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You should respond in a well-developed paragraph (300–350 words) integrating an evidence-based resource , Respectfully agree and disagree with your peers’ responses and explain your reasoning by including your rationales in your explanation .At Least 2 APA references each

Response 1

The purpose of this discussion is to discuss and describe treatment for R.S. who is diagnosed with bacterial vaginosis. Identifying the specific goals of treatment for this patient is essential to care for R.S. The specific goal of the Metronidazole treatment is to resolve the signs and symptoms of infection (Vallerand & Sanoski. 2016). The length of time for complete resolution of the infection depends on the organism and site of infection Vallerand, A. & Sanoski, C. (2016). Moreover, other specific goal of treatment is to relieve vaginal symptoms, and potentially decrease the risk of acquiring HIV and other sexually transmitted infections such as Chlamydia, trachomatis, Neisseria gonorrhea, and viral STIs (Coudray & Madhivanan. 2020). The drug therapy this writer would prescribe is metronidazole because it will help to fight the signs and symptoms of infection in R.S. (Woo, Terri Moser, Robinson & Marylou. 2020). Metronidazole is the first pharmacological method to treat bacterial vaginosis (Woo, Terri Moser, Robinson & Marylou. 2020). This medication is indicated for anaerobic bacterial infection (Woo, Terri Moser, Robinson & Marylou. 2020). The metronidazole mechanism of action is disrupting DNA and protein synthesis in susceptible organisms (Vallerand & Sanoski. 2016). This writer would prescribe Metronidazole as 500 mg orally twice daily for 7 days (Woo, Terri Moser, Robinson & Marylou. 2020).

Metronidazole has parameters for monitoring the success of the therapy. This writer will assess the patient R.S. for signs of infection by monitoring the vitals signs, the appearance of discharge, and the white blood cell count (Vallerand & Sanoski. 2016). This assessment will occur at the beginning of and throughout therapy (Vallerand & Sanoski. 2016). Additionally, this writer will obtain specimens for culture and sensitivity before therapy and at the end of the therapy (Vallerand & Sanoski. 2016). Patient education is a crucial component of the prescribed treatment. This writer will instruct the patient to take medication as direction and even when feeling better (Vallerand & Sanoski. 2016). This writer will also instruct the patient that metronidazole may be taken with meals or a snack to decrease GI irritation (Woo, Terri Moser, Robinson & Marylou. 2020). More importantly, this writer will instruct and educate patient to avoid alcohol beverages during therapy and for 48 hours after completing it (Woo, Terri Moser, Robinson & Marylou. 2020). Similarly, this writer will instruct patient to abstain from sexual contact or use condoms for seven days after therapy begins (Woo, Terri Moser, Robinson & Marylou. 2020). Lastly, this will advise the patient to consult health care professional if no improvement in a few days or if signs and symptoms of superinfection (black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stools) develop (Vallerand & Sanoski. 2016). Metronidazole has several adverse effects. If the patient has seizures or stevens-johnson syndrome while taking this medication this writer would change the medication (Vallerand & Sanoski. 2016). One drug-drug interaction occurs with alcohol (Vallerand & Sanoski. 2016). Disulfram-like reaction may occur with alcohol ingestion (Vallerand & Sanoski. 2016).

Bacterial vaginosis has two treatment options. If the patient does not show signs of improvement with metronidazole. The second choice therapy is clindamycin: oral preparations or intravaginal ovules. Clindamycin would be prescribed to the patient as 300 mg orally twice daily for 7 days (Petrina, Cosentino, Rabe & Hillier. 2017). Clindamycin is the second line of treatment because the medication is an anti-infective used to treat symptomatic women (Vallerand & Sanoski. 2016). Alternative methods to help treat bacterial vaginosis are yogurt, probiotics, or boric acid (Falconi‐McCahill. 2019). Lifestyle management should be recommended for R.S. This writer will educate patients that many of the infections treated with metronidazole are due to sexual transmission (Woo, Terri Moser, Robinson & Marylou. 2020). This writer will advise R.S. the route of transmission and promote refraining from activity until the treatment is complete (Woo, Terri Moser, Robinson & Marylou. 2020).

Response 2

Some conditions may affect the client in the community which can make the client feel embarrassed to seek medical attention, but it can be as dangerous as any other health condition when treatment is not delivered promptly and those conditions are associated with sexually transmitted diseases (STD). It can be situations when the person may also infect the partner and both may need treatment. In the discussion board this week R.S. is a 32 years old female which has been having a vaginal discharge for the past month and only have one partner and has been diagnosed with Bacterial Vaginosis. Although Bacterial vaginosis is not considered a sexually transmitted infection the reason for occurrence is associated with multiple sex partners, douching, unprotected intercourse, and the decrease amount of natural flora (Woo, 2020). This condition is caused primarily due to a replacement of the normal flora which is acidic at pH 4.5 to an overgrowth of anaerobic organisms such as Prevotella spp., Mobiluncus spp., Gardnerella vaginalis, or Mycoplasma hominis (Woo, 2020). These organisms tend to grow in a less acidic environment, as presented by the case study were R.S. pH is 5.5 during microscopic examination.

The main goal of treatment for this condition is to make the symptoms subside before it morphs into something more serious. The first-line treatment is usually initiated with metronidazole 0.75% gel applied vaginally for five days (Allen, 2020). By initiating this therapy, the patient will also monitor itself and follow up with the prescriber whether the treatment is being effective. This type of condition may reoccur on multiple occasions and is important for the patient to seek the prescriber if the condition reoccurs where a different treatment option may be needed. The reason for choosing this treatment option is that it is the least amount of time and can have a better effect since is applied to the site. However, the patient needs to take some precautions during therapy such as do not consume alcohol during and at least three days after the completion of treatment due to the risk for disulfiram-like reactions (Woo, 2020). The patient should also report any burning, stinging, or change in taste which are rare symptoms, but it should be reported while in this therapy (Mayo clinic, 2020). The prescriber should seek a different treatment or add therapy if this first-line treatment is not being effective.

Although there is a different option that someone may take this writer would prescribe clindamycin 300mg twice daily for 7 days as second-line therapy. The reason for prescribing an oral medication is that it would act quickly and have a more systemic action instead of continuing with the topical option. Besides, it could only be that the patient did not have a useful treatment with the clotrimazole cream due to not following the treatment correctly which can affect the overall treatment. By reading the literature this writer did not found many over-the-counter (OTC) treatment options while treating this condition. The most mentioned OTC was the introduction of probiotics as an adjunct therapy with the antibiotic, but there was no convincing data that attest to its efficacy (Ellington, & Saccomano, 2020). However, while taking antibiotics such as clindamycin, taking a probiotic can decrease the chances of damaging the intestinal natural flora, in this situation it may not help with the current bacterial vaginosis, but it will protect the natural flora which implies that it may be a good reason to take a probiotic while on antibiotic therapy. The main dietary recommendation while taking clindamycin is not to take grapefruit juice together. Clindamycin is a CYP3A4 substrate and grapefruit juice is a strong inhibitor of this substrate, which implies that while taking Clindamycin R.S. should avoid grapefruit juice (WellRx, 2020).Other education factors can help this patient prevent reoccurrences such as limiting sexual partners, using condoms, improving hygiene with sharing sex toys, and the avoidance of douching (Ellington, K., & Saccomano, S. J. (2020). Overall, educating the patient to take/administer the medication as prescribed. Communicate with the prescriber any adverse effects are also an important recommendation to be made while treating the patient in the community.

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