The benefit of co-trimoxazole treatment in the management of acute watery diarrhea caused by invasive bacterial infection
Keywords:
invasive bacteria, diarrhea, fecal leukocyte, antimicrobial
Abstract
Background World Health Organization (WHO) states thatantimicrobials are reliably helpful only for children with bloody
diarrhea (probable shigellosis), suspected cholera with severe
dehydration, and symptomatic infection caused by Giardia lamblia.
The benefit of antimicrobial treatment in management of acute
watery diarrhea caused by invasive bacterial infection is still debated.
Objective To prove the benefit of co-trimoxazole treatment in
the management of acute watery diarrhea caused by invasive
bacterial infection in patients age 2–24 months.
Methods This was a randomized, double blind clinical trial
involving infants and children aged 2–24 months with acute
watery diarrhea caused by invasive bacterial infection without
co-morbidity or complications. Invasive bacterial infection was
defined by fecal leukocytes greater than ten cells (+2) per high
power field on stool. Subjects were assigned to receive either co-
trimoxazole or placebo. The duration and frequency of diarrhea
between two groups were compared.
Result Of 70 patients (co-trimoxazole, n=35; placebo, n=35),
42 (60%) were children aged 12–24 months, of whom 61% were
undernourished. Males were affected 1.2 times as much as females.
The clinical manifestations were mild-moderate dehydration
(64%), mucus in the stool (100%), fever (24%), vomiting (10%),
fever with vomiting (56%) and lactose malabsorption (53%).
Duration of diarrhea in placebo group (mean 117.0 [SD 28.1]
hours) was not significantly different (P=0.43) compared to that
in co-trimoxazole group (mean 122.5 [SD 30.1] hours). Frequency
of diarrhea per day in placebo group (mean 5.23 [SD 1.48] times)
was not significantly different either (P=0.37) compared to that
in co-trimoxazole group (mean 5.64 [SD 2.20] times).
Conclusion It is concluded that co-trimoxazole therapy provides
no benefit to patients with acute watery diarrhea caused by
invasive bacterial infection. This disorder seems to be self-
limited.
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manual for physicians and other senior health workers.
WHO/CDD/SER/80.2 rev.4. Geneva, Switzerland: World
Health Organization; 2005.
4. Heisig DG, Threatte GA, Henry JB. Laboratory diagnosis of
gastrointestinal and pancreatic disorder. In: Henr JB, Davey
FR, Herman CJ, McPherson, Pincus MR, Threatte GA, et
al, editors. Clinical diagnosis and management by laboratory
methods. 20 th ed. Saunder;2001.p.462-75.
5. Pai C, Gillis F, Tuomanen E, Marks MI. Placebo-controlled
double-blind evaluation of trimethoprim-sulfamethoxazole
treatment of Yersinia enterocolitica gastroenteritis. J Pediatr
1984;104:308-11.
6. Proulx F, Turgeon JP, Delage G, Lafleur L, Chicoine L. Ran-
domized, controlled trial of antibiotic therapy for Escheri-
chia coli O157:H7 enteritis. J Pediatr 1992;121:299-303.
7. DuPont HL, Reves RR, Galindo E, Sullivan P, Wood LW,
Mendiola JG. Treatment of traveler’s diarrhea with trimethoprim/sulfamethoxazole and with trimethoprime
alone. N Engl J Med 1982;307:841-4.
8. Thoren A, Wolde-Mariam T, Stintzing G, Wadstrom, Habie D.
Antibiotic in the treatment of gastroenteritis caused by entero-
pathogenic escherichia coli. J Infect Dis 1980;141:27-31.
9. Grisaru-Soen G, Wysoki MG, Keller N. Risk factors for de-
velopment of nontyphoid salmonella bacterimia. Clin Pediatr
2004;43:825-9
10. Departemen Kesehatan RI. Epidemiologi dan etiologi diare.
In: Ditjen PPM dan PlP Departemen Kesehatan, editor. Buku
ajar diare. Jakarta: Depkes;1999.p.3-14.
11. Guandalini S. Acute diarrhea. In: Walker WA, Goulet O,
Kleinman RE, Sherman PM, Shneider BL, Sanderson IR, editor.
Pediatric gastrointestinal disease. 4 th ed. BC Decker;2004. p.166-
79.
12. DeWitt TG, Humphrey KF, McCarthy P. Clinical predictors
of acute Bacterial Diarrhea in young children. Pediatrics
1985;76:551-6.
13. Diniz-Santos D, Santana JS, Barreto JR, Andrade MG, Silva
LR. Epidemiological and microbiological aspects of acute bac-
terial diarrhea in children from Salvador, Bahia, Brazil. Braz
J Infect Dis 2005;9:77-83.
14. Anders BJ, Paisley JW, Lauer BA, Reller LB. Double-blind
placebo controlled trial of erythromycin for treatment of
Campylobacter enteritis. Lancet 1982;1:131-2.
15. Robins-Browne RM, Mackenjee MK, Bodasing MN, Coovadia
HM. Treatment of Campylobacter-associated enteritis with
erythromycin. Am J Dis Child 1983; 137:282-5.
16. Checkley W, Gilman RH, Black RE, Lescano AG, Cabrera
L, Taylor DN. Effect of nutritional status on diarrhea in Pe-
ruvian children. J Pediatr 2002;140:210-8.
17. Tomkins A. Nutritional status and severity of diarrhea among
pre-school children in rural Nigeria. Lancet 1981;18:860-2.
18. Nelson JD, Kusmiesz H, Jackson LH, Woodman E. Treat-
ment of Salmonella gastroenteritis with ampicillin,
amoxicillin, or placebo. Pediatrics 1980;65:1125-30.
19. Jawetz E. Sulfonamides and trimethoprim. In: Katzung BG,
editor.Basic and clinical pharmacology. 5th ed. Appleton and
Lange, Connecticut; 1992.p.661-6.
20. Pracoyo NE, Sugianingsih S, Syamsidar, Misnardiarly.
Resistensi antibotik terhadap kuman enteropatogen pada
pasien diare dari beberapa rumah sakit di Jakarta. MKI
2001;28:705-8.
21. Soelaeman EJ, Purnomo B, Soehardjo HN, Digdowirogo HS.
Causative agents of acute diarrhea in children. Asian-
Oceanian J of Pediatric Child Health 2003;2:64-8.
Published
2007-07-01
How to Cite
1.
Dharmawan B, Firmansyah A, Chair I. The benefit of co-trimoxazole treatment in the management of acute watery diarrhea caused by invasive bacterial infection. PI [Internet]. 1Jul.2007 [cited 18Apr.2024];47(3):104-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/354
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Received 2016-08-25
Accepted 2016-08-25
Published 2007-07-01
Accepted 2016-08-25
Published 2007-07-01
