COMPARISON OF EFFECTIVENESS OF TOPICAL METRONIDAZOLE & GLYCERYL TRINITRATE V/S TOPICAL GLYCERYL TRINITRATE ALONE IN THE MANAGEMENT OF ACUTE ANAL FISSURE

Abstract

OBJECTIVE

To compare the efficacy of topical metronidazole and topical 0.2% GTN vs topical 0.2% GTN alone in patients of anal fissure.

METHODOLOGY

A prospective, interventional, comparative study was conducted in the Surgical Unit VI of Civil Hospital Karachi over six months. A total of 158 patients aged 18–70 years with acute anal fissure (<6 weeks’ duration) were consecutively enrolled and randomly allocated into two groups: Group A received topical metronidazole with 0.2% glyceryl trinitrate, and Group B received 0.2% glyceryl trinitrate alone. Data was analyzed using SPSS version 26 with a significance level of p ≤ 0.05.

RESULTS

A total of 158 patients were included, with an overall mean age of 39.4 ± 10.7 years; 51.9% were males and 48.1% females. The combination of metronidazole with 0.2% glyceryl trinitrate demonstrated higher efficacy (p=0.023) and greater pain reduction at all follow-up intervals (p<0.01) than GTN alone. Efficacy was significantly higher among males (p=0.033) and younger patients aged 18–40 years (p=0.044), while differences among females and older patients were not significant.

CONCLUSION

The findings of this study demonstrate that combining topical metronidazole with 0.2% glyceryl trinitrate enhances healing and provides faster pain relief in patients with acute anal fissure compared to monotherapy. The addition of metronidazole improves therapeutic response, especially among younger adults, by addressing both inflammation and infection at the fissure site. This combination represents a safe, effective, and easily applicable first-line treatment option for managing acute anal fissure in clinical settings.