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Year : 1995  |  Volume : 61  |  Issue : 1  |  Page : 19-20

Metronidazole in management of trophic ulcers in leprosy

Correspondence Address:
S Mishra

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Source of Support: None, Conflict of Interest: None

PMID: 20952865

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Efficacy of metronidazole was assessed in 20 leprosy cases with trophic ulcers with poor response to oral and topical antibiotic. Oral metronidazole 400 mg three times daily for one week and topical metronidazole gel 1% for three weeks were found to be very effective.

Keywords: Trophic ulcer, Leprosy, Metronidazole

How to cite this article:
Mishra S, Singh P C, Mishra M. Metronidazole in management of trophic ulcers in leprosy. Indian J Dermatol Venereol Leprol 1995;61:19-20

How to cite this URL:
Mishra S, Singh P C, Mishra M. Metronidazole in management of trophic ulcers in leprosy. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2019 Nov 21];61:19-20. Available from: http://www.ijdvl.com/text.asp?1995/61/1/19/4118

  Introduction Top

In neurotrophic ulcers as in leprosy, the major aetiological factors leading to ulceration of the foot, are peripheral neuropathy and ischaemia. These ulcers with insufficient tissue nutrition are frequently infected by anaerobic organisms. They provide an ideal anaerobic environment for pathogenic anaerobes.[1],[2] Infection by anaerobic organisms gives rise to putrid and repulsive odour and stagnation of healing process. Present study was undertaken to observe the influence of metroindazloe in trophic ulcers in leprosy cases where ulcers were not healing satisfactorily in spite of various antibiotics and other treatments.

  Materials and Methods Top

Twenty leprosy cases of different age group (15-80 years) having foul smelling trophic ulcers on foot showing poor response to antibiotics both systemic and local, were taken for study. There were 18 males and 2 females. They were suffering from leprosy of varying duration. Fifteen cases were under MDT, 5 cases had been released from treatment. All patients were admitted to Skin and V.D. Ward. These patients were tried with different antibiotics, systemic and topical, but the ulcers refused to heal and foul smell persisted. There was no history of adverse reaction to metronidazole in these cases. All patients were investigated and other diseases like diabetes, any other neurological abnormality and osteomyelitis were excluded.

The patients were put on metronidazole therapy, both oral and topical. Oral metronidazole was given as 400 mg three times daily for seven days. Topical metronidazol gel 1% application twice daily was done following cleaning and debridement of the ulcer. A loose dressing was done. Bacteriological culture for anaerobes was not done. The characteristic putrid odour, when present, was taken as sufficient indication of the presence of anaerobic organisms.[3]

The patients were evaluated every week using the following parameters:

  1. I. Smell. (with score)

    1. a. No odour even at very close range.[1]

    2. b. Faint odour detected only at close range with dressing removed.[2]

    3. c. Moderate odour detected at about 6 feet with dressing removed.[3]

    4. d. Strong odour noted in room even when dressings are in situ.[4]

  2. II. Appearance.

    1. a. Ulcer healed.[1]

    2. b. Marked evidence of healding-ulcer healing with marked granulation tissue. No slough.[2]

    3. c. Beginning to heal - minor degree of granulation tissue, floor of ulcer sloughing.[3]

    4. d. No sign of healing - oedema and cellulitis of surrounding tissue. Base of ulcer shows well-marked slough.[4]

Pain could not be judged in neurotrophic ulcer in leprosy. Patients were observed for 3 weeks.

  Results Top

Smell - All twenty cases were at highest rank score[4] at start of treatment. 5 cases [25%] became odourless at end of third day. At end of second week all cases became odourless even at close range.

Appearance - At end of first week all cases showed score[3]. At the end of second week 19 cases showed score[2] with marked evidence of healing and no slough. Size and depth of ulcers were reduced. Complete healing was observed by 21 days in 15 cases. In our case score 3 persisted by end of third week. There was no sign of epithelialization. Size and depth remained same, only the foul smell disappeared. The case was referred for histopathological study.

In another 4 cases complete epithelialization did not occur, but there was no foul odour, no slough. The size and depth reduced markedly. Plaster boot was given in these cases.

  Discussion Top

Secondary infection by anaerobes of a variety of chronic pathological lesions such as pressure sores, venous ulcers, neurotropic ulcers and fungating malignancies may cause serious social difficulties ti the affected individual and to others due to putrid and repulsive odour and stagnation of healing process. Metronidazole therapy, systemic and topical, is dramatically effective in these setting.[4][5][6] Effect of metronidazole orally was noticeable as it caused the ulcer to lose slough and allowed healthy granulation tissue to develop and healing process to proceed. Rapid decrease in depth of ulcer occurred. The real significance of the regimen is in the result of the objective measurement of size although the subjective measurement provide valuable supporting data. The anaerobic organisms appear to be eliminated by metronidazole despite the relatively poor blood supply associated with trophic ulcers. Our present study shows the beneficial effects of metronidazole, topical and systemic, in poorly healing foul smelling trophic ulcers in leprosy cases.

  References Top

1.Louie TJ, Barriett JG, Tarly FP, et al. Aerobic and anaerobic bacteria in diabetic foot ulcers. Ann Int Med 1976;85:461-3.  Back to cited text no. 1    
2.Sapico FL, Canawati HN, Witte JL, et al. Quantitative aerobic and anaerobic bacteriolgoy of infected diabetic foot. J Clin Microbiol 1980;2:413-20.  Back to cited text no. 2    
3.Wills AT. Anaerobic Bacteriology; Clinical laboratory Practice. London: Butterworth 1977;246.  Back to cited text no. 3    
4.Jones PH, Willis AT, Ferguson IR. Treatment of anaerobically infected pressure sores with topical metronidazole. Lancet 1978;1:214.  Back to cited text no. 4    
5.Astord RFV, Plant Gt, Maher J, et al. Metronidazole in smelly tumors. Lancet 1980;1:874-5.  Back to cited text no. 5    
6.Dankert J, Holloway Y, Bouma J et al. Metronidazole in smelly gynaecological tumors. Lancet, 1981;2:1295.  Back to cited text no. 6    


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