title: No advantage for antibiotic treatment over placebo in Blastocystis hominis-positive children with recurrent abdominal pain.
abstract: OBJECTIVE
  The aim of the study was to investigate whether recurrent abdominal pain (RAP) in Blastocystis hominis-positive children can be treated successfully with trimethoprim-sulfamethoxazole (TMP/SMX).
  
  
  METHODS
  From October 2004 to December 2008, all of the patients referred to the Division of Gastroenterology and Nutrition of the University Children's Hospital Zurich because of RAP and detection of B hominis in stool samples as the only pathological finding after a standard workup were offered to participate in the study. Patients were randomly assigned into 2 groups. TMP/SMX or placebo was given for 7 days in a double-blind, placebo-controlled manner. Pain index (PI) was measured with a visual analogue scale. Two weeks after completion of treatment, 3 stool samples were collected and patients were followed clinically. If B hominis was still present, metronidazole was given for 7 days.
  
  
  RESULTS
  Forty patients were included; 37 finished the study (TMP/SMX n = 20, placebo n = 17). Mean PI declined from 7.1 to 3.6 for all of the patients, with a decrease from 6.9 to 4.1 in the TMP/SMX and 7.4 to 3.0 in the placebo group, irrespective of detection of B hominis after treatment. There was no statistically significant difference in PI reduction between the 2 groups. Metronidazole treatment led to a further PI decline from 3.7 to 1.9. Eradication rates were 35% (TMP/SMX) and 44% (metronidazole), compared with spontaneous clearance of 29% in the placebo group.
  
  
  CONCLUSIONS
  There is no advantage for TPM/SMX over placebo in the treatment of RAP in B hominis-positive children.
authors: Division of Gastroenterology and Nutrition, University Children's Hospital Zurich, Zürich, Switzerland.
authors: Klaas
authors: K
authors: Heyland
authors: Michael
authors: M
authors: Friedt
authors: Patrick
authors: P
authors: Buehr
authors: Christian P
authors: CP
authors: Braegger
mesh_terms: D015746:Abdominal Pain / Q000382:microbiology / Q000503:physiopathology* / Q000517:prevention & control; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016776:Blastocystis Infections / Q000188:drug therapy*; D016845:Blastocystis hominis / Q000187:drug effects* / Q000472:pathogenicity; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D012008:Recurrence; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D015662:Trimethoprim, Sulfamethoxazole Drug Combination