# Assessment of Treatment Effectiveness in Acute and Chronic Anal Fissures

## TL;DR

This study evaluates how topical metronidazole affects healing in acute and chronic anal fissures, finding it may help some patients with specific symptoms.

## Contribution

The study investigates the effectiveness of topical metronidazole in treating anal fissures, highlighting its potential for selected cases with inflammation.

## Key findings

- Topical metronidazole was associated with improved mucosal healing in patients with acute anal fissures and inflammation.
- There were no significant differences in follow-up intervals or VAS score improvements between groups.
- The benefit of metronidazole was not uniform across all patients, and microbial involvement remains unclear without microbiological data.

## Abstract

Background and Objectives: Anal fissures are a common condition in the general population, for which there are multiple treatment options. It is essential to select the most appropriate treatment for the right patient. This study aimed to observe and evaluate the effect of topical antibiotherapy, which is widely used in the management of wounds and chronic infections, on the healing of acute and chronic anal fissures. Materials and Methods: Hospital records of 625 individuals diagnosed with an anal fissure were reviewed. Previous treatments, including 0.4% glyceryl trinitrate and 5% lidocaine, were recorded. A total of 118 patients were included: 49 patients who received additional topical metronidazole due to inflammation, induration and minimal purulent discharge, in the absence of an abscess; and 69 uncomplicated patients who received only standard treatment, as per the exclusion criteria. Results: The mean age of the participants was 41.06 ± 10.70 years. No significant differences were found between the groups regarding age or sex (p = 0.616 and p = 0.665, respectively). However, prior treatment history and mucosal healing differed significantly between the two groups (p = 0.001 and p = 0.024, respectively). There were no significant differences in follow-up intervals, additional treatment requirements or improvement in VAS scores (p = 0.546, 0.904 and 0.154, respectively). Conclusions: Topical metronidazole may be associated with improved mucosal healing in selected patients with acute anal fissures presenting with clinical features such as local inflammation, minimal discharge or incision-related changes. However, the observed benefit does not appear to be uniform across all patients, and, in the absence of microbiological data, the extent of microbial involvement remains uncertain. Accordingly, topical metronidazole may be considered for carefully selected cases of acute anal fissure based on clinical judgement, while avoiding routine or indiscriminate antibiotic use.