Clinical pilot study: efficacy of triple antibiotic therapy in Blastocystis positive irritable bowel syndrome patients

Gut Pathogens

Rebecca Traub²  Helle Bielefeldt-Ohmann¹  Robyn Nagel³ 

[1] Australian Infectious Diseases Research Centre, The University of Queensland, St. Lucia, Australia;Faculty of Veterinary Science, The University of Melbourne, Parkville 3052, Victoria, Australia;Toowoomba Gastroenterology Clinic, Suite 105 Medici Medical Centre, 15 Scott Street, Toowoomba 4350, Queensland, Australia

关键词: PCR;    Irritable bowel syndrome;    Therapy;    Blastocystis;   

Others  :  1133839
DOI  :  10.1186/s13099-014-0034-0

 received in 2014-06-25, accepted in 2014-08-07,  发布年份 2014

【 摘 要 】

Background

Blastocystis species are common human enteric parasites. Carriage has been linked to Irritable Bowel Syndrome (IBS). Treatment of Blastocystis spp. with antimicrobials is problematic and insensitive diagnostic methods and re-infection complicate assessment of eradication. We investigated whether triple antibiotic therapy comprising diloxanide furoate, trimethoprim/sulfamethoxazole and secnidazole (TAB) given to diarrhoea-predominant IBS (D-IBS) patients positive for Blastocystis would achieve eradication.

Methods

In a longitudinal, prospective case study 10 D-IBS Blastocystis-positive patients took 14 days of diloxanide furoate 500 mg thrice daily, trimethoprim/sulfamethoxazole 160/80 mg twice daily and secnidazole 400 mg thrice daily. Faecal specimens were collected at baseline, day 15 and 4 weeks after completion of TAB. Specimens were analysed using faecal smear, culture and polymerase chain reaction (PCR) of the 16 SSU rRNA. Patients kept a concurrent clinical diary.

Results

Six (60%) patients cleared Blastocystis spp. after TAB, including three who had failed previous therapy. Subtypes detected were ST3 (60%), ST4 (40%), ST1 (20%) and ST7, 8 (10%); four patients had mixed ST infections. Serum immunoglobulin A (IgA) levels were low in 40% of patients. Higher rates of Blastocystis clearance were observed in patients symptomatic for less than a year (Mann–Whitney, p = 0.032, 95% confidence) with no associations found with age, previous antibiotic therapy, faecal parasite load, ST, IgA level or clinical improvement.

Conclusions

Clearance of Blastocystis spp. was achieved with TAB in 60% of D-IBS patients, an improvement over conventional monotherapy. Higher clearance rates are needed to facilitate investigation of the relevance of this parasite in clinically heterogenous IBS.

【 授权许可】

   
2014 Nagel et al.; licensee BioMed Central Ltd.

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