tinidazole
Sources réglementaires consultées
Indications approuvées
- Trichomonase, giardiase, amibiase et vaginose bactérienne chez les femmes adultes non enceintes.
Contre-indications
Absolues
- Hypersensibilité au tinidazole ou aux nitro-imidazolés ; syndrome de Cockayne.
Mises en garde cliniques
- Un risque potentiel de cancérogénicité a été observé avec les médicaments de cette classe ; limiter le tinidazole aux indications approuvées et éviter l’usage chronique. — DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- Mise en garde majeure · Il peut provoquer des convulsions, une neuropathie périphérique et des cytopénies ; arrêter en cas de symptômes neurologiques et éviter les traitements chroniques. — DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
Interactions médicamenteuses
- ModéréeAlcool ou propylène glycol
Mécanisme: Il peut provoquer une réaction de type disulfirame.
Recommandation: Éviter pendant le traitement et pendant 3 jours après.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- ModéréeDisulfirame
Mécanisme: Il augmente le risque de réactions psychotiques.
Recommandation: Ne pas utiliser si du disulfirame a été pris au cours des 2 semaines précédentes.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- SévèreWarfarine
Mécanisme: Il potentialise l’effet anticoagulant.
Recommandation: Adapter et surveiller l’INR pendant le traitement et jusqu’à 8 jours après.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- SévèreLithium, ciclosporine ou tacrolimus
Mécanisme: Le tinidazole peut augmenter leurs concentrations et leur toxicité.
Recommandation: Surveiller les concentrations, la fonction rénale et la toxicité ; adapter si nécessaire.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- Sévère5-fluorouracile
Mécanisme: Il peut réduire la clairance et augmenter la toxicité.
Recommandation: Surveiller la toxicité et adapter le traitement anticancéreux avec l’équipe responsable.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- SévèrePhénytoïne ou fosphénytoïne
Mécanisme: L’interaction peut modifier les concentrations des deux traitements.
Recommandation: Surveiller les concentrations et la réponse clinique et adapter si nécessaire.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- SévèreInducteurs ou inhibiteurs du CYP3A4
Mécanisme: Les inducteurs peuvent réduire l’exposition et les inhibiteurs peuvent l’augmenter.
Recommandation: Surveiller une perte d’efficacité ou une toxicité et adapter ou utiliser une alternative si nécessaire.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
Effets indésirables
Communs (≥1%)
Nausées, goût métallique, douleur abdominale et céphalées
Rares mais graves
Convulsions, neuropathie périphérique et cytopénies sévères
Grossesse et allaitement
Pendant la grossesse, utiliser uniquement si le bénéfice l’emporte sur le risque ; l’étiquette locale n’établit pas d’interdiction propre au premier trimestre. Interrompre l’allaitement pendant le traitement et pendant 72 heures après la dernière dose.
Bibliographie récente (PubMed)
Vaginitis is a general term for inflammation of the vagina with symptoms such as vulvovaginal itching, burning, irritation, dyspareunia, odor, or abnormal vaginal discharge. It is a common condition that results in 5 million to 10 million office visits annually. The leading infectious causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Noninfectious causes include atrophic, irritant, and inflammatory vaginitis. Bacterial vaginosis usually presents with a thin, homogenous vaginal discharge and a fishy odor. Vulvovaginal candidiasis often manifests with a white, thick, curd-like discharge, pruritus, and vulvar erythema. Trichomoniasis usually presents with a green or yellow frothy discharge, and speculum examination may reveal cervical erythema with petechiae. Noninfectious vaginitis can present with clear or purulent discharge and can be pruritic depending on the etiology. Bacterial vaginosis can be diagnosed using Amsel criteria, Gram stain, or a nucleic acid amplification test (NAAT). Vulvovaginal candidiasis can be diagnosed by visualization of yeast hyphae or budding yeast on microscopy, vaginal fungal culture, polymerase chain reaction testing, or NAAT. Trichomoniasis can be diagnosed with visualization of motile, flagellated protozoa on saline microscopy, NAAT, or DNA probe test. Bacterial vaginosis is treated with oral or intravaginal metronidazole or intravaginal clindamycin. Vulvovaginal candidiasis is managed with topical or oral antifungals. Trichomoniasis is treated with oral metronidazole or tinidazole. When treating trichomoniasis, testing for reinfection, as well as other sexually transmitted infections, is recommended. Treatments for noninfectious vaginitis include vaginal lubricants and moisturizers, topical hormones, and topical steroids, depending on the cause.
Amoebiasis, caused by Entamoeba histolytica, remains a major public health issue, particularly in developing countries with poor sanitation. It is also a significant challenge among those who travel to endemic areas, causing, in many cases, so-called traveler diarrhea. Approximately 10 percent of the global population is estimated to be affected by this parasitic infection. The primary route of transmission is the consumption of food or water contaminated with E. histolytica cysts. While most infected individuals may remain asymptomatic, some develop severe complications, including hemorrhagic colitis, liver abscesses, and, in extreme cases, colonic perforation. It has been estimated that amoebiasis is responsible for nearly 100,000 deaths annually. Standard treatment for amoebic colitis involves a combination of luminal agents (such as paromomycin, diloxanide furoate, and diiodohydroxyquin) and tissue amoebicides (including metronidazole and tinidazole). Although these treatments are effective, new therapeutic options to improve patient outcomes are needed. One promising avenue for drug discovery is the β-carbonic anhydrase enzyme (EhiCA) of E. histolytica, which has emerged as a potential target for novel antiamoebic therapies. EhiCA was recently produced as a recombinant protein and has been used in kinetic and inhibition studies with various sulfonamides and anions, with promising results.
The spontaneous cure rate of chronic endometritis is very low, and doxycycline alone or a combination of levofloxacin and tinidazole are the 2 most widely used antibiotic regimens for treating chronic endometritis. However, there is currently no consensus regarding the optimal antibiotic regimen. This study aimed to assess the effectiveness and safety of doxycycline alone and levofloxacin combined with tinidazole as antibiotic therapies for chronic endometritis. In this parallel randomized controlled trial comparing 2 antibiotic therapies for chronic endometritis, 172 patients with chronic endometritis diagnosed using CD138 were randomly divided into treatment and control groups. Levofloxacin combined with tinidazole was administered to the treatment group, whereas doxycycline alone was administered to the control group. Repeated hysteroscopy and endometrial biopsies were performed during the first menstrual proliferative period after antibiotic therapy to evaluate the resolution of chronic endometritis. The one-course cure rate for chronic endometritis, based on the conversion of CD138 expression from positive to negative, and the incidence of adverse reactions were compared between the groups. A total of 160 patients were enrolled, with 79 in the treatment group and 81 in the control group. After one course of antibiotic therapy, there was no difference in the chronic endometritis cure rate between the groups (84.8% vs 77.8%) (P=.255). In the subgroup analysis based on chronic endometritis severity, there were no differences between the groups regardless of whether chronic endometritis was mild (88.9% vs 83.7%) (P=.464) or severe (79.4% vs 68.8%) (P=.322). In the intent-to-treat analysis (n=172), the cure rates were 77.9% (67/86) and 73.3% (63/86) in the treatment and control groups, respectively, showing no difference between the groups (P=.595). The incidence of adverse reactions was significantly higher in the treatment group (11.6% vs 2.3%, P=.032) in the safe
Trichomoniasis is the most common sexually transmitted infection. It is caused by the parasite Trichomonas vaginalis. Nitroimidazoles, particularly metronidazole and tinidazole, have been the main treatment options for decades. They still remain the standard treatment, and resistance to them is relatively rare. However, cases of resistance do occur, and the side effects can be significant. This highlights the urgent need for new drugs with different mechanisms of action. Promisingly, several innovative leads have emerged. Interesting drug targets in T. vaginalis include two β-carbonic anhydrases, which have been recently described. These enzymes have been characterized in terms of their structural and kinetic properties, and potential inhibitors have been identified. This new knowledge on β-carbonic anhydrases offers hope for the development of novel antitrichomonal agents to effectively combat this parasitic disease in the future.