Comparison of nitrimidazine and metronidazole in the treatment of trichomonal vaginitis.

Until the introduction of metronidazole, the treatment of trichomonal vaginitis presented a considerable therapeutic problem. Local treatment was commonly followed by recurrence of the condition, doubtless partly because vaginal treatment alone failed to eliminate all foci of infection. Moreover, it became apparent that trichomonal infection was also often present in the male (Watt and Jennison, 1960; Catterall and Nicol, 1960) and no effective treatment in the male was available. The introduction of metronidazole by Durel, Roiron, Siboulet, and Borel (1959), however, resulted in a dramatic change, with a high percentage of both men and women responding rapidly to treatment with the drug (Rodin, King, Nicol, and Barrow, 1960). That metronidazole was not effective in all cases, however, soon became apparent (Rodin, King, Nicol, and Barrow, 1960; Willcox, 1960), and the search continued for a compound that would give even more effective results. In 1969, a new synthetic compound derived from nitro-imidazole, nitrimidazine, was introduced for the treatment of trichomoniasis (Emanueli and de Carneri, 1969). It was claimed that the trichomonicidal activity in blood serum samples taken from humans treated orally with 250 mg. doses of the new product was stronger and more rapid than with metronidazole (de Carneri, Cantone, Emanueli, Giraldi, Logemanin, Meinardi, Monti, Nannini, Tosilini, and Vita, 1969). Moreover, whereas the metabolites of metronidazole were inactive, those of nitrimidazine were stated to retain part of their activity. Therapeutic action was thus provided not only by the drug itself but also by its principal metabolites (de Carneri and others, 1969). Various claims for the therapeutic effectiveness of nitrimidazine have been made since its introduction. Emanueli and de Carneri (1969) reported an overall cure rate of 92-5 per cent. using different dosage regimens. With a dosage of 250 mg. twice daily for 6 days, Cohen (1971) stated that 62 of 63 women completing surveillance were cured. Moffett, McGill,