Metronidazole Polpharma and Tinidazolum Polpharma tablets. Analyzes were performed on chromatographic plates precoated with silica gel 60F254 using the optimal mobile phase: chloroform + methanol + diethylamine in a volume ratio of 9:1:1. The method has been validated. The intraday and interday precision values for the three different concentrations ranged from 0.99% to 1.48% and 0.89% to 1.76%, and the precision values ranged from 1.13% to 2.48% and 0.95% to 2.49% for metronidazole and tinidazole, respectively. The limit of quantification (LOQ) was 0.036 and 0.066 µg/spot for metronidazole and tinidazole, respectively. The mean recovery was 103.1% and 100.6% for metronidazole and tinidazole, respectively. The content of metronidazole and tinidazole in tablets in relation to the content declared by the manufacturer was 101.3% and 99.8%, respectively. The obtained results were verified using the pharmacopoeial method. The presented method is fast, sensitive, precise, selective, accurate and robust. It allows for the analysis of several samples on one chromatography plate at the same time.

Previously, we reported that metronidazole MICs are not dependent on the expression levels of nim genes in B. fragilis strains; and we also compared the proteomes of metronidazole-resistant laboratory B. fragilis strains to those of their susceptible parent strains. Here, we used RT-qPCR to correlate the expression levels of 18 candidate genes in a panel of selected, clinical nim gene-positive and -negative B. fragilis strains to their metronidazole MICs. Metronidazole MICs were correlated to the expression of certain tested genes. Specifically, lactate dehydrogenase expression correlated positively, whereas cytochrome fumarate reductase/succinate dehydrogenase, malate dehydrogenase, phosphoglycerate kinase redox and gat (GCN5-like acetyltransferase), and relA (stringent response) regulatory gene expressions correlated negatively with metronidazole MICs. This result provides evidence for the involvement of carbohydrate catabolic enzymes in metronidazole resistance in B. fragilis. This result was supported by direct substrate utilization tests. However, the exact roles of these genes/proteins should be determined in deletion–complementation tests. Moreover, the exact redox cofactor(s) participating in metronidazole activation need to be identified.

Poly(acrylic acid) (PAAc) hydrogels possess good bioadhesive properties and allow enhanced penetration of drugs. In addition, it is possible to localize the absorption site of the drug in the hydrogel and increase the drug residence time. As opposed to other cross-linking processes radiation-induced polymer cross-linking can be easily and rapidly carried out without the use of cross-linking agents and other chemical additives. In this study, we fabricated metronidazole (MD) containing PAAc hydrogel (MD/PAAc) with different MD contents (0.1, 0.25, 0.5 wt%) using varying radiation doses (25, 50, 75 kGy) by gamma-irradiation. The physical and thermal properties were determined by gel content analysis, swelling ratio measurements, compressive strength measurements, differential scanning calorimetery, and thermogravimetric analysis. The properties of the hydrogel degraded due to the crystalline nature of MD. The properties of the hydrogel degraded due to the crystalline nature of MD. Cumulative release observed after 50 min in the case of 0.5MD/PAAc and 0.1MD/PAAc was 50% and 10%, respectively. Our findings suggest that MD/PAAc could be a suitable drug delivery carrier for use with radiation-based techniques.

Background. Metronidazole treats obligate anaerobic bacterial and protozoal infections, with an elimination half-life of around eight hours. The long elimination half-life, the favorable ratio of steady-state serum levels to minimum inhibitory concentration, and the presence of active metabolites lead to consideration of metronidazole use at 12-hour dosage intervals. This systematic review aimed to compare the clinical outcomes of twice-daily and thrice-daily metronidazole dosing. Methods. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. PubMed, Scopus, Science Direct, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials to systematically identify all relevant studies published up to June 16, 2023. Results. The final analysis included two published retrospective cohort studies; a single site (n = 200) and a multisite study (n = 85) of ‘good’ quality, as measured by the Newcastle-Ottawa scale. The reported baseline characteristics of the 8-hour and 12-hour dosing groups were comparable, and neither study identified significant differences in primary and secondary clinical outcomes. Meta-analysis of the need to escalate antibiotic therapy also showed no statistically significant differences using the Mantel-Haenszel fixed-effect method (95% CI: 47.6% lower to 6.4 times higher risk, p = 0.342) and inverse-variance method (RR: 1.87, 95% CI: 0.52-6.65, p = 0.336). Conclusions. Dosing metronidazole every 12 hours is as effective as every 8-hour dosing for anaerobic infections. Healthcare systems may consider the adoption of every 12-hour metronidazole dosing with continued evaluation of patient outcomes.

The purpose of this study was to investigate the effect of chitosan (CS) and Alginate (Alg) polymers concentrations and CaCl2 concentration on metronidazole (MET) drug loading (LE), size particles and zeta potential. Nanocomposites were prepared by ionotropic pregelation method. A (21 *31 *21) *3= 36 full factorial design (FFD) was used to predict statistical equation and responses. The MET-CS-AlgNPs nanocomposites were characterized by X-ray diffraction, Fourier-transform infrared spectroscopy, thermal gravimetric analysis, scanning electron microscope and in vitro drug release studies. All data indicated the presence of drug into MET-CS-AlgNPs nanocomposites. The release profile of MET-CS-AlgNPs nanocomposites was found to be sustained

In Belgium, around a quarter of M. genitalium infections are resistant to both macrolides and fluoroquinolones -termed multi-drug-resistant (MDR) infections. It is unclear what the best treatment is for these infections. We report the first two cases of MDR M. genitalium urethritis treated with combination therapy of minocycline, metronidazole, methenamine and pristinamycin. In both cases, this treatment resulted in microbiological and clinical cure.

Interpolyelectrolyte complexes Eudragit® EPO/L100 received in different pH were characterized by different degree of swelling in mimicking fasted stomach medium (0.1 M HCl) and saved their shape during 6 hours of the experiment. The microenvironmental changes in IPECs structure during swelling testing were inves-tigated using FT-IR spectroscopy, thermal and elemental analysis. Both samples of IPECs during swelling were transformed to a similar structure with approximately the same composition. IPEC samples showed bioadhesive properties that was not significantly different from the positive control (Carbopol) in the test with the mucin compacts. The release rate of metronidazole (class I BCS) from IPEC matrices increased with the increasing degree of swelling. IPEC 1 provided 49.62 ± 6.20% and IPEC 2 – 87.69 ± 5.15 % of metronidazole release after 6 hours in mimicking fasted stomach medium (0.1 M HCl). Total amount of released acyclovir (class III BCS) from IPEC 1 was 25.76 ± 5.67 % and from IPEC 2 was 21.48 ± 5.00 %. Release of both drugs was controlled by relaxation of polymeric chains in matrices according to the Peppas-Sahlin model. According to the received results, investigated interpolymer complexes are perspective for further evalua-tion as carriers for gastroretentive bioadhesive systems.

Simple Summary: The distribution of typical bacterial redox enzymes such as pyruvate-ferredoxin oxidoreductase (PFOR) in protozoa remains interestingly puzzling. Previous studies have demonstrated diverse cellular localizations of PFOR in some amitochondriate anaerobic protozoa. PFOR is of particular pharmacological importance because it catalyzes the reductive bio-activation of nitro-based prodrugs to cytotoxic radical metabolites. Metronidazole was developed primarily as an antiprotozoal agent against infections caused by Trichomonas vaginalis. However, its antimicrobial spectrum was subsequently expanded to cover anaerobic bacterial infections. It has been shown that mutations in the genes encoding PFOR result in inherent resistance of PFOR-possessing anaerobic protozoa and bacteria to nitro-based prodrugs. Deciphering the evolutionary history of PFOR is crucial in deepening our understanding of the evolution of anaerobic pathogens and unfold new approaches for drug discovery and targeting in pathogen chemotherapy. Abstract: The present frontrunners in the chemotherapy of infections caused by protozoa are nitro-based prodrugs that are selectively activated by PFOR-mediated redox reactions. This study seeks to analyze the distribution of PFOR in selected protozoa and bacteria by applying comparative bioinformatics approaches to test the hypothesis that PFOR was most likely acquired through horizontal gene transfer (HGT) from bacteria. Furthermore, to identify other genes that were putatively acquired using proteome-wide and gene expression analyses. A plausible explanation for the patchy occurrence of PFOR in protozoa is based on the hypothesis that bacteria are potential sources of genes that enhance optimal adaptation of protozoa in hostile environments. The exclusively expressed proteins obtained from Entamoeba histolytica and the putative gene donor, Desulfovibrio vulgaris, showed an over-expression of eleven genes involved in intermediary metabolism. If these results can be reproduced in other PFOR-possessing protozoa, it would provide a more validated evidence to support the horizontal transfer of pfor from bacteria.

Background: The important periodontal disease pathogen Porphyromonas gingivalis produces large biofilms that increase its pathogenicity. Finding natural antimicrobial agents is crucial because of the rise in antibiotic resistance. Objective: The purpose of this study was to determine if plant extracts such as Symphytum officinale (S) and Panax ginseng (G) were effective against P. gingivalis separately and in combination with a common antibiotic Metronidazole (F). Materials and Procedures: Six different dilutions were produced the plant extracts and antibiotic separately and in combination with G and F and S and F using two-fold serial dilution technique. To evaluate the effects of these substances biofilm inhibition experiments were conducted. Plaque samples were collected from periodontitis patients to isolate P. gingivalis and standard strain of P. gingivalis (ATCC 33277) were bought. Additionally, Acylated Homoserine Lactones (AHLs) detection was carried out to look for any activity that would interfere with quorum sensing. GraphPad prism was used for statistical analysis with p value < 0.05. Results: The combinations of Symphytum Officinale and Metronidazole (S+F) showed the maximum effectiveness in biofilm inhibition (98.7%), which was better than G+F (98.2%) with substantial variations in biofilm inhibition levels in different treatment regimes. Notably, the isolate from the patient was more active than the standard strain. Additionally, the plant extracts and their combinations at particular dilutions had notable inhibitory effects on the generation of AHL (p <0.05). Conclusion: The study highlights the possibility of Symphytum Officinale and Panax Ginseng as effective treatments for P. gingivalis biofilm and AHLs, both on their own and in combination with Metronidazole. These organic substances may open the door to cutting-edge methods of treating periodontal disorders.

Bacterial nitroreductase enzymes that convert prodrugs to cytotoxins are valuable tools for creating transgenic targeted ablation models to study cellular function and cell-specific regeneration paradigms. We recently engineered a nitroreductase (“NTR 2.0”) for substantially enhanced reduction of the prodrug metronidazole, which permits faster cell ablation kinetics, cleaner interrogations of cell function, ablation of previously recalcitrant cell types, and extended ablation paradigms useful for modelling chronic diseases. To provide insight into the enhanced enzymatic mechanism of NTR 2.0, we have solved the X-ray crystal structure at 1.85 Angstroms resolution and compared it to the parental enzyme, NfsB from Vibrio vulnificus. We additionally present a survey of reductive activity with eight alternative nitroaromatic substrates, to provide access to alternative ablation prodrugs, and explore applications such as remediation of dinitrotoluene pollutants. The predicted binding modes of four key substrates were investigated using molecular modelling.

Background: The biofilm-forming bacteria Porphyromonas gingivalis (P. gingivalis) is primarily responsible for periodontal disorders, which continue to be a global health issue. Despite the widespread use of antibiotics like metronidazole, other potent therapeutic a crucial quorum sensing molecule implicated in the formation of P. gingivalis biofilm. Approaches are now being explored due to the growing challenge of antibiotic resistance. Objective: In particular, chemicals from Symphytum Officinale (S) and Panax Ginseng (G) plants will be examined in this study to assess if they have the ability to inhibit biofilm and to prevent the development of acylated homoserine lactones (AHLs), a quorum sensing molecule. Materials and Methods: With Metronidazole serving as a control, the antibacterial effects of these substances (Symphytum Officinale and Panax Ginseng) were examined against a standard strain and a clinical isolate of P. gingivalis. Dilutions of these plant extracts were used either alone (G+S) or in conjunction with metronidazole (G+S+F), to assess their antibacterial activity using antibacterial susceptibility test (inhibition zone), biofilm inhibition and disruption assay (optical density) and quorum sensing inhibition assay (AHL). Results: The combinations of Symphytum officinale, Panax Ginseng and metronidazole (S+G+F) showed the maximum effectiveness with highest zone of inhibition (25.000±0.001 mm) and biofilm inhibition (98.46%), and were comparable to G+S (inhibition zone of 24.341±0.593 mm and biofilm inhibition of 97.76%), and significantly different in the degree of biofilm inhibition with different treatment scenarios. Additionally, the plant's extracts and combinations are specific concentrations had a significant effect on the suppression of the generation of AHL (p < 0.05). Conclusion: According to preliminary research, these plant-derived substances, especially when paired with metronidazole, significantly inhibited the growth of P. gingivalis biofilm providing valuable information for the development of innovative therapeutic approaches for periodontitis and other biofilm-associated illnesses.