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Efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting
1Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
Metronidazole showed no benefit for persistent diarrhea without Giardia. Nalidixic acid offered a modest benefit, but not enough for routine use in children.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Clinical Trials
Background:
- Persistent diarrhea is a significant health concern in children.
- Antimicrobial treatments are often used, but their efficacy in non-dysenteric cases requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of antimicrobial therapy for persistent diarrhea in children.
- To compare metronidazole alone and in combination with nalidixic acid against placebo.
Main Methods:
- A double-blind, randomized field trial was conducted.
- 156 children aged 4-36 months with persistent diarrhea (excluding Giardia) were enrolled.
- Participants received either nalidixic acid/metronidazole, metronidazole alone, or placebo for 7 days.
Main Results:
- Metronidazole did not significantly improve diarrheal duration, stool frequency, recovery rates, or weight gain compared to placebo.
- The combination of nalidixic acid and metronidazole showed a trend towards faster recovery (17.5% more by day 3) and reduced stool frequency (26.8% less by day 7) versus metronidazole alone.
- Weight gain was similar between the combination and metronidazole-only groups.
Conclusions:
- Metronidazole is not therapeutically beneficial for persistent diarrhea unrelated to Giardia.
- Nalidixic acid demonstrates a minor clinical benefit, insufficient for routine recommendation in this condition.
Objectives:
To determine the efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting.
Methods:
In this double-blind field trial, 156 children aged 4-36 months with persistent diarrhoea not associated with Giardia lamblia infestation seeking treatment in a community outpatient clinic, were randomized to receive a combination of nalidixic acid and metronidazole, metronidazole alone, or placebo for 7 days.
Results:
In comparison with placebo, metronidazole treatment did not result in a significant reduction in the mean post-enrollment diarrhoeal duration and stool frequency, increase in the proportion of patients recovered by days 3, 5 and 7 of treatment, and increase in weight gain at days 7 and 14. Comparing the combination of nalidixic acid and metronidazole with metronidazole alone, 17.5% more children treated with the combination recovered by day 3 of treatment (p = 0.08) and the mean stool frequency ascertained on day 7 for the previous 24 h was 26.8% less in them (p = 0.05). The weight gains at days 7 and 14 were similar in the two groups.
Conclusions:
These findings indicate that metronidazole offers no therapeutic benefit in persistent diarrhoea not associated with Giardia lamblia and nalidixic acid has only a modest clinical benefit, which is not substantial enough to warrant its routine use.