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1.  Effect of Rasanjana Madhu Ashchyotana in Netra Abhishyanda (Mucopurulent Conjunctivitis) 
Ayu  2011;32(3):365-369.
To evaluate the comparative efficacy of Ayurvedic formulation a Rasanjana Madhu (RM) eye drops and Honey Rose (HR) water eye drops in Netra Abhishyanda in mucopurulent conjunctivitis, the current study is planned. Total of 35 patients attending the outpatient department of Shalakya Tantra at R. G. G. Postgraduate Ayurvedic College, Paprola, Distt. Kangra, Himachal Pradesh with characteristic features of Netra Abhishyanda were selected for the present study. Twenty patients were given trial drug, i.e., RM eye drops, while 15 patients were given HR eye drops. Random sampling technique was adopted for the present study. The duration of the treatment was 7 days with 1 week follow-up. Patients receiving the trial group demonstrated reduction of redness, burning sensation, lacrimation, photophobia, foreign body sensation, discharge, and congestion, which were statistically significant with 93% patients cured or markedly improved category. Signs and symptoms stated above were also statistically reduced with HR eye drops, probably because of well-documented hygroscopic and bacteriocidal properties of honey. Based on the study, it can be concluded that, RM eye drops are very effective in the management of Netra Abhishyanda viz. Infective conjunctivitis.
PMCID: PMC3326884  PMID: 22529652
Abhishyanda; infective conjunctivitis; Rasanjana Madhu eye drops; rose water eye drops
2.  A comparative study of Bilvadi Yoga Ashchyotana and eye drops in Vataja Abhishyanda (Simple Allergic Conjunctivitis) 
Ayu  2012;33(1):97-101.
Simple allergic conjunctivitis is the most common form of ocular allergy (prevalence 5 – 22 %). It is a hypersensitivity reaction to specific airborne antigens. The disease Vataja Abhishyanda, which is due to vitiation of Vata Pradhana Tridosha is comparable with this condition. The management of simple allergic conjunctivitis in modern ophthalmology is very expensive and it should be followed lifelong and Ayurveda can provide better relief in such manifestation. This is the first research study on Vataja Abhishyanda. Patients were selected from the Outpatient Department (OPD), Inpatient Department (IPD), of the Shalakya Tantra Department and were randomly divided into two groups. In Group-A Bilvadi Ashchyotana and in Group-B Bilvadi eye drops were instilled for three months. Total 32 patients were registered and 27 patients completed the course of treatment. Bilvadi Ashchyotana gave better results in Toda, Sangharsha, Parushya, Kandu and Ragata as compared with Bilvadi Eye Drops in Vataja Abhishyanda.
PMCID: PMC3456873  PMID: 23049192
Ashchyotana; eye drops; simple allergic conjunctivitis; Vataja Abhishyanda
3.  Ocular myasis and associated mucopurulent conjuctivitis acquired occupationally: A case study 
Ocular myasis and associated mucopurulent conjunctivitis in human eyes is a rare phenomenon. However, if the sheep bot fly abounds and poor hygienic environment prevails, the Oestrous ovis deposits its larvae in the conjunctival eye sac of human. The present paper reports a case study of ocular myasis among sheep farm workers caused by Oestrous ovis. The ocular myasis and the associated mucopurulent conjunctivitis are occupationally acquired in these cases. This study also suggests the treatment of patients and the recovery of the larvae.
PMCID: PMC2796773  PMID: 20040993
Mucopurulent conjuctivitis; occupational ocular myasis; oestrus ovis
4.  Bilateral symmetrical corneal melting following intravesical Bacille Calmette-Guerin therapy for bladder carcinoma 
Oman Journal of Ophthalmology  2012;5(2):106-108.
A 63-year-old man with unremarkable previous ocular history presented with bilateral symmetrical corneal ulceration along with mucopurulent conjunctivitis and dry eye 10 days after the fourth dose of intravesical Bacille Calmette-Guerin (BCG) instillation for treatment of bladder carcinoma. Slit lamp examination revealed thinning of the cornea at the base of the ulcer in both eyes. Conjunctival swab and scraping from ulcer sent for Gram and acid fast bacilli stain and culture were negative. On the basis of history, clinical examination, and laboratory investigations, we diagnosed it as bilateral immune mediated sterile corneal ulceration along with mucopurulent conjunctivitis and dry eye. He was treated with topical antibiotics, cycloplegics, cyclosporine, lubricant gel, and bandage contact lens. There was progressive stromal melting, descemetocele formation, and perforation in the inferior part of cornea in both the eyes. He was treated with pulse steroid and paramedian tarsorraphy in both eyes. The patient was subsequently lost to follow-up. We report this case to highlight this rare complication of BCG therapy, in order to improve their management protocol in patients with similar clinical profile. We could not find a similar case after thorough PubMed search.
PMCID: PMC3441015  PMID: 22993466
Bacille Calmette-Guerin; bladder carcinoma; corneal ulcer; descemetocele
5.  Infectious conjunctivitis caused by Pseudomonas aeruginosa isolated from a bathroom 
BMC Research Notes  2013;6:245.
The elucidation of the routes of transmission of a pathogen is crucial for the prevention of infectious diseases caused by bacteria that are not a resident in human tissue. The purpose of this report is to describe a case of suture-related conjunctivitis caused by Pseudomonas aeruginosa for which we identified the transmission route using pulsed-field gel electrophoresis (PFGE).
Case presentation
A 38-year-old man, who had undergone surgery for glaucoma 2 years ago previously, presented with redness, discomfort, and mucopurulent discharge in the right eye. A 9–0 silk suture had been left on the conjunctiva. A strain of P. aeruginosa was isolated from a culture obtained from the suture, and the patient was therefore diagnosed with suture-related conjunctivitis caused by P. aeruginosa. The conjunctivitis was cured by the application of an antimicrobial ophthalmic solution and removal of the suture. We used PFGE to survey of the indoor and outdoor environments around the patient’s house and office in order to elucidate the route of transmission of the infection. Three strains of P. aeruginosa were isolated from the patient’s indoor environment, and the isolate obtained from the patient’s bathroom was identical to that from the suture.
The case highlights the fact that an indoor environmental strain of P. aeruginosa can cause ocular infections.
PMCID: PMC3702478  PMID: 23815865
Pseudomonas aeruginosa; Conjunctivitis; Bathroom; Pulsed-field Gel Electrophoresis
6.  Listeria monocytogenes endophthalmitis following keratoconjunctivitis 
Endophthalmitis due to endogenous or exogenous bacteria is a rare infection of the eye. We report a case of endophthalmitis following Listeria monocytogenes keratoconjunctivitis in a 27-year-old healthy white male presenting with hand motion visual acuity, right eye mucopurulent conjunctivitis, elevated intraocular pressure, and pigmented hypopyon 6 months post-keratectomy. The conjunctivitis was unresponsive to a 5-day course of topical tobramycin eye drops, and the patient developed keratitis with pain that progressed to endophthalmitis after 21 days. Diagnostic B-scan revealed vitreous exudates. Intraocular fluid specimen showed Gram-positive organisms and the aqueous culture grew penicillin-/aminoglycoside-sensitive L. monocytogenes. The patient was given intravitreal and systemic vancomycin and ceftazidime. The eye was unresponsive to intravenous penicillin and gentamicin; the anterior chamber progressively flattened and developed phthisis bulbi. L. monocytogenes keratoconjunctivitis may lead to bacterial endophthalmitis. Prompt culture and early antibiotic therapy are recommended.
PMCID: PMC3908887  PMID: 24493921
conjunctivitis; L. monocytogenes; endophthalmitis
7.  Keratoconjunctivitis caused by an unusual retained conjunctival foreign body: A frequently unrecognized entity 
Indian Journal of Ophthalmology  2014;62(5):633-635.
The purpose of this study is to describe a case series of keratoconjunctivitis caused by a retained bindi (dot) in six children who presented to a tertiary eye care facility in Southern India.
Patients and Methods:
Over a period of 11 years (January 2000 and January 2012), six children (all female, ranging in age from 6 months to 3 years) were diagnosed with ocular manifestations subsequent to a retained bindi.
All patients presented with redness, photophobia, extensive lacrimation, and blepharospasm. Two patients presented with mucopurulent conjunctivitis, three patients with suppurative keratitis and one patient presented with corneal epithelial defect. After removal of the foreign body the response to topical antibiotics was good in five of six cases, whereas one patient required therapeutic keratoplasty.
Young children presenting with unilateral keratitis and conjunctivitis should alert the clinician to the possibility of a retained foreign body in the eye.
PMCID: PMC4065521  PMID: 24881616
Bindi; keratitis; keratoconjunctivitis
8.  OA01.44. Efficacy of arjunatwak mukhalepa and panchanimba churna in the management of vyanga facial melanosis 
Ancient Science of Life  2012;32(Suppl 1):S44.
The smooth and glowing complexion of face increases the beauty of a person and also gives tremendous self-confidence. Vyanga is a disease which decreases the glowing complexion of face and affects the skin. Even though it is considered as kshudra roga (minor disease), it has got a major importance as a cosmetic problem in the society. It is characterized by the presence of painless and bluish-black patches on face. Treating this condition has become a problem, since safe drugs are not available for long term therapy. So the study was aimed to evaluate the efficacy of Arjunatwak lepa with Madhu and Panchanimba churna internally.
For clinical study, 30 clinically diagnosed patients were registered and divided into two groups with 15 patients in each group. In Group-A patients were administered with Arjunatwak lepa with Madhu for 21days. In Group-B patients were administered with both Arjunatwak lepa with Madhu and Panchanimba churna internally for 21days
In Group A, out of 15 patients, 09 patients were cured completely, which was statistically significant at the level of p<0.01. 4 patients have shown marked improvement, 2 patients showed slight improvement. In Group B, out of 15 patients, 12 patients had attained normal skin color, which was statistically highly significant at the level of p<0.001, 1 patient had mild improvement, 2 patients have moderate improvement. Statistically significant result was obtained in symptom bluish-black patch over the face. The clinical study has shown that combined therapy in Group-B gives better results than topical treatment.
From the observations and results of this study, it can be concluded that combined therapy using Arjunatwak lepa along with Panchanimba churna have provided better results in depigmentation of the patches seen in Vyanga roga than local therapy.
PMCID: PMC3800923
9.  A case report of fowl plague keratoconjunctivitis. 
A case of human fowl plague keratoconjunctivitis occurred after accidental laboratory exposure. The conjunctivitis was characterised by follicle formation and a mucopurulent discharge, and ran a self-limiting course over two weeks. The keratitis was of an unusual type and consisted of small intraepithelial opacities, which appeared after one week and resolved completely over the next three weeks. The infection, confirmed by viral culture, was produced by Dutch strain (Hav 1 Neq 1) of fowl plague virus.
PMCID: PMC1042886  PMID: 843515
Twenty-four cases of an acute ophthalmia of cattle have been observed. The infection is characterized by photophobia, severe congestion of the vessels of the eyeball, conjunctivitis, congestion and edema of the membrana nictitans, edema of the eyelids, accompanied by a thick, yellowish white mucus or mucopurulent exudate. In certain cases corneal ulcers and extensive corneal opacities developed. From all cases a characteristic diplobacillus was obtained. The organism was usually observed in the exudate in large numbers. The morphology, the hemolytic properties, and the proteolytic activities readily assist in its identification. Instillation of a few drops of bouillon suspensions of pure cultures beneath the eyelids of normal cattle gave rise to characteristic inflammations. The organism is not pathogenic for laboratory animals.
PMCID: PMC2128430  PMID: 19868779
11.  Role of honey (Madhu) in the management of wounds (Dushta Vrana) 
Application of Madhu (honey) is one among the Shashthi Upakrama (sixty treatment modalities) described by Sushruta. Clinical observation has shown its effectiveness in treatment of Dushta Vrana (chronic wounds). We report a case of Dushta Vrana on the anterior aspect of the right leg that was treated successfully with local application of Madhu and Neem (Azadirachata indica) bark decoction.
PMCID: PMC3059452  PMID: 21455457
Dushta Vrana; Madhu; Neem bark; Shashthi Upakrama
12.  Role of Pradhamana Nasya and Trayodashanga Kwatha in the management of Dushta Pratishyaya with special reference to chronic sinusitis 
Ayu  2010;31(3):325-331.
Dushta Pratishyaya is the chronic stage of Pratishyaya, which occurs due to neglect or improper management of the disease Pratishyaya. In modern science, chronic sinusitis can be correlated with Dushta Pratishyaya on the basis of the signs, symptoms, complications, and prognosis. Changing lifestyles, rapid urbanization, and the increase in cases of antibiotic resistance are responsible for the rise in the prevalence of sinusitis. In the present clinical study, 37 patients were registered and were randomly divided into three groups: A, B, and C; of the 37 patients, 31 completed the full course of treatment. In group A, Trayodashanga Kwatha with Madhu was given orally; in group B, Pradhamana Nasya with Trikatu + Triphala Churna was administered; and in group C (combined group), Pradhamana Nasya was administered initially, followed by oral Trayodashanga Kwatha with Madhu. In group A, complete relief was observed in 10% of the patients; in group B, marked improvement was observed in 81.82% of patients; and in group C, marked relief was observed in 60% of patients. In comparison to other groups (Group A and Group B), Group C showed percentage wise better results in most of the symptoms.
PMCID: PMC3221066  PMID: 22131734
Dushta Pratishyaya; chronic sinusitis; Trayodashanga Kwatha; Pradhamana Nasya
13.  Vranaropaka effect of Laksha Churna with Madhu on wound after removal of Danta Sharkara 
Ayu  2012;33(1):92-96.
According to Sushruta, disease in which plaque formed on teeth and hardened by the action of deranged Vayu, lies in a crystallized form at root of teeth is called as Dantasharkara. According to Vagbhata, accumulation of dirt on teeth by not cleaning them daily or of Kapha dehydrated by Vata adhering to the teeth, becoming hard and emits bad odor is known as Dantasharkara (Tartar). Tartar manifests as a deposit of inorganic salts composed primarily of calcium carbonate and phosphate mixed with food debris, bacteria and desquamated epithelial cells which reduce the quality of whiteness and strength of the teeth. Teeth loss is also not uncommon in tartar sufferers. Such deposits tend to destroy the healthy growth and function of teeth. It should be removed in such a way as not to hurt the roots of the teeth and then parts should be rubbed (Pratisarana) with Laksha Churna and Madhu. In trial group, management of tartar is attempted by local rubbing of Laksha Churna with Madhu on the surface of teeth and gingiva. Regeneration, repair and new attachment are the aspects of periodontal healing that are achieved by gingival physiotherapy on scaling wound. Pratisarana of Laksha Churna with Madhu is easy to apply, cost effective and free from side effects in comparison to systemic use of modern drugs.
PMCID: PMC3456872  PMID: 23049191
Dantasharkara; Laksha Churna; Madhu; Pratisarana; Vranaropaka
14.  Wound healing activity of honey: A pilot study 
Ayu  2012;33(3):374-377.
Vrana (wound) and its sequels play a major concern in the field of surgery as Vrana Ropana (wound healing) requires uneventful healing. The aim of the study was to evaluate the changes in physical and morphological properties due to topical application of Madhu (honey) on fresh traumatic wounds or cutaneous wounds. Ten patients of wounds of either sex were randomly selected. Site of the wound, shape, size, floor, and margin were recorded on day 0 and observed on day 7, 15, 20, and till the end of the healing for the progression of granulation, scar type, shape, size, and clinical symptoms. There was significant improvement in the healing process as Madhu possesses antibacterial, wound cleansing, wound healing properties and showed beneficiary effects.
PMCID: PMC3665090  PMID: 23723644
Madhu; Vrana; Vrana Ropana; Vrana shodhana
15.  Beat frequency of cilia from sites of purulent infection. 
Thorax  1986;41(6):453-458.
Mucociliary clearance depends on the interaction between cilia and mucus; it is delayed in the presence of purulent secretions. Nasal mucociliary clearance was examined by the saccharin method and nasal ciliary beat frequency by a photometric technique. Four groups were studied: normal controls, patients with bronchiectasis without nasal symptoms, patients with chronic mucopurulent sinusitis alone, and patients with chronic mucopurulent sinusitis and bronchiectasis. Nasal mucociliary clearance was prolonged in infected patients. Cilia obtained from the site of purulent secretions were found to beat more slowly in vitro (mucopurulent sinusitis 12.1 Hz, mucopurulent sinusitis and bronchiectasis 11.6 Hz), than those obtained from normal controls (14.3 Hz) and from patients with bronchiectasis alone (13.6 Hz). The cause of the ciliary slowing seemed most likely to be the release of host factors during the inflammatory response, rather than the particular organism isolated. Ciliary slowing may contribute to the observed delay of mucociliary clearance in conditions in which purulent secretions are present.
PMCID: PMC460363  PMID: 3787521
16.  Mucopurulent cervicitis: a clinical entity? 
Genitourinary Medicine  1988;64(3):169-171.
Of 297 women attending a sexually transmitted disease clinic who were examined for the presence of mucopurulent cervicitis, 96 (32%) satisfied the diagnostic criteria. Mucopurulent cervicitis was strongly associated with the isolation of Chlamydia trachomatis and Neisseria gonorrhoeae. It was also associated with bacterial vaginosis, the use of oral contraceptives, and sexual contact with men who had non-gonococcal urethritis. Conversely, the presence of opaque cervical secretions did not show these associations, and the results indicated no difference in genital infections in women with clear cervical secretions whether or not more than 10 polymorphonuclear leucocytes per field (at a magnification of x 1000) were present. The findings support the suggestion that mucopurulent cervicitis is a definite clinical entity that requires investigation and treatment.
PMCID: PMC1194193  PMID: 3137151
17.  The BCG World Atlas: A Database of Global BCG Vaccination Policies and Practices 
PLoS Medicine  2011;8(3):e1001012.
Madhu Pai and colleagues introduce the BCG World Atlas, an open access, user friendly Web site for TB clinicians to discern global BCG vaccination policies and practices and improve the care of their patients.
PMCID: PMC3062527  PMID: 21445325
18.  Role of Aragvadhadi Sutra in the Management of Fistula -in-Ano 
Ancient Science of Life  2000;19(3-4):110-112.
Traditional Medicine has its own importance for the treatment of various medical and surgical diseases irrespective of tremendous development of modern medicine. There are number of diseases were after repeated surgery. Fistula-in ano is one such condition which is prone to recurrence even after repeated surgery and can be effectively treated by Ayurvedic medicines. An extensive work has been done on the treatment of Bhagandara by Kshara sutra exploring various aspects of the problem and finding our the solution to them1. the present study is related to similar type of medicated thread known as Aragvadadi Sutra which has been mentioned by sushruta in Bhagandara. It consists of Aragvadha (Cassia fistula), Haridra (Curcuma longa), Agaru (Aquilaria agalocha), Madhu (Honey) and Ghrita (Ghee). This is the first non-caustic thread being tried on different types of Bhagandara. Especially it is a painless thread, non-irritant and very useful in sensitive patients like children, females and elders.
PMCID: PMC3336432  PMID: 22556930
19.  A comparative study on Vamana Karma with Madanaphala and Krutavedhana in Ekakushtha (Psoriasis) 
Ayu  2011;32(4):487-493.
Vamana Karma (therapeutic emesis) is the best therapy for the elimination of vitiated Kapha Dosha. In the present clinical practice Madanaphala (Randia dumetorum) is mainly used for Vamana Karma. Apart from Madanaphala, five other drugs, and in total 355 formulations are described in Charaka Samhita; one of them is Krutavedhana (Luffa acutangula) kalpa (formulations). Krutavedhana is specially indicated in Gadha (compact) Dosha condition like Kushtha (skin diseases), Garavisha (slow poison), and so on, for Vamana Karma. The present study aimed to observe the effect on Vamana Karma and by that its effect on Ekakushtha (Psoriasis). Krutavedhana Beeja Churna (seed powder) was given with Madhu (honey) and Saindhava (rock salt) as Vamana Yoga (emetic formulation), to compare it with Madanaphala Pippali Churna (seed powder). After the Sansarjana Krama (special dietetic schedule), Panchatikta Ghrita (medicated ghee) was given as Shamana Sneha (pacifying oleation). An average dose of Krutavedhana was 5.9 g. Krutavedhana could produce a good number of Vega (bouts), Pittanta Lakshana (bile coming out at the end of Vamana), and Pravara Shuddhi (maximum cleansing) in a majority of patients. Madanaphala is the best among all Vamaka (emetic) drugs, but Krutavedhana showed a similar to higher effect on Vamana Karma in terms of Antiki, Maniki, Vaigiki, and Laingiki Shuddhi (cleansing criteria). Vamana Karma by Krutavedhana showed better relief in Matsyashakalopamam (silvery scale), Kandu (itching), and Rukshataa (dryness), while Madanapahala showed better relief in Krishnaruna Varna (erythema). After completion of the Shamana (pacifying) treatment, both the groups showed nearly the same effect on Asvedanam (lack of perspiration), Matsyashakalopamam, Kandu, Rukshataa, Krishnaruna Varna, and Mahaavaastu (bigger lesion).
PMCID: PMC3361923  PMID: 22661842
Ekakushtha; Krutavedhana; Madanaphala; Panchatikta Ghrita; Psoriasis; Vamana Karma
20.  Clinical efficacy of Gokshura-Punarnava Basti in the management of microalbuminuria in diabetes mellitus 
Ayu  2012;33(4):537-541.
Microalbuminuria is the strong predictor of diabetic nephropathy, which is the main cause of morbidity and mortality in patients with diabetes mellitus (DM). Microalbuminuria is also characterized by increased prevalence of arterial hypertension, proliferative retinopathy, and peripheral neuropathy. The study was planned to evaluate the effect of Gokshura-Punarnava Basti in the management of microalbuminuria in DM (Madhumeha). Eligible diabetic patients with urine albumin excretion between 30 and 300 mg in 24 h were randomly divided into two groups. Asthapana Basti (decoction enema) of Gokshura and Punarnava Kwatha (decoction), Kalka (paste), Taila (medicated oil), Madhu (honey), and Saindhava (rock salt) for 6 consecutive days and Anuvasana (unctuous enema) of Gokshura-Punarnava Taila on 1st and 8th day by traditional Basti Putaka method was given in study group. Tablet Enalapril 5 mg, twice daily for 30 days was given to the patients in control group. The primary outcome measures were percentage change in the presenting complaints of diabetes, urine microalbumin, Blood Sugar Level (BSL), and Blood Pressure (BP). Enalapril showed 33.33% improvement, where as Gokshura-Punarnava Basti showed 79.59% improvement in the presenting complaints of diabetes, urine microalbumin, BSL and BP. Gokshura-Punarnava Basti has shown superior results in the management of microalbuminuria in DM as compared to control drug.
PMCID: PMC3665195  PMID: 23723672
Basti; diabetes mellitus; Gokshura; Madhumeha; microalbuminuria; Punarnava1
21.  OA01.06. A clinical evaluation of langlimool (gloriosa superba) on inderlupta w.s.r. to alopacia areata 
Ancient Science of Life  2012;32(Suppl 1):S6.
Beauty has very important role in our life. Hair plays very vital role in our beauty. A human body without hair would be seen just as a tree without leaves. So everyone has an ambition that his/her hair should be long, black and thick. In Ayurveda there are many synonyms for Hair loss as Inderlupta, KhaIitya, rujya etc. Indralupta is a unique, idiopathic, non-cictricial, non-inflammatory alopecia, presents as discoid areas of hair loss.
Therapeutic assessment of lepa of sodhita langalimoola was carried out on the patient of Indralupta. Lepa of the fine powder of langali moola was made with madhu. External application was done twice a day for a period of 60 days. Selection of Cases Source: For the present study, patients with Indralupta were screened out from OPD & IPD of NIA, Jaipur. Number of cases: 30 Patients were registered from OPD & IPD of NIA Jaipur. Grouping of Patients: Selected patients were randomly divided into two groups. Group A: This group of 15 patients was treated with Gomutra sodhit Langali moola with honey for external application. Group B: This group of 15 patients was treated with Godugdha sodhit Langali moola with honey for external application.
Result :
It was observed that after 60 days of treatment with Gomutrashodhit Langlimool in Group A there was reduction in Hair fall which is statistically highly significant (P<0.001) and highly significant improvement was observed in reducing dandruff.(p<0.001). Where as in Group B Godugdashodhit Langlimool application reduced the hair fall to statistically significant level (p<0.01) and statistically significant in reducing the dandruff in patient with Indralupta (P<0.01).
Gomutrasodhit Langali moola churna was highly effective in the management of Indralupta.
PMCID: PMC3800940
22.  Short term response of patients with bronchiectasis to treatment with amoxycillin given in standard or high doses orally or by inhalation. 
Thorax  1986;41(7):559-565.
The effect of three amoxycillin treatment regimens on purulent secretions of patients with bronchiectasis has been studied. On the basis of information recorded on a diary card the patients were divided into three groups, according to the usual nature of their secretions: seven who produced mucoid sputum, which occasionally became purulent; seven whose secretions were usually mucopurulent but occasionally purulent; and 19 whose secretions were persistently purulent. Treatment with capsules of amoxycillin in a dosage of 250 mg three times a day resulted in clearance of purulent secretions in patients of the mucoid group when they were treated for a clinical exacerbation. The sputum remained clear in these patients for long periods before a further exacerbation (median 6 1/2, range 1-11 months). The mucopurulent-purulent group also responded to this dosage but sputum purulence returned more rapidly (median 9, range 4-31 days). Only three of the 19 (17%) patients with persistently purulent secretions showed a macroscopic response to this dosage, whereas seven (60%) of 12 patients who received the higher dosage (3 g sachets twice a day) responded. Among the failures, some responded to nebulised amoxycillin, suggesting that higher levels of amoxycillin in secretions are required in these patients. Macroscopic clearance of purulent secretions was finally achieved in most of the patients studied. The response was not always predictable from the results of sputum culture. Clearance of secretions by antibiotics was also identified by the patients, using a diary card score. Improvements in well being and in symptoms were noticed even in the group who usually produced mucopurulent and purulent secretions even though they appeared to be clinically stable before treatment.
PMCID: PMC460390  PMID: 3787536
23.  Prevalence and Treatment Outcome of Cervicitis of Unknown Etiology 
Sexually transmitted diseases  2013;40(5):10.1097/OLQ.0b013e31828bfcb1.
Mucopurulent cervicitis (MPC) is a clinical syndrome characterized by mucopurulent discharge from the cervix and other signs of inflammation. This was a phase III, multi-center study designed to evaluate the effectiveness of placebo versus empiric antibiotic treatment for clinical cure of MPC of unknown etiology at 2 months follow-up. Unfortunately, enrollment was terminated due to low accrual of women with cervicitis of unknown etiology but important prevalence and outcome data were obtained.
Five hundred seventy-seven women were screened for MPC. Women with MPC were randomized to the treatment or placebo arm of the study and the two arms were evaluated based upon the etiology, clinical cure rates, adverse events (AEs) and rates of pelvic inflammatory disease (PID).
One hundred thirty-one or 23% (131/577) of screened women were found to have MPC. Eighty-seven were enrolled and randomized. After excluding women with sexually transmitted infections and other exclusions, 61% (53/87) had cervicitis of unknown etiology. The overall clinical failure rate was 30% (10/33) and the clinical cure rate was only 24% (8/33). Rates were not significantly different between the arms. There were 24 gastrointestinal (GI) AEs in the treatment arm compared to 1 AE in the placebo arm.
Over half of the cases of MPC were of unknown etiology. Clinical cure rates for the placebo and treatment arms were extremely low, with most women concluding the study with a partial response. Gastrointestinal AEs were higher in the treatment arm.
PMCID: PMC3868214  PMID: 23588127
Mucopurulent Cervicitis; Cervicitis; Trichomonas; Bacterial Vaginosis; Chlamydia; Gonorrhea; Mycoplasma genitalium
24.  Daily oral grepafloxacin vs. twice daily oral doxycycline in the treatment of Chlamydia trachomatis endocervical infection. 
OBJECTIVE: To compare the efficacy and safety of a 7-day course of treatment with oral grepafloxacin, 400 mg once daily, and oral doxycycline, 100 mg twice daily, in patients with chlamydial cervicitis. METHODS: Women aged 18 years or older attending 17 sexually transmitted disease clinics in the United States who had clinical signs of mucopurulent cervicitis or who had a recent positive culture or nonculture test for Chlamydia trachomatis or who had contact with a male partner with a positive culture for C. trachomatis were enrolled into this randomized, double-blind, active-controlled clinical study. The diagnosis of chlamydial cervicitis was based on culture for C. trachomatis. Patients were randomized to receive a 7-day course of treatment with either oral grepafloxacin, 400 mg once daily, or oral doxycycline, 100 mg twice daily. Response to therapy was assessed 3-8 days and 21-28 days after completion of treatment. The primary measure of efficacy was eradication of C. trachomatis at the 21-28 day follow-up visit. Clinical success, defined as improvement or complete resolution of the signs and symptoms of cervicitis, was a secondary measure of efficacy. RESULTS: Of the 451 female patients enrolled, 228 received grepafloxacin and 223 received doxycycline. In all, 154/451 (35%) patients were evaluable at the 21-28 day follow-up (81 who received grepafloxacin and 73 who received doxycycline). Microbiologic and clinical success rates demonstrated the equivalence of the two treatments. The C. trachomatis eradication rates were 96.3% (78/81) and 98.6% (72/73) for patients receiving grepafloxacin or doxycycline, respectively. The two study drugs were also equivalent in resolving clinical signs and symptoms, with clinical success rates of 88.9% (64/72) and 89.5% (51/57) for patients treated with grepafloxacin and doxycycline, respectively. Both drugs were well tolerated, with 47% of patients receiving grepafloxacin and 46% of patients receiving doxycycline experiencing drug-related adverse events, none of which was serious. CONCLUSIONS: Seven days of treatment with oral grepafloxacin, 400 mg once daily, was as effective as 7 days of treatment with oral doxycycline, 100 mg twice daily, in patients with cervicitis caused by C. trachomatis. Both agents were well tolerated and had comparable safety profiles. Grepafloxacin's once-daily dosing regimen may offer advantages in terms of patient compliance.
PMCID: PMC1784789  PMID: 9785106
25.  Mycoplasma Genitalium Among Women With Nongonococcal, Nonchlamydial Pelvic Inflammatory Disease 
Pelvic inflammatory disease (PID) is a frequent condition of young women, often resulting in reproductive morbidity. Although Neisseria gonorrhoeae and/or Chlamydia trachomatis are/is recovered from approximately a third to a half of women with PID, the etiologic agent is often unidentified. We need PCR to test for M genitalium among a pilot sample of 50 women with nongonococcal, nonchlamydial endometritis enrolled in the PID evaluation and clinical health (PEACH) study. All participants had pelvic pain, pelvic organ tenderness, and leukorrhea, mucopurulent cervicitis, or untreated cervicitis. Endometritis was defined as ≥5 surface epithelium neutrophils per ×400 field absent of menstrual endometrium and/or ≥2 stromal plasma cells per ×120 field. We detected M genitalium in 7 (14%) of the women tested: 6 (12%) in cervical specimens and 4 (8%) in endometrial specimens. We conclude that M genitalium is prevalent in the endometrium of women with nongonococcal, nonchlamydial PID.
PMCID: PMC1581464  PMID: 17485798

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