Efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting.
OBJECTIVE
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.
Bahl
R
R
Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.
Bhandari
N
N
Bhan
M K
MK
Saxena
M
M
Bagati
A
A
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000994:Antitrichomonal Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D003968:Diarrhea, Infantile / Q000188:drug therapy*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006801:Humans; D007223:Infant; D008795:Metronidazole / Q000627:therapeutic use*; D009268:Nalidixic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D000994:Antitrichomonal Agents; D008795:Metronidazole; D009268:Nalidixic Acid