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Original Article
- The importance of topical metronidazole in the treatment of acute anal fissure: a double-blind study controlled for prospective randomization
- Tuba Mert
- Ann Coloproctol. 2023;39(2):131-138. Published online January 18, 2022
- DOI: https://doi.org/10.3393/ac.2021.00675.0096
- 7,867 View
- 299 Download
- 6 Web of Science
- 9 Citations
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Graphical Abstract
Abstract
PDF - Purpose
Acute anal fissure, a disease characterized by severe pain in the anorectal area, reduces quality of life and becomes chronic absent appropriate treatment. More recently, anaerobic infections have been noted as contributive to etiopathogenesis. This study investigates topical metronidazole’s effect in the treatment of acute anal fissure.
Methods
Our prospective randomized controlled double-blind study included 2 groups of 100 patients older than 18 years from our General Surgery Clinic with anal fissure complaints for less than 8 weeks. Topical diltiazem treatment was started in group 1, and topical diltiazem and metronidazole treatment in group 2. Pain levels were evaluated by the visual analogue scale (VAS) score, and recovery status was evaluated by physical examination findings ab initio and at the 1st, 4th, and 6th weeks. VAS score levels, demographic, clinical, and recovery status were then compared.
Results
There was no difference between the groups as to age, sex, pain on defecation, bleeding, constipation, and duration of pain, bleeding and constipation (P>0.05). From week 1, fissure epithelialization and healing rates were higher in group 2 (P<0.001); group 2 VAS score levels were lower than in group 1 (P<0.001) and achieved by group 1 only in week 4 (P=0.073).
Conclusion
Adding topical metronidazole to treatment reduces the duration and severity of pain, shortens healing time, and increases the healing rate. -
Citations
Citations to this article as recorded by
- A comparative study between combination of topical metronidazole and diltiazem vs diltiazem alone in treatment of acute anal fissure
Abhishek Jain, Rafat Khan, Nitin Garg
International Surgery Journal.2025; 12(3): 350. CrossRef - Search for bacterial biofilms in the chronic anal fissure (descriptive study with in-depth visualization)
M. A. Ignatenko, A. A. Ponomarenko, M. V. Zhurina, N. A. Kostrikina, E. E. Zharkov, Yu. A. Nikolaev, A. R. Melkumyan
Koloproktologia.2025; 24(3): 95. CrossRef - Efficacy of local metronidazole with glyceryl trinitrate versus topical glyceryl trinitrate alone in the treatment of acute anal fissure: a randomized clinical trial
Hesham M. Elgendy, Ahmed AbdelMawla, Ahmed F. Hussein
The Egyptian Journal of Surgery.2024; 43(1): 304. CrossRef - Belgian consensus guideline on the management of anal fissures
P Roelandt, G Bislenghi, G Coremans, D De Looze, M.A. Denis, H De Schepper, P Dewint, J Geldof, I Gijsen, N Komen, H Ruymbeke, J Stijns, M Surmont, D Van de Putte, S Van den Broeck, B Van Geluwe, J Wyndaele
Acta Gastro Enterologica Belgica.2024; 87(2): 304. CrossRef - Avances terapéuticos en el abordaje de las fisuras anales: explorando la sinergia entre Farmacología y Nanotecnología
Carlos Ostwaldo Pazmiño-Chiluiza, María Luisa González Rodríguez
Ars Pharmaceutica (Internet).2024; 65(4): 409. CrossRef - Local plus oral antibiotics and strict avoidance of constipation is effective and helps prevents surgery in most cases of anal fissure
Pankaj Garg, Vipul D. Yagnik, Kaushik Bhattacharya
Annals of Coloproctology.2023; 39(2): 188. CrossRef - COMPARATIVE STUDY ON THE EFFICACY OF TOPICAL METRONIDAZOLE, TOPICAL NITROGLYCERINE, AND TOPICAL DILTIAZEM IN THE MANAGEMENT OF CHRONIC ANAL FISSURE
PURSHOTAM DASS GUPTA, FAHAD TAUHEED, ANURAG SARASWAT, Karthik P
Asian Journal of Pharmaceutical and Clinical Research.2023; : 141. CrossRef - The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure
Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Francesca Iacobellis, Luigi Brusciano, Luigi Monaco, Domenico Izzo, Alfredo Giordano, Michele Pinto, Corrado Fantini, Marcello Gasparrini, Michele Schiano Di Visconte, Francesca Milazzo, Giovanni Ferrer
BMC Surgery.2023;[Epub] CrossRef - Comparative Efficacy of Topical Metronidazole and Glyceryl Trinitrate Versus Topical Glyceryl Trinitrate Alone in the Treatment of Acute Anal Fissure: A Randomized Clinical Trial
M Hasaan Shahid, Sidra Javed, Saryia Javed, Anwar Zeb Khan, Adeel Kaiser, Reda H Mithany
Cureus.2022;[Epub] CrossRef
- A comparative study between combination of topical metronidazole and diltiazem vs diltiazem alone in treatment of acute anal fissure
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