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Chronic non-specific diarrhea of infancy successfully treated with trimethoprim-sulfamethoxazole
K A Dahlström1, L Danielsson, M Kalin
1Dept. of Pediatrics, Huddinge University Hospital, Stockholm, Sweden.
Insights
Bacterial overgrowth in the small intestine may cause chronic non-specific diarrhea in infants. Treatment with trimethoprim-sulfamethoxazole effectively resolved diarrhea in most affected children.
Area of Science:
- Pediatrics
- Gastroenterology
- Microbiology
Background:
- Chronic non-specific diarrhea of infancy is a common pediatric condition.
- The etiology of this condition is often unclear.
- Small intestinal bacterial overgrowth (SIBO) is a potential contributing factor.
Purpose of the Study:
- To investigate the prevalence of SIBO in infants with chronic non-specific diarrhea.
- To determine the efficacy of trimethoprim-sulfamethoxazole in treating SIBO-associated diarrhea.
- To compare antibiotic treatment with dietary modification.
Main Methods:
- Evaluated 15 infants with chronic non-specific diarrhea.
- Assessed for small intestinal bacterial overgrowth (SIBO).
- Treated 10 children with trimethoprim-sulfamethoxazole and 5 with a low-lactose diet.
Main Results:
- SIBO was detected in 10 of 11 investigated children, with microflora originating from the upper respiratory tract.
- 90% of children treated with trimethoprim-sulfamethoxazole experienced immediate diarrhea cessation.
- Diarrhea persisted in all children receiving a low-lactose diet (p = 0.004).
Conclusions:
- Small intestinal bacterial overgrowth by upper respiratory tract microflora is a potential cause of chronic non-specific diarrhea in infants.
- Trimethoprim-sulfamethoxazole offers a successful treatment for this condition.
- Dietary interventions may be less effective for SIBO-related infant diarrhea.
Abstract:
Fifteen children who fulfilled the criteria of chronic non-specific diarrhea of infancy were evaluated for intestinal bacterial overgrowth. In 10 of 11 successfully investigated children we found bacterial overgrowth of the small intestine by upper respiratory tract microflora. In 9 of 10 children (group I) treated with trimethoprim-sulfamethoxazole the diarrhea ceased immediately, whereas in all children in group II (n = 5; 3 children excluded because of growth of Yersinia enterocolitica) treated with low-lactose diet the diarrhea persisted (p = 0.004). The results indicate that bacterial overgrowth of the small intestine by upper respiratory tract microflora may be a cause of chronic non-specific diarrhea and that this diarrhea may be successfully treated with trimethoprim-sulfamethoxazole.