Antral Uses

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What is Antral?

Antral is used to treat bacterial infections in different areas of the body. The extended-release tablets are used to treat women with vaginal infections (bacterial vaginosis).

Antral belongs to the class of medicines known as antibiotics. It works by killing bacteria or preventing their growth. However, Antral will not work for colds, flu, or other virus infections.

Antral is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, Antral is used in certain patients with the following medical conditions:

  • Clostridium difficile diarrhea or colitis (antibiotic-associated colitis).
  • Crohn's disease (inflammatory bowel disease).
  • Gastritis or stomach ulcers due to Helicobacter pylori.
  • Giardiasis (parasite infection in the intestines).

Antral indications

infoAn indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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Symptomatic Trichomoniasis

Antral is indicated for the treatment of symptomatic trichomoniasis in females and males when the presence of thetrichomonad has been confirmed by appropriate laboratory procedures (wet smears and/or cultures).

Asymptomatic Trichomoniasis

Antral is indicated in the treatment of asymptomatic females when the organism is associated with endocervi-citis, cervicitis, or cervical erosion. Since there is evidence that presence of the trichomonad can interfere with accurate assessment of abnormal cytological smears, additional smears should be performed after eradication of the parasite.

Treatment of Asymptomatic Consorts.

T. vagi-nalis infection is a venereal disease. Therefore, asymptomatic sexual partners of treated patients should be treated simultaneously if the organism has been found to be present, in order to prevent reinfection of the partner. The decision as to whether to treat an asymptomatic male partner who has a negative culture or one for whom no culture has been attempted is an individual one. In making this decision, it should be noted that there is evidence that a woman may become reinfected if her consort is not treated. Also, since there can be considerable difficulty in isolating the organism from the asymptomatic male carrier, negative smears and cultures cannot be relied upon in this regard. In any event, the consort should be treated with Antral in cases of reinfection.

Amebiasis

Antral is indicated in the treatment of acute intestinal amebiasis (amebic dysen-tery)and amebic liver abscess.

In amebic liver abscess, Antral therapy does not obviate the need for aspiration or drainage of pus.

Anaerobic Bacterial Infections

Antral is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Indicated surgical procedures should be performed in conjunction with Antral therapy. In a mixed aerobic and anaerobic infection, antimicrobials appropriate for the treatment of the aerobic infection should be used in addition to Antral.

In the treatment of most serious anaerobic infections, Antral I.V. (Antral hydrochloride) or Antral I.V. RTU® (Antral) is usually administered initially. This may be followed by oral ther-apy with Antral at the discretion of the physician.

INTRA-ABDOMINAL INFECTIONS, including peritonitis, intra-abdominal abscess, and liver abscess, caused by Bacteroides species including the B. fragilis group (B. fragilis, B. distasonis,B. ovatus, B. thetaiotaomicron, B. vulgatus), Clostrid-ium species, Eubacterium species, Peptococcus niger, and Peptostreptococcus species.

SKIN AND SKIN STRUCTURE INFECTIONS caused by Bacteroides species including the B. fragilis group, Clostridium species, Peptococcus niger,Peptostreptococcus species, and Fusobacte-rium species.

GYNECOLOGIC INFECTIONS, including endo-metritis, endomyometritis, tubo-ovarian abscess, and postsurgical vaginal cuff infection, caused by Bacteroides species including the B. fragilis group, Clostridium species, Peptococcusniger, and Pepto-streptococcus species.

BACTERIAL SEPTICEMIA caused by Bacteroides species including the B. fragilis group, and Clos-tridium species.

BONE AND JOINT INFECTIONS, as adjunctive therapy, caused by Bacteroides species including the B. fragilis group.

CENTRAL NERVOUS SYSTEM (CNS) INFECTIONS, including meningitis and brain abscess, caused by Bacteroides species including the B.fragilis group.

LOWER RESPIRATORY TRACT INFECTIONS, including pneumonia, empyema, and lung abscess, caused by Bacteroides species including the B. fragilis group.

ENDOCARDITIS caused by Bacteroides species including the B.fragilis group.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Antral and other antibacterial drugs, Antral should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

How should I use Antral?

Use Antral gel as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • An extra patient leaflet is available with Antral gel. Talk to your pharmacist if you have questions about this information.
  • If you are using Antral gel once daily, use it at bedtime.
  • Remove the cap from the tube and break the metal seal on the tube with the pointed tip of the cap. Screw the end of the applicator onto the tube. Slowly squeeze gel out of the tube and into the applicator. The plunger will stop when the applicator is full. Unscrew applicator and replace the cap on the tube.
  • You may insert Antral gel lying on your back with your knees bent or in any comfortable position. Hold the filled applicator by the barrel, and gently insert into the vagina as far as it will comfortably go. Slowly press the plunger until it stops, and then remove the applicator.
  • If you will be using Antral gel twice daily, you will need to clean the applicator after your first dose of the day and use it again for your second dose. To clean the applicator, pull the plunger out of the barrel. Wash both the plunger and barrel in warm, soapy water and rinse well. To put the applicator back together, gently push the plunger back into the barrel.
  • Wash your hands immediately after using Antral gel.
  • When you throw the applicator away, be sure that it is out of the reach of children and pets.
  • Using Antral gel at the same time each day will help you remember to use it.
  • To clear up your infection completely, use Antral gel for the full course of treatment. Keep using it even if you feel better in a few days.
  • If you miss a dose of Antral gel, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Antral gel.

Uses of Antral in details

infoThere are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
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Antral is an antibiotic that is used to treat a wide variety of infections. It works by stopping the growth of certain bacteria and parasites.

This antibiotic treats only certain bacterial and parasitic infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

Antral may also be used with other medications to treat certain stomach/intestinal ulcers caused by a bacteria (H. pylori).

How to use Antral

Take this medication by mouth as directed by your doctor. To prevent stomach upset, take this medication with food or a full glass of water or milk. The dosage is based on your medical condition and response to treatment.

Antibiotics work best when the amount of medicine in your body is kept at a constant level. Take this drug at evenly spaced intervals.

Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.

Tell your doctor if your condition lasts or gets worse.

Antral description

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Each 100 mL contains Metronidazole USP 500 mg, sodium chloride USP 0.72% w/v, water for injection USP as needed.

Antral injection, USP is a parenteral dosage form of the synthetic antibacterial agent 1-(β-hydroxyethyl)-2-methyl-5-nitroimidazole. The empirical formula is C6H9N3O3 and the molecular weight is 171.15.

Antral injection, USP in 100 mL is a sterile, nonpyrogenic, iso-osmotic, buffered solution of 500 mg Antral, USP, 790 mg sodium chloride, USP, 47.6 mg dried dibasic sodium phosphate, USP and 22.9 mg anhydrous citric acid, USP. Antral injection, USP has an osmolarity of 310 mOsmol/L (calc) and a pH of 5.5 (4.5 to 7).

Antral dosage

Usual Adult Dose for Acne Rosacea

Antral topical 1% gel or cream: Apply a thin film to the affected area once a day.

Antral topical 0.75% gel, cream, or lotion: Apply a thin film to the affected area twice a day.

Usual Adult Dose for Bacterial Vaginosis

Insert one applicatorful of Antral topical 0.75% vaginal gel intravaginally once (at bedtime) or twice a day for 5 consecutive days.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Gel, cream, lotion: Data not available

Vaginal gel: The manufacturer recommends caution when administering this drug to patients with severe hepatic disease.

Dose Adjustments

The duration of topical therapy is 4 to 10 weeks depending on the nature and severity of the condition.

Precautions

Patients should be advised to use Antral topical less frequently or discontinue use if a reaction suggesting local irritation occurs.

Convulsive seizures and peripheral neuropathy have been reported in patients receiving oral or IV Antral. If abnormal neurologic signs appear, Antral topical vaginal gel should be discontinued at once. The use of Antral topical 1% gel should be reevaluated at once if abnormal neurologic signs appear. Antral topical should be used with caution in patients with central nervous system diseases.

Antral topical should be used with caution in patients with evidence of, or history of blood dyscrasia.

Although disulfiram-like reactions have not been reported in patients receiving vaginal Antral, the manufacturer recommends that alcohol be avoided. Antral topical vaginal gel should not be used in patients who have taken disulfiram within the last 2 weeks.

Safety and efficacy have not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Other Comments

Antral topical may cause eye irritation if applied too close to the eyes. Contact with the eyes should be avoided.

Topical areas to be treated should be washed with a mild cleanser prior to application.

The manufacturer recommends avoidance of vaginal intercourse during treatment with Antral topical vaginal gel.

Antral interactions

See also:
What other drugs will affect Antral?

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The intravaginal administration of a single 5 gram dose of Antral results in relatively lower mean systemic exposure to Antral that is approximately 2% to 5% of that achieved following a 500 mg oral dose of Antral. The following drug interactions were reported for oral Antral.

Disulfiram

Use of oral Antral has been associated with psychotic reactions in alcoholic patients who are using disulfiram concurrently. Antral (Antral vaginal gel) should not be used by patients who have taken disulfiram within the last two weeks.

Alcoholic Beverages

Use of oral Antral has been associated with a disulfiram-like reaction (abdominal cramps, nausea, vomiting, headaches, and flushing) to alcohol. Alcoholic beverages and preparations containing ethanol or propylene glycol should not be consumed during and for at least three days after Antral therapy.

Coumarin and Other

Oral Anticoagulants

Use of oral Antral has been reported to potentiate the anticoagulant effect of warfarin and other coumarin anticoagulants, resulting in a prolongation of prothrombin time. This possible drug interaction should be considered when Antral (Antral vaginal gel) is prescribed for patients on this type of anticoagulant therapy. In patients on oral anticoagulants, consider monitoring prothrombin time, international normalized ratio (INR), and other coagulation parameters while on Antral.

Lithium

Short-term use of oral Antral has been associated with elevation of serum lithium concentrations and, in a few cases signs of lithium toxicity, in patients stabilized on relatively high doses of lithium. Use Antral (Antral vaginal gel) with caution in patients treated with lithium and consider monitoring lithium serum concentrations while on Antral.

Cimetidine

Use of oral Antral with cimetidine may prolong the half-life and decrease plasma clearance of Antral. No dose adjustment of Antral (Antral vaginal gel) is necessary.

Antral side effects

See also:
What are the possible side effects of Antral?

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The data described below reflect exposure to Antral compared to another formulation of vaginal Antral in 220 women in a single trial. The population was non-pregnant females (age range 18 to 72 years, the mean was 33 years +/- 11 years) with bacterial vaginosis. The racial demographic of those enrolled was 71 (32%) of White, 143 (65%) of Black, 3 (1%) of Hispanic, 2 (1%) of Asian, and 1 (0%) of other. Patients administered an applicator full of Antral (Antral vaginal gel) intravaginally once daily at bedtime for 5 days.

There were no deaths or serious adverse reactions related to drug therapy in the clinical trial. Antral (Antral vaginal gel) was discontinued in 5 patients (2.3%) due to adverse reactions.

The incidence of all adverse reactions in Antral (Antral vaginal gel) -treated patients was 42% (92/220). Adverse reactions occurring in ≥ 1% of patients were: fungal infection* (12%), headache (7%), pruritus (6%), abdominal pain (5%), nausea (3%), dysmenorrhea (3%), pharyngitis (2%), rash (1%), infection (1%), diarrhea (1%), breast pain (1%), and metrorrhagia (1%).

* Known or previously unrecognized vaginal candidiasis may present more prominent symptoms during therapy with Antral (Antral vaginal gel). Approximately 10% of patients treated with Antral (Antral vaginal gel) developed Candida vaginitis during or immediately after therapy.

Additional uncommon events, reported by < 1% of those women treated with Antral (Antral vaginal gel) included:

General: allergic reaction, back pain, flu syndrome, mucous membrane disorder, pain

Gastrointestinal: anorexia, constipation, dyspepsia, flatulence, gingivitis, vomiting

Nervous System: depression, dizziness, insomnia

Respiratory System: asthma, rhinitis

Skin and Appendages: acne, sweating, urticaria

Urogenital System: breast enlargement, dysuria, female lactation, labial edema, leucorrhea, menorrhagia, pyleonephritis, salpingitis, urinary frequency, urinary tract infection, vaginitis, vulvovaginal disorder

Other Antral Formulations

Other Vaginal Formulations

Other reactions that have been reported in association with the use of other formulations of Antral vaginal gel include: unusual taste and decreased appetite.

Topical (Dermal) Formulations

Other reactions that have been reported in association with the use of topical (dermal) formulations of Antral include skin irritation, transient skin erythema, and mild skin dryness and burning. None of these adverse reactions exceeded an incidence of 2% of patients.

Oral and

Parenteral Formulations

The following adverse reactions and altered laboratory tests have been reported with the oral or parenteral use of Antral:

Cardiovascular: Flattening of the T-wave may be seen in electrocardiographic tracings.

Nervous System: The most serious adverse reactions reported in patients treated with Antral have been convulsive seizures, encephalopathy, aseptic meningitis, optic and peripheral neuropathy, the latter characterized mainly by numbness or paresthesia of an extremity. In addition, patients have reported syncope, vertigo, incoordination, ataxia, confusion, dysarthria, irritability, depression, weakness, and insomnia.

Gastrointestinal: Abdominal discomfort, nausea, vomiting, diarrhea, an unpleasant metallic taste, anorexia, epigastric distress, abdominal cramping, constipation, “furry” tongue, glossitis, stomatitis, pancreatitis, and modification of taste of alcoholic beverages.

Genitourinary: Overgrowth of Candida in the vagina, dyspareunia, decreased libido, proctitis.

Hematopoietic: Reversible neutropenia, reversible thrombocytopenia.

Hypersensitivity Reactions: Urticaria; erythematous rash; Stevens-Johnson Syndrome, toxic epidermal necrolysis, flushing; nasal congestion; dryness of the mouth, vagina, or vulva; fever; pruritus; fleeting joint pains.

Renal: Dysuria, cystitis, polyuria, incontinence, a sense of pelvic pressure, darkened urine.

Antral contraindications

See also:
What is the most important information I should know about Antral?

Hypersensitivity

The use of Antral (Antral vaginal gel) is contraindicated in patients with a history of hypersensitivity to Antral, other nitroimidazole derivatives, or parabens. Reported reactions include urticaria; erythematous rash; Stevens-Johnson Syndrome, toxic epidermal necrolysis, flushing; nasal congestion; dryness of the mouth, vagina, or vulva; fever; pruritus; fleeting joint pains.

Psychotic Reaction with Disulfiram

Use of oral Antral is associated with psychotic reactions in alcoholic patients who were using disulfiram concurrently. Do not administer Antral (Antral vaginal gel) to patients who have taken disulfiram within the last two weeks.

Interaction with Alcohol

Use of oral Antral is associated with a disulfiram-like reaction to alcohol, including abdominal cramps, nausea, vomiting, headaches, and flushing. Discontinue alcohol consumption during and for at least three days after therapy with Antral (Antral vaginal gel).



Active ingredient matches for Antral:

Metronidazole in Mexico.


List of Antral substitutes (brand and generic names)

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Unit description / dosage (Manufacturer)Price, USD
Antizoal infusion 5 mg/mL / PP1 100 mL x 1's (Shijiazhuang No. 4)
Apo-Metronidazole 250 mg x 1 Bottle 100 Tablet
Apo-Metronidazole 250 mg x 1 Bottle 500 Tablet
Apo-Metronidazole 250 mg x 1 Bottle 1000 Tablet
Apo-Metronidazole 250 mg x 500's
Tablets; Oral; Metronidazole 250 mg
Apo-metronidazole tablet 250 mg (Apotex Inc (Canada))
Apo-metronidazole capsule 500 mg (Apotex Inc (Canada))
Suppositories; Vaginal; Metronidazole (Medika)
Tablet, Film-Coated; Oral; Metronidazole 250 mg (Medika)
Tablet, Film-Coated; Oral; Metronidazole 500 mg (Medika)
Tablets, Film-Coated; Oral; Metronidazole 250 mg (Medika)
Tablets, Film-Coated; Oral; Metronidazole 500 mg (Medika)
Suppositories; Vaginal; Metronidazole
Tablet, Film-Coated; Oral; Metronidazole 250 mg (Montavit)
Tablet, Film-Coated; Oral; Metronidazole 500 mg (Montavit)
Tablets, Film-Coated; Oral; Metronidazole 250 mg (Montavit)
Tablets, Film-Coated; Oral; Metronidazole 500 mg (Montavit)
ARISTOGYL Capsule/ Tablet / 400mg / 10 units (Aristo)$ 0.10
ARISTOGYL Capsule/ Tablet / 200mg / 10 units (Aristo)$ 0.07
ARISTOGYL Liquid / 100mg per ml / 60ml units (Aristo)$ 0.17
200 mg x 10's (Aristo)$ 0.07
400 mg x 10's (Aristo)$ 0.11
100 mg x 5 mL x 60ml (Aristo)$ 0.16
Suspension; Oral; Metronidazole 100 mg / 5 ml (Aristo)
Tablets; Oral; Metronidazole 200 mg (Aristo)
Tablets; Oral; Metronidazole 400 mg (Aristo)
Aristogyl 200mg TAB / 10 (Aristo)$ 0.07
Aristogyl 400mg TAB / 10 (Aristo)$ 0.11
Aristogyl 100mg x 5mL SUSP / 60ml (Aristo)$ 0.16
ARISTOGYL 200MG TABLET 1 strip / 10 tablets each (Aristo)$ 0.07
ARISTOGYL 400MG TABLET 1 strip / 10 tablets each (Aristo)$ 0.13
ARISTOGYL SUSPENSION 1 bottle / 60 ML suspension each (Aristo)$ 0.16
ARISTOGYL tab 200 mg x 10's (Aristo)$ 0.07
ARISTOGYL tab 400 mg x 10's (Aristo)$ 0.11
ARISTOGYL oral susp 100 mg x 5 mL x 60ml (Aristo)$ 0.16
Aristogyl 400mg Tablet (Aristo)$ 0.01

References

  1. DailyMed. "BISMUTH SUBCITRATE POTASSIUM; METRONIDAZOLE; TETRACYCLINE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. PubChem. "metronidazole". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. DrugBank. "metronidazole". http://www.drugbank.ca/drugs/DB00916 (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology

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