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Parasitology Research

, Volume 108, Issue 3, pp 541–545 | Cite as

Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection

  • Ener Cagri Dinleyici
  • Makbule Eren
  • Nihal Dogan
  • Serap Reyhanioglu
  • Zeynel Abidin Yargic
  • Yvan Vandenplas
Original Paper

Abstract

Although many Blastocystis infections remain asymptomatic, recent data suggest it also causes frequent symptoms. Therapy should be limited to patients with persistent symptoms and a complete workup for alternative etiologies. The goal of this study was to compare the natural evolution (no treatment) to the efficacy of Saccharomyces boulardii (S. boulardii) or metronidazole for the duration of diarrhea and the duration of colonization in children with gastrointestinal symptoms and positive stool examination for Blastocystis hominis. This randomized single-blinded clinical trial included children presenting with gastrointestinal symptoms (abdominal pain, diarrhea, nausea–vomiting, flatulence) more than 2 weeks and confirmed B. hominis by stool examination (B. hominis cysts in the stool with microscopic examination of the fresh stool). The primary end points were clinical evaluation and result of microscopic stool examination at day 15. Secondary end points were the same end points at day 30. Randomization was performed by alternating inclusion: group A, S. boulardii (250 mg twice a day, Reflor®) during 10 days; group B, metronidazole (30 mg/kg twice daily) for 10 days; group C, no treatment. At day 15 and 30 after inclusion, the patients were re-evaluated, and stool samples were examined microscopically. On day 15, children that were still symptomatic and/or were still B. hominis-infected in group C were treated with metronidazole for 10 days. There was no statistically significant difference between the three study groups for age, gender, and the presence of diarrhea and abdominal pain. On day 15, clinical cure was observed in 77.7% in group A (n, 18); in 66.6% in group B (n, 15); and 40% in group C (n:15) (p < 0.031, between groups A and C). Disappearance of the cysts from the stools on day 15 was 80% in group B, 72.2% in group A, and 26.6% in group C (p = 0.011, between group B and group C; p = 0.013, between group A and group C). At the end of the first month after inclusion, clinical cure rate was 94.4% in group A and 73.3% in group B (p = 0.11). Parasitological cure rate for B. hominis was very comparable between both groups (94.4% vs. 93.3%, p = 0.43). Metronidazole or S. boulardii has potential beneficial effects in B. hominis infection (symptoms, presence of parasites). These findings challenge the actual guidelines.

Keywords

Irritable Bowel Syndrome Metronidazole Tinidazole Clinical Cure Rate Amebiasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgement

This study presents as a poster presentation in the 43rd Annual Meeting of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) in 9–12 June 2010 at Istanbul, and the abstract of this study was published in a supplemental issue in the Journal of Pediatric Gastroenterology and Nutrition.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Ener Cagri Dinleyici
    • 1
  • Makbule Eren
    • 2
  • Nihal Dogan
    • 3
  • Serap Reyhanioglu
    • 1
  • Zeynel Abidin Yargic
    • 1
  • Yvan Vandenplas
    • 4
  1. 1.Department of PediatricsEskisehir Osmangazi University Faculty of MedicineEskisehirTurkey
  2. 2.Department of Pediatrics, Division of Pediatric Gastroenterology and HepatologyEskisehir Osmangazi University Faculty of MedicineEskisehirTurkey
  3. 3.Department of ParasitologyEskisehir Osmangazi University, Faculty of MedicineEskisehirTurkey
  4. 4.Universitair Ziekenhuis Brussel Kinderen, Vrije Universiteit BrusselBrusselsBelgium

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