please respond to the following discussion post at the end of the instructions. Please use your in text citation and also reference according to the APA guidelines. Use your own words, do not use direct quotes on this order. Use scholarly peer reviewed references within the last 5 years to support your response. please avoid using consumer level resources such as drugs. com or mayoclinic.com. please use the appropriate sources this is professional level course. respond the following discussion board post using peer reviewed scholarly sources to support your answer. L.T: 1. List specific goals of treatment for this patient.
Bacterial vaginosis (BV) is caused by a disruption of the normal flora in the vagina, which may result from douching and sexual activity, such as in this case with R. S. (U.S. Department of Health and Human Services, 2021). BV may be asymptomatic, but typical symptoms include white vaginal discharge, fishy odor especially after intercourse, and possibly cervicitis (Sobel & Mitchell, 2022). The vaginal pH may be higher than normal and clue cells can be assessed under a microscope, such as with R.S. (Lin et al., 2021). The normal pH of the vagina is 3.8-5.0 because of the presence of normal flora keeping it acidic, particularly Lactobacilli (Lin et al., 2021). In BV, Lactobacilli is reduced, and other bacteria increase, causing the pH of the vagina to become more alkalotic (Sobel, 2022a). Goals of treatment for R. S. include cessation of her symptoms, as well as prevention of recurrence and STDs.
2. What drug therapy would you prescribe? Why?
The drug therapy I would prescribe for R. S. is metronidazole gel 0.75% vaginal inserts once daily for 5 days (Sobel, 2022b). Vaginal administration treats the infection directly at the source and side effects are less common than with oral administration (Sobel, 2022b). However, R. S. may prefer to take oral metronidazole, which is also fine. In this case, I would instead prescribe her metronidazole 500 mg twice daily for 7 days (Sobel, 2022b). This type of treatment is one I would strongly collaborate with the patient to see which form of administration she prefers, as both are considered equally effective for the treatment of BV.
3. What are the parameters for monitoring the success of the therapy?
Parameters for monitoring success of treatment include cessation of odor and discharge, and absence of recurrence following treatment. More than 50% of women have a recurrent BV infection within the year following initial infection (Morrill et al., 2020). Prevention is aimed at individual risk factors.
4. Discuss specific patient education based on the prescribed therapy.
Specific patient education for this case includes discussion of risk factors for BV and the course of treatment. Douching is associated with a disruption of normal vaginal flora, putting the vagina at risk for infection, including BV and STDs (U.S. Department of Health and Human Services, 2022). Other risk factors for BV include smoking; sexual activity, including oral intercourse; a new sex partner; multiple sex partners; unprotected sex; history of HSV-2 or HIV; women of color; a diet high in fat and low in fiber, folate, vitamin E, and calcium; and being overweight (U.S. Department of Health and Human Services, 2021; Sobel & Mitchell, 2022). These should be discussed in detail with R. S. to prevent future infections. I would educate her on common side effects of metronidazole, including nausea, vomiting, cramping, and metallic taste (Whalen et al., 2019, p. 606). Oral metronidazole should be taken with a full meal to avoid GI upset (Tucker, 2022, p. 267). The evidence for alcohol consumption with metronidazole therapy causing a possible disulfiram-like reaction is lacking, and patients do not need to be advised to stop drinking alcohol during treatment (Sobel, 2022b). R. S. should also be advised to refrain from sexual activity during treatment (U.S. Department of Health and Human Services, 2021).
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
One adverse reaction that would cause me to change therapy is an allergic reaction, albeit rare (Sobel, 2022b). Another reaction that may warrant a change of therapy are severe GI issues (Tucker, 2022, p. 267). If R. S. does not tolerate the side effects of metronidazole, I would prescribe second-line treatment.
6. What would be the choice for second-line therapy? Provide rationale
My second-line treatment choice would be clindamycin 2% vaginal cream once daily for 7 days, which is the second drug of choice for treating BV (Sobel, 2022b). Allergic reactions are more common with this antibiotic than metronidazole, which should be monitored closely especially in those with other allergies (Tucker, 2022, p. 88). Oral clindamycin should be avoided because it may cause c. diff (Sobel, 2022b).
7. What OTC or alternative medications would be appropriate for this patient?
Lactobacilli species probiotics may assist in treating BV with antibiotic therapy and preventing recurrence by reinstituting the vagina’s normal flora (Sobel, 2022b). Another recommendation is the use of boric acid vaginal suppositories in addition to antibiotics, especially in those with recurrent BV, which helps to restore the pH of the vagina (Sobel, 2022b).
8. What dietary or lifestyle changes should be recommended?
Dietary and lifestyle recommendations for R. S. are plentiful. I would advise her to avoid douching and smoking. I would also encourage her to use condoms. I would explain the importance of a balanced diet and maintaining a healthy weight in prevention of recurrence, as well as for other benefits.
9. Describe one or two drug–drug or drug–food interaction for the selected agent.
One drug-drug reaction with metronidazole is with warfarin. Metronidazole may increase the effects of warfarin and thus increase INR and bleeding risk (Sobel, 2022b). There is limited evidence to support that alcohol consumption and metronidazole therapy may produce a disulfiram-like reaction but continues to be a warning on many manufacturer labels (Sobel, 2022b). Therefore, it is important to have an open discussion regarding this topic with patients for them to make their own assessment.