Tuesday, January 19, 2021




1. (Q)What is the rationale for combining clotrimazole and metronidazole

Clotrimazole is an antifungal agent. It takes care of candida albicans [thrush].

(A)Metronidazole is an antiprotozoal/antibacterial agent that takes care of the anaerobic bacteria and protozoa such as  Trichomonas vaginalis, Gardnerella vaginalis and Streptococci.

Since vaginitis usually presents as cases of mixed infection[fungal/bacterial/protozoal], Klovinal offers a competitive advantage of fixed-dose combination of clotrimazole and metronidazole in a single pessary

2. (Q) Bacteria are NOT known to form spores, how do you explain “lactobacillus spores”

(A) Certain species are spore producing. [https://en.wikipedia.org/wiki/Bacillus_coagulans/], [Asian J. Pharm. Tech. 2013; Vol. 3: Issue 1, Pg 05-08].

3. (Q) How do you guarantee the integrity of the lactobacillus since it is co-formulated with metronidazole which is potentially bactericidal?

(A) The lactobacillus is co-formulated as the spore [inert] form. The spores become vegetative only when the environment [vaginal] is conducive.

4. (Q) Why do some patient experience “peppery feeling” in their vagina during the course of treatment with Klovinal.

(A) Such peppery feeling is usually an indication of severe candidiasis in such patients. However, the feeling usually resolves within three days during the course of therapy. They do not need to discontinue therapy with Klovinal

5. (Q) Why is Klovinal not packed with applicator?

(A) Applicators are found to be culprits in reintroducing infections into the vagina especially after the first/second usage. Most women do not care to clean the applicators, and those that take time to clean usually do not clean it properly.

The average woman will naturally clean her fingers before/after inserting a pessary. Hence, the highest level of hygiene is maintained when pessaries are inserted by fingers.

Klovinal pessary is best inserted with the fingers.


6. (A) Compare miconazole/metronidazole and clotrimazole/metronidazole

(B) Miconazole and clotrimazole are both imidazole antifungal agents. 

A study showed that clotrimazole 1 per cent vaginal cream applied over 7 days has a slightly, but not significantly, better efficacy than the miconazole nitrate 2 per cent vaginal cream applied over 14 days, with no adverse reactions, in the treatment of vulvovaginal candidiasis. [Am J Obstet Gynecol. 1978 Oct 1;132(3):321-3.]



7. (Q) Why the combination with lactobacillus


(A) Human vagina represents a dynamic ecosystem dominated by certain species of Lactobacillus. 

This microorganism restricts the growth of pathogens by using properties of steric exclusion and inhibitory substance production. 

Serious complications including bacterial vaginosis and vaginal cancer are often determined in women with reduced numbers of lactobacilli. Local application of Lactobacillus is consequently promising to keep the vagina colonized by this strain, which consequently reduces the infections. 

Hence, co-formulation of lactobacillus with the regular pharmacologic agent used in treating vaginitis has dual advantage

a. symptomatic relief is achieved, and;

b. lactobacillus spp is repopulated in the vagina ecosystem in order to continue its regulatory functions, and thereby reducing the incidence of recurrence.




Seagreen Pharmaceuticals LTD
3 Okunfolami street, Anthony village, Lagos, NG

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Phone: 08183260033


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