Introduction     Bacterial Vaginosis (BV) occurs when the body’s bacterial flora becomes altered, resulting in changes in the predominant lactobacilli in conjunction with the overgrowth of facultative aerobic bacterial species such as Bacteroides, Mobiluncus, Peptococcus, mycoplasma, and Streptococcus (Woo & Robinson, 2020). Infections associated with BV present with a clear copious vaginal discharge with a foul odor, with a ph greater than 4.5 (Woo & Robinson, 2020). According to Onderdonk et al. (2016), Bacterial vaginosis (BV) is one of the most prevalent microbiological syndromes among women of childbearing age that has been associated with various health conditions that include pelvic inflammatory disease, preterm births, increased susceptibility to HIV infections, and other chronic health problems. Pregnant women presenting with symptoms are presumed to be at high risk for preterm delivery despite being a highly controversial topic within the medical community (Woo & Robinson, 2020).     Srinivasan et al. (2015), in their research study, indicate that the composition of molecule metabolites within the women’s vagina in conjunction with the metabolism of human-derived nutrients impacts cell function and inflammation, making women more susceptible to disease. However, little research has been performed that has examined the associations of vaginal bacteria and metabolites using quantitative PCR (qPCR) data to link and or show correlations between fastidious vaginal bacteria to metabolite concentrations (Srinivasan et al., 2015).List specific goals of treatment for this patient.     The primary objective for treating patients with BV is to determine the source of infection by either taking a sample of vaginal secretions and placing the sample under a microscope and or performing a ph test (Woo & Robinson, 2020). This writer would assess how long this patient has been using commercial douche products, inquiring if there were any specific reasons or if the products were more for prophylactic purposes. Aslan and Bechelaghem (2018) indicate in their research study that vaginal douching has been associated with bacterial vaginosis infections as they may inhibit or reduce the colonization of beneficial Lactobacilli strains, with the authors concluding that vaginal douching does lower the growth of Lactobacilli strains and thus should be used cautiously. Lastly, this writer would remind the client to practice safe sex, as this can limit the possibility of BV infections.What drug therapy would you prescribe? Why     Based on the information provided in the case study, RS has been symptomatic for approximately one month. However, there is no mention of recurring infections, so this writer will assume this is a first-time infection that this patient has experienced. According to Woo and Robinson (2020), treatment with Metronidazole is the first-line drug for BV infections per CDC guidelines. This writer would prescribe Metronidazole 500 mg oral BID for seven days (Woo & Robinson, 2020).What are the parameters for monitoring the success of the therapy?     BV infections with proper pharmacological treatment, usually consisting of either Metronidazole, Clindamycin, and Tinidazole, can resolve in 2-12 months, depending on the severity (Woo & Robinson, 2020). The most important aspects of successful treatment include consistency with prescribed treatments and restoring the vagina’s healthy bacteria by eating foods rich in lactobacilli such as yogurts.Discuss specific patient education based on the prescribed therapy.     Metronidazole is an antibiotic used to treat BV infections. Thus patient teaching should include discussing the importance of completing the antibiotic regime and avoiding missed dosing to limit the potential for antibiotic resistance (Woo & Robinson, 2020). Zaman et al. (2017) indicate that antibiotics are real “wonder drugs” used for decades to combat microbes for both therapeutic and prophylactical purposes used in many industries. However, uncertainty has arisen due to microbes becoming increasingly resistant to common antibiotics. Reminding patients to avoid alcohol consumption is essential as alcohol can cause additional unwarranted side effects such as hot flushes, palpitations, headaches, and a general feeling of sickness (Woo & Robinson, 2020).What would be the choice for second-line therapy? Provide rationale     Tinidazole is another treatment option for BV infections with similar properties and effectiveness compared to Metronidazole’s as a first-line treatment (Woo & Robinson, 2020). This writer would prescribe 1g taken by mouth daily taken with food x5 days.What OTC or alternative medications would be appropriate for this patient?     Probiotics are a great way to help maintain an optimal bacterial environment to help minimize the chance of infections (Woo & Robinson, 2020). Vaginal probiotics containing at least 8 billion units of Lactobacillus rhamnosus, Lactobacillus acidophilus, and Streptococcus thermophilus per capsule is recommended (Woo & Robinson, 2020). According to Heczko et al. (2015), one of the most proposed on-antibiotic therapies for BV is vaginal probiotics, as they have been shown in research studies to help facilitate restoring the normal vaginal microbiota, especially in combined therapies with metronidazole or clindamycin treatments.What dietary or lifestyle changes should be recommended?     Research conducted by Taheri et al. (2015) has shown powerful correlations between a diet high in dietary saturated fat vs. low saturated fat can influence higher occurrences of BV infections. To add diets high in micronutrients such as folate, vitamin A, and calcium have been linked to lower occurrences of severe BV infections in women (Taheri et al., 2015). This writer would educate and encourage the client in this case study to follow these recommended dietary guidelines.Describe one or two drug-drug or drug-food interactions for the selected agent.     Patients prescribed Metronidazole for BV infections are urged to avoid alcohol consumption entirely or alcohol-containing products such as cough drops, cold syrups, and aftershave due to adverse side effects such as stomach upset and heart palpitations, and a general feeling of sickness (Woo & Robinson, 2020). Patients should avoid Metronidazole if using Disulfiram, a drug used in the treatment of alcoholism if used within two weeks of starting treatment Metronidazole treatment (Woo & Robinson, 2020).                                                                                                     My References

Aslan, E., & Bechelaghem, N. (2018). To ‘douche’or not to ‘douche’: hygiene habits may have detrimental effects on vaginal microbiota. Journal of Obstetrics and Gynaecology, 38(5), 678-681.Heczko, P. B., Tomusiak, A., Adamski, P., Jakimiuk, A. J., StefaÅ„ski, G., MikoÅ‚ajczyk-CichoÅ„ska, A., … & Strus, M. (2015). Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial. BMC women’s health, 15(1), 115.Onderdonk, A. B., Delaney, M. L., & Fichorova, R. N. (2016). The human microbiome during bacterial vaginosis. Clinical microbiology reviews, 29(2), 223-238.Srinivasan, S., Morgan, M. T., Fiedler, T. L., Djukovic, D., Hoffman, N. G., Raftery, D., … & Fredricks, D. N. (2015). Metabolic signatures of bacterial vaginosis. MBio, 6(2).Taheri, M., Baheiraei, A., Foroushani, A. R., Nikmanesh, B., & Modarres, M. (2015). Treatment of vitamin D deficiency is an effective method in the elimination of asymptomatic bacterial vaginosis: A placebo-controlled randomized clinical trial. The Indian journal of medical research, 141(6), 799.Woo, T. M., & Robinson, M. V. (2020). Pharmacotherapeutics for advanced practice nurse prescribers. Philadelphia, PA: F.A. Davis Company.Zaman, S. B., Hussain, M. A., Nye, R., Mehta, V., Mamun, K. T., & Hossain, N. (2017). A review on antibiotic resistance: alarm bells are ringing. Cureus, 9(6).

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