Tinidazole

Class: Antiprotozoals, Miscellaneous
VA Class: AP109
Chemical Name: 1-[2-(Ethylsulfonyl)ethyl]-2-methyl-5-nitro-1H-imidazole
Molecular Formula: C₈H₁₃N₃O₄S
CAS Number: 19387-91-8
Brands: Tindamax

• 
  

  Metronidazole (a nitroimidazole anti-infective chemically similar to tinidazole) is carcinogenic in mice and rats.^{1 31}

  
  


• 
  

  Carcinogenic potential of tinidazole not evaluated in animal studies to date.¹

  
  


• 
  

  Avoid unnecessary use; reserve for use in approved indications.¹ (See Uses.)

  
  

Introduction

Antiprotozoal and antibacterial; ^{1 58 59 63 64 65 68} nitroimidazole derivative.^{1 58 59 63 64 65 68}

Uses for Tinidazole

Amebiasis

Treatment of intestinal amebiasis and amebic liver abscess caused by Entamoeba histolytica in adults and children >3 years of age.^{1 18 25 26 27 28 29 30 34 43 47 48 49 50 51 52 53 54 69} Designated an orphan drug by FDA for treatment of amebiasis.²

Oral tinidazole or oral metronidazole followed by a luminal amebicide (iodoquinol, paromomycin) is the regimen of choice for mild to moderate or severe intestinal disease and for amebic hepatic abscess.^{18 24 25 26 27 34 47}

Not recommended for treatment of asymptomatic cyst passers;^{1 18 47} these patients should be treated with a luminal amebicide such as iodoquinol, paromomycin, or diloxanide furoate (not commercially available in the US).^{18 25 26 27}

Giardiasis

Treatment of giardiasis caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis) in adults and children >3 years of age.^{1 18 20 21 22 23 24 34 40 41 43 44 45 46 56 57} Designated an orphan drug by FDA for use in this condition.²

Drugs of choice are metronidazole,^{17 18 20} tinidazole,^{17 18 20} or nitazoxanide;^{17 18} alternatives are paromomycin (especially in pregnant women),^{17 18 20} furazolidone (not commercially available in the US),^{17 18 20} or quinacrine (not commercially available in the US).^{17 18}

Treatment of asymptomatic carriers of giardiasis† not recommended, except possibly to prevent transmission from carriers in households of patients with hypogammaglobulinemia or cystic fibrosis or pregnant women with toddlers.¹⁸

Trichomoniasis

Treatment of symptomatic and asymptomatic trichomoniasis in men and women in whom Trichomonas vaginalis has been demonstrated by an appropriate diagnostic procedure (e.g., wet smear and/or culture, OSOM Trichomonas Rapid Test, Affirm VP III).^{1 3 4 5 9 11 13 14 15 16 18 35 36 38 39 67 68}

Drug of choice is metronidazole or tinidazole.^{9 17 18} Tinidazole may be effective in some patients who do not respond to metronidazole,^{3 62} but some T. vaginalis isolates with reduced susceptibility to metronidazole may also have reduced susceptibility to tinidazole.^{1 61 62}

Goal of treatment is to provide symptomatic relief, achieve microbiologic cure, and reduce transmission.^{1 7 8 9 15} To achieve this goal, both the index patient and sexual (particularly steady) partner(s) should be treated simultaneously;^{1 7 8 9 15} treat sexual contacts presumptively even if they are asymptomatic and/or T. vaginalis has not been demonstrated.⁶⁷

Bacterial Vaginosis

Treatment of bacterial vaginosis (formerly called Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, Corynebacterium vaginitis, or anaerobic vaginosis) in nonpregnant women.^{1 72 73} Rule out other pathogens commonly associated with vulvovaginitis (e.g., Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, Candida albicans, herpes simplex viruses).¹

CDC recommends treatment of bacterial vaginosis in all symptomatic nonpregnant women.⁹ Routine treatment of sex partners not recommended.⁹

Nongonococcal Urethritis

Treatment of recurrent and persistent urethritis† in patients with nongonococcal urethritis who have already been treated with a recommended regimen.⁹

For treatment of nongonococcal urethritis in adults, CDC recommends a single oral dose of azithromycin or a 7-day regimen of doxycycline; alternative regimens are a 7-day regimen of oral erythromycin base or ethylsuccinate or a 7-day regimen of oral ofloxacin or oral levofloxacin.⁹ Patients are instructed to abstain from sexual intercourse until 7 days after initiation of treatment and to return for evaluation if symptoms persist or recur after completion of therapy; symptoms alone (without documentation of signs or laboratory evidence of urethral inflammation) are not sufficient basis for retreatment.⁹

Patients with persistent or recurrent urethritis who were not compliant with the treatment regimen or were reexposed to untreated sexual partner(s) should be retreated with the initial regimen.⁹ If patient with recurrent and persistent urethritis was compliant with the regimen and reexposure can be excluded, CDC recommends a single oral dose of metronidazole or tinidazole given in conjunction with a single oral dose of azithromycin (if azithromycin was not used in the initial regimen).⁹

Tinidazole Dosage and Administration

Administration

Oral Administration

Administer orally once daily with food.¹

Administration with meals may reduce incidence of adverse GI effects.¹

Do not consume alcohol during or for 3 days after completion of tinidazole therapy.¹

For children and other patients unable to swallow tablets, an oral suspension may be prepared extemporaneously using the tablets.¹

Extemporaneous Oral Suspension

To prepare an oral suspension containing 66.7 mg/mL, grind 2 g (four 500-mg tablets) to a fine powder with a mortar and pestle.¹ Add approximately 10 mL of cherry syrup to the powder and mix until smooth.¹ Transfer suspension to a graduated amber container;¹ use several small rinses of the cherry syrup to transfer any remaining drug in the mortar to provide a suspension with a final volume of 30 mL.¹

Shake suspension well prior to administration of each dose.¹

Dosage

Pediatric Patients

Amebiasis

Entamoeba histolytica Infections

Oral

Children >3 years of age (intestinal amebiasis): 50 mg/kg (up to 2 g) once daily given for 3 days;^{1 17} follow-up with an oral luminal amebicide (e.g., iodoquinol, paromomycin).^{1 18 25 47}

Children >3 years of age (amebic liver abscess): 50 mg/kg (up to 2 g) once daily given for 3–5 days;^{1 17} follow-up with an oral luminal amebicide (e.g., iodoquinol, paromomycin).^{1 18 25 47}

Giardiasis

Oral

Children >3 years of age: 50 mg/kg (up to 2 g) given as a single dose.^{1 17}

Trichomoniasis†

Oral

Children >3 years of age†: 50 mg/kg (up to 2 g) given as a single dose.¹⁷

Adults

Amebiasis

Entamoeba histolytic Infections

Oral

Intestinal amebiasis: 2 g once daily given for 3 days;^{1 17} follow-up with an oral luminal amebicide (e.g., iodoquinol, paromomycin).^{1 18 25 47}

Amebic liver abscess: 2 g once daily for 3–5 days;^{1 17} follow-up with an oral luminal amebicide (e.g., iodoquinol, paromomycin).^{1 18 25 47}

Giardiasis

Oral

2 g given as a single dose.^{1 17}

Trichomoniasis

Oral

2 g given as a single dose.^{1 9 17}

Treat sexual partners of the patient simultaneously using the same dosage.^{1 9 67}

For treatment failure following a metronidazole regimen (e.g., single 2-g dose of metronidazole), CDC recommends retreatment with a single 2-g dose of tinidazole; if retreatment fails, CDC recommends tinidazole 2 g once daily for 5 days.⁹ If multiple-dose regimen fails, consult a specialist.⁹

Bacterial Vaginosis

Nonpregnant Women

Oral

2 g once daily for 2 days or 1 g once daily for 5 days.¹

Nongonococcal Urethritis†

Oral

CDC recommends a single 2-g dose of tinidazole in conjunction with a single1-g dose of oral azithromycin (if azithromycin not used in the initial regimen) for treatment of recurrent and persistent urethritis in patients who previously received a recommended regimen. (See Nongonococcal Urethritis under Uses.)⁹

Prescribing Limits

Pediatric Patients

Oral

Children >3 years of age: Maximum 50 mg/kg (up to 2 g) daily or as a single dose.^{1 17}

Special Populations

Hepatic Impairment

Data insufficient to make specific dosage recommendations.¹ Use usual dosage with caution.¹ (See Hepatic Impairment under Cautions.)

Renal Impairment

Dosage adjustments not needed, unless patient is undergoing hemodialysis.^{1 60}

If given on a day that hemodialysis is performed, administer an additional dose (equivalent to 50% of the recommended dose) after the dialysis session.^{1 60}

Geriatric Patients

Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.¹

Cautions for Tinidazole

Contraindications

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  History of hypersensitivity reaction to tinidazole or other nitroimidazole derivatives.¹

  
  


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  First trimester of pregnancy.¹

  
  


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  Breast-feeding.¹ (See Lactation under Cautions.)

  
  

Warnings/Precautions

Warnings

Carcinogenicity

Carcinogenic effects reported in mice and rats following chronic oral administration of metronidazole (a chemically related nitroimidazole anti-infective).^{1 31} (See Boxed Warning). Similar animal studies using tinidazole have not been reported to date.¹

Because of potential risks, tinidazole should be reserved for approved indications only and unnecessary use avoided.¹

Nervous System Effects

Convulsive seizures and peripheral neuropathy (characterized by numbness or paresthesia of an extremity) reported with tinidazole and other nitroimidazoles (e.g., metronidazole).^{1 31}

If abnormal neurologic signs develop, promptly discontinue drug.¹

Sensitivity Reactions

Hypersensitivity Reactions

Hypersensitivity reactions (e.g., urticaria, pruritus, rash, flushing, sweating, dryness of mouth, fever, burning sensation, thirst, salivation, angioedema, bronchospasm, dyspnea, Stevens-Johnson syndrome, erythema multiforme) reported.^{1 55}

General Precautions

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of tinidazole and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.¹

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.¹ In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.¹

History of Blood Dyscrasia

Use with caution in patients with evidence or history of blood dyscrasia.^{1 58}

As with other nitroimidazoles (e.g., metronidazole), transient leukopenia and neutropenia may occur; persistent hematologic abnormalities not reported to date.^{1 31 58}

If retreatment is necessary, perform total and differential leukocyte counts.¹

Candidiasis

Vaginal candidiasis reported; treat with an appropriate antifungal.¹

Specific Populations

Pregnancy

Category C (second and third trimesters).¹

Contraindicated during first trimester.¹

Not evaluated for treatment of bacterial vaginosis in pregnant women.¹

Lactation

Distributed into milk in concentrations similar to serum concentrations.^{1 66} Interrupt breast-feeding during therapy and for 72 hours following the last dose.^{1 66}

Pediatric Use

Safety and efficacy not established in pediatric patients ≤3 years of age.¹ Some data available regarding safety and efficacy for treatment of giardiasis in pediatric patients <3 years of age†.^{18 23 32 42 43 44 57}

Safety and efficacy in pediatric patients >3 years of age established only for treatment of amebiasis or giardiasis.^{1 18}

Monitor pediatric patients closely if duration of therapy is >3 days (e.g., for treatment of amebic liver abscess)¹ since only limited data available.^{1 32 69}

Adverse effects reported in pediatric patients generally similar in nature and frequency to those reported in adults.¹

Geriatric Use

Experience in those ≥65 years of age insufficient to determine whether they respond differently than younger adults.¹

Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.¹

Hepatic Impairment

Use with caution;¹ pharmacokinetics not evaluated.¹

Studies using metronidazole (a chemically similar nitroimidazole) indicate reduced elimination and increased plasma concentrations in severe hepatic dysfunction.^{1 31}

Renal Impairment

Dosage adjustment may be needed in patients undergoing hemodialysis.¹ (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

GI effects (metallic/bitter taste, nausea, anorexia, dyspepsia/cramps/epigastric discomfort, vomiting, constipation), nervous system effects (weakness/fatigue/malaise, dizziness, headache).¹

Interactions for Tinidazole

Metabolized principally by CYP3A4.¹

Does not inhibit CYP1A2, 2B6, 2C9, 2D6, 2E1, or 3A4 in vitro.¹

Drugs Affecting or Metabolized by Hepatic Microsomal Enzymes

Inhibitors of CYP3A4: Potential pharmacokinetic interaction (increased plasma tinidazole concentrations).¹

Inducers of CYP3A4: Potential pharmacokinetic interaction (decreased plasma tinidazole concentrations).¹

Specific Drugs and Laboratory Tests

No formal drug interaction studies performed with tinidazole to date; interactions reported with metronidazole (a chemically similar nitroimidazole) may occur with tinidazole.¹

Drug or Test	Interaction	Comments
Alcohol	Alcoholic beverages or preparations containing alcohol or propylene glycol may cause abdominal cramps, nausea, vomiting, headaches, and flushing 1	Avoid alcoholic beverages and preparations containing alcohol or propylene glycol during or for 3 days following completion of tinidazole therapy1
Anticoagulants, oral (warfarin)	Possible increased PT and enhanced anticoagulant effects1	Monitor PT and warfarin dosage carefully during concomitant use and for up to 8 days after the last tinidazole dose1 32
Antifungal agents (ketoconazole)	Possible prolonged half-life, decreased clearance, and increased plasma concentrations of tinidazole1
Cholestyramine	Studies using metronidazole indicate cholestyramine decreases oral bioavailability of the nitroimidazole by 21%1	Give tinidazole and cholestyramine doses at separate times1
Cimetidine	Possible prolonged half-life, decreased clearance, and increased plasma concentrations of tinidazole1
Disulfiram	Experience with metronidazole and disulfiram indicates psychotic reactions can occur; such reactions not reported to date with tinidazole 1 31	Do not use concomitantly; do not initiate tinidazole until 2 weeks after disulfiram is discontinued1
Fluorouracil	Experience with metronidazole and fluorouracil indicates decreased fluorouracil clearance, increased fluorouracil-associated adverse effects, no increased therapeutic benefit1	If concomitant use of tinidazole and fluorouracil is unavoidable, monitor for fluorouracil toxicity1
Immunosuppressive agents (cyclosporine, tacrolimus)	Experience with metronidazole indicates increased plasma concentrations of cyclosporine or tacrolimus1	Monitor for cyclosporine or tacrolimus toxicity if tinidazole used concomitantly with one of these drugs1
Lithium	Experience with metronidazole and lithium indicates increased lithium concentrations;1 not reported to date with tinidazole1	Measure serum lithium and creatinine concentrations after several days of concomitant lithium and tinidazole therapy to detect potential lithium intoxication1
Phenobarbital	Possible increased elimination and decreased plasma concentrations of tinidazole1
Phenytoin or fosphenytoin	Experience with oral metronidazole and IV phenytoin indicates prolonged phenytoin half-life and reduced phenytoin clearance;1 not reported with oral phenytoin and oral metronidazole1 Possible increased elimination and decreased plasma concentrations of tinidazole1
Rifampin	Possible increased elimination and decreased plasma concentrations of tinidazole1
Tests based on ultraviolet (UV) absorbance	Falsely decreased serum concentrations (including undetectable concentrations) of AST, ALT, LDH, triglycerides, or hexokinase glucose may be reported during tinidazole therapy if results are based on decreases in UV absorbance that occur during oxidation-reduction of NADH/NAD1 UV absorbance peaks of NADH and tinidazole are similar1	Use caution when interpreting test results based on UV absorbance during tinidazole therapy1
Tetracyclines	Experience with metronidazole indicates oxytetracycline (no longer commercially available in the US) may inhibit therapeutic effects of the nitroimidazole1

Tinidazole Pharmacokinetics

Absorption

Bioavailability

Estimated oral bioavailability >90%.⁶³

Rapidly absorbed following oral administration; peak plasma concentrations usually attained within about 2 hours.^{1 32 63 68}

Pharmacokinetic parameters reported with extemporaneous oral suspension containing 66.7 mg/mL (prepared using crushed 500-mg tablets and cherry syrup) in healthy individuals after an overnight fast similar to those reported with tablets swallowed whole under fasted conditions.^{1 32}

Food

Administration with food delays time to peak plasma concentrations by approximately 2 hours and decreases peak plasma concentrations by 10%,^{1 32} but does not affect AUC or elimination half-life.^{1 32}

Distribution

Extent

Distributed into virtually all body tissues and body fluids.^{1 32 63}

Crosses blood-brain barrier.^{1 32 63}

Crosses placenta and is distributed into breast milk.¹

Plasma Protein Binding

12%.^{1 32 63}

Elimination

Metabolism

Extensively metabolized prior to elimination.^{1 63 1}

Partially metabolized via oxidation, hydroxylation, and conjugation.^{1 63} Metabolized principally by CYP3A4.¹

Present in plasma principally as unchanged drug with small amounts of the 2-hydroxymethyl metabolite.^{1 32 63}

Elimination Route

Eliminated by the liver and kidneys.¹

Excreted in urine as unchanged drug (20–25%) and in feces (12%).^{1 32 63 68}

Removed by hemodialysis.^{1 60}

Not known whether removed by CAPD.¹

Half-life

Approximately 12–14 hours.^{1 32 58 63 68}

Special Populations

Hepatic impairment: Pharmacokinetics not evaluated.¹ Studies using metronidazole (a chemically similar nitroimidazole) indicate reduced elimination and increased plasma concentrations in severe hepatic impairment.^{1 31}

Severe renal impairment: Pharmacokinetics not affected by severe impairment (Cl_cr <22 mL/min).¹

Hemodialysis patients: Clearance increased and elimination half-life decreased (from 12 hours to 4.9 hours).^{1 60} (See Renal Impairment under Dosage and Administration.)

Stability

Storage

Oral

Tablets

20–25°C (may be exposed to 15–30°C);¹ protect from light.¹

Extemporaneous Oral Suspension

Suspension containing 66.7 mg/mL: Stable for 7 days at room temperature.¹ (See Extemporaneous Oral Suspension under Dosage and Administration.)

Actions and SpectrumActions

• 
  

  Amebicidal, trichomonacidal, and bactericidal.^{1 32 58 59 63 64 65 68}

  
  


• 
  

  Cell extracts of Trichomonas appear to reduce the nitroimidazole group of tinidazole and generate the free nitro radical, which may be responsible for the drug’s anti-infective activity.^{1 32 59 65} Mechanism of activity against Giardia and Entamoeba histolytica not known.¹

  
  


• 
  

  Protozoa: Active in vitro and in clinical infections against Trichomonas vaginalis, G. duodenalis (also known as G. lamblia or G. intestinalis), and E. histolytica.^{1 58 59 65}

  
  


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  Anaerobes: Active in vitro against many anaerobic bacteria including some Bacteroides^{58 64} (e.g., B. fragilis,^{32 59 63 64 65 68} B. melaninogenicus⁶³ ), some Clostridium^{32 59 63} (e.g., C. difficile,³² C. perfringens^{63 64} ), Prevotella,³² Fusobacterium,^{63 64 68} Peptococcus,^{32 58 59 63} and Peptostreptococcus.^{32 58 59 63}

  
  


• 
  

  Other organisms: Active against Helicobacter pylori ³² and Gardnerella vaginalis.^{32 59 65} Inactive against most Lactobacillus normally resident in vagina.^{1 32}

  
  


• 
  

  Potential for development of resistance in Giardia, E. histolytica, or bacteria associated with bacterial vaginosis not evaluated.¹

  
  


• 
  

  Although clinical importance unclear,⁶¹ some T. vaginalis with reduced susceptibility to metronidazole also have reduced susceptibility to tinidazole in vitro.^{1 61 62 61}

  
  

Advice to Patients

• 
  

  Importance of taking with food to reduce the incidence of adverse GI effects (e.g., epigastric discomfort).¹

  
  


• 
  

  Advise patients to avoid alcoholic beverages and preparations containing alcohol or propylene glycol during and for at least 3 days after receiving tinidazole.¹

  
  


• 
  

  Advise patients to promptly discontinue tinidazole and contact clinician if abnormal neurologic signs occur.¹

  
  


• 
  

  Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, and any concomitant illnesses.¹

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹

  
  


• 
  

  Importance of advising patients of other important precautionary information.¹ (See Cautions.)

  
  

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Tinidazole

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Tablets, film-coated	250 mg	Tindamax (scored)	Mission
		500 mg	Tindamax (scored)	Mission

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Tindamax 500MG Tablets (MISSION): 20/$195.88 or 60/$556.36

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions July 2009. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

1. Mission Pharmacal. Tindamax (tinidazole tablets) prescribing information. San Antonio, TX; 2007 Jul.

2. Food and Drug Administration. Orphan designation pursuant to Section 526 of the Federal Food and Cosmetic Act as amended by the Orphan Drug Act. (P.L. 97-414). Rockville, MD; From FDA website (). Accessed 2004 Aug.

3. Hager WD. Treatment of metronidazole-resistant Trichomonas vaginalis with tinidazole: case reports of three patients. Sex Transm Dis. 2004; 31:343-5. [PubMed 15167642]

4. Gulmezoglu AM, Garner P. Trichomoniasis treatment in women: a systematic review. Trop Med Int Health. 1998; 3:553-8. [IDIS 412104] [PubMed 9705189]

5. O-Prasertsawat P, Jetsawangsri T. Split-dose metronidazole or single-dose tinidazole for the treatment of vaginal trichomoniasis. Sex Transm Dis. 1992; 19:295-7. [IDIS 521309] [PubMed 1411848]

7. Lossick JG. Treatment of sexually transmitted vaginosis/vaginitis. Rev Infect Dis. 1990; 12(Suppl 6):S665-81. [IDIS 300932] [PubMed 2201078]

8. Heine P, McGregor JA. Trichomonas vaginalis: a reemerging pathogen. Clin Obstet Gynecol. 1993; 36:137-44. [PubMed 8435938]

9. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006; 55(RR-11):1-95.

10. Lossick JG. Treatment of Trichomonas vaginalis infections. Rev Infect Dis. 1982; 4(Suppl):S801-18.

11. Lossick JG, Kent HL. Trichomoniasis: trends in diagnosis and management. Am J Obstet Gynecol. 1991; 165:1217-22. [IDIS 290714] [PubMed 1951578]

13. Anjaeyulu R, Gupte SA, Desai DB. Single-dose treatment of trichomonal vaginitis: a comparison of tinidazole and metronidazole. J Int Med Res. 1977; 5:438-41. [PubMed 590601]

14. Bloch B, Smyth E. The treatment of Trichomonas vaginalis vaginitis: an open controlled prospective study comparing a single dose of metronidazole tablets, benzoyl metronidazole suspension and tinidazole tablets. S Afr Med J. 1985; 67:455-7. [IDIS 200360] [PubMed 3885425]

15. Lyng J, Christensen J. A double-blind study of the value of treatment with a single dose tinidazole of partners to females with trichomoniasis. Acta Obstet Gynecol Scand. 1981; 60:199-201. [PubMed 7018164]

16. Chaudhuri P, Drogendijk AC. A double-blind controlled clinical trial of carnidazole and tinidazole in the treatment of vaginal trichomoniasis. Eur J Obstet Gynecol Reprod Biol. 1980; 10:325-8. [PubMed 6995193]

17. Anon. Drugs for parasitic infections. From the Medical Letter web site (). Aug 2008.

18. American Academy of Pediatrics. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006.

19. Hill DR. Giardiasis: issues in diagnosis and management. Infect Dis Clin North Am. 1993; 7:503-25. [PubMed 8254157]

20. Ortega YR, Adam RD. Giardia: overview and update. Clin Infect Dis. 1997; 25:545-50. [IDIS 393721] [PubMed 9314441]

21. Nigam P, Kapoor KK, Kumar AJ et al. Clinical profile of giardiasis and comparison of its therapeutic response to metronidazole and tinidazole. J Assoc Physicians India. 1991; 39:613-5. [PubMed 1814877]

22. Gupta JP, Jain AK, Nanivadekar AS. Efficacy of tinidazole (Fasigyn) in giardiasis by parasitologic, biochemical, and gut transit studies. Indian J Gastroenterol. 1989; 8:103-4. [PubMed 2707840]

23. Cervetto JL, Ramonet M, Nahmod LH et al. Giardiasis. Functional, immunological and histological study of the small bowel: therapeutic trial with a single dose of tinidazole. Arg Gastroenterol. 1987; 24:102-12.

24. Speelman P. Single-dose tinidazole for the treatment of giardiasis. Antimicrob Agents Chemother. 1985; 27:227-9. [IDIS 196181] [PubMed 3985604]

25. Ravdin JI. Amebiasis. Clin Infect Dis. 1995; 20:1453-66. [IDIS 349015] [PubMed 7548493]

26. Aucott JN, Ravdin JI. Amebiasis and “nonpathogenic” intestinal protozoa. Infect Dis Clin North Am. 1993; 7:467-85. [PubMed 8254155]

27. Reed SL. Amebiasis: an update. Clin Infect Dis. 1992; 14:385-93. [IDIS 292053] [PubMed 1554822]

28. Lim JK. Clinical trial of tinidazole (Fasigyn) in acute and chronic intestinal Amoebiasis. Kisaengchunghak Chapchi. 1974; 12:135-140. [PubMed 12913475]

29. Salles JM, Bechara C, Tavares AM et al. Comparative study of the efficacy and tolerability of secnidazole suspension (single dose) and tinidazole suspension (two days dosage) in the treatment of amebiasis in children. Braz J Infect Dis. 1999; 3:80-88. [PubMed 11098194]

30. Boonyapisit S, Chinapak O, Plengvanit U. Amoebic liver abscess in Thailand, clinical analysis of 418 cases. J Med Assoc Thai. 1993;76:243-6.

31. G.D. Searle. Flagyl (metronidazole tablets) prescribing information. Chicago, IL; 2003 Aug.

32. Presutti Laboratories, Arlington Heights, IL: personal communication.

34. Centers for Disease Control and Prevention. Health information for international travel, 2005–2006. Atlanta, GA: US Department of Health and Human Services; 2005. Updates available from CDC website ().

35. Forna F, Gulmezoglu AM. Interventions for treating Trichomoniasis in women (Cochrane review). In: The Cochrane Library. Issue 2. Oxford, United Kingdom: update software 2004.

36. Gabriel G, Robertson E, Thin RN. Single dose treatment of trichomoniasis. J Int Med Res. 1982;10:129-30.

37. Rees PH, McGlashan HE, Mwega V. Single-dose treatment of vaginal trichomoniasis with tinidazole. East Afr Med J. 1974;51:782-5.

38. Mati JK, Wallace RJ. The treatment of trichomonal vaginitis using a single dose of tinidazole by mouth. East Afr Med J. 1974;51:883-8.

39. Sobel JD. Vaginitis. N Engl J Med.1997;337:1896-903.

40. Zaat JO, Mank T, Assendelft WJ. Drugs for treating giardiasis (Cochrane Database). In: The Cochrane Library. Issue 3. Oxford, United Kingdom: update software 2004.

41. Jokipii L, Jokipii AMM. Single-dose metronidazole and tinidazole as therapy for giardiasis: success rates, side effects, and drug absorption and elimination. J Infect Dis. 1979;140:984-88.

42. Danzig S, Hatchuel WLF. Single-dose treatment of giardiasis with tinidazole. S Afr Med J. 1974; 52:708.

43. Bakshi JS, Ghiara JM, Nanivadekar AS. How does tinidazole compare with metronidazole? Drugs. 1978;4315:33-42.

44. Gazder AJ & Banerjee M: Single-dose treatment of giardiasis in children: a comparison of tinidazole and metronidazole. Curr Med Res Opin. 1977; 5:164-68.

45. Centers for Disease Control and Prevention. CDC surveillance summaries: giardiasis surveillance United States, 1992–1997. MMWR CDC Surveill Summ. 2000;49:1-13.

46. Kyronseppa H, Pettersson T. Treatment of giardiasis: relative efficacy of metronidazole as compared with tinidazole. Scand J Inf Dis. .1981; 13:311-12.

47. Haque R, Huston CD, Hughes M, et al. Amebiasis. N Engl J Med. 2003;348:1565-73.

48. Mabadadeje AF, Oredugba. Single-dose tinidazole treatment of amebic dysentery. Curr Ther Res. 1977;21:685-8.

49. Swami B, Lavakusulu D, Devi CS. Tinidazole and metronidazole in the treatment of intestinal amoebiasis. Curr Med Res Opin. 1977;5:152-6.

50. Ahmed T, Ali F, Sarwar SG. Clinical evaluation of tinidazole in amoebiasis in children. Arch Dis Childhood. 1976;51:388-89.

51. Singh G, Kumar S. Short course of single daily dosage treatment with tinidazole and metronidazole in intestinal amoebiasis: a comparative study. Curr Med Res Opin. 1977;5:157-60.

52. Islam N, Hasan K. Tinidazole and metronidazole