The use of metronidazole in management of methylmalonic and propionic acidaemias
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Gut bacteria have been implicated as an important source of propionate in children with inborn errors of propionate metabolism. We have investigated the value of oral metronidazole (10–20 mg/kg per day) in five children with methylmalonic acidaemia (MMA) and four with propionic acidaemia (PA). Urinary excretion of propionate metabolites fell significantly during the treatment in all subjects, the mean decrease being 41% (range 12–76,P<0.01), while mean plasma propionate was reduced from 45.0 μmol/l to 25.1 μmol/l (P<0.05). Substantial reduction of the gut bacterial population was confirmed by lactulose breath hydrogen tests and by stool culture, and stool propionate concentration was reduced in most subjects. Clinical improvement was noted in three children. These results suggest that long-term antimicrobial therapy may offer significant clinical benefit to children with inborn errors of propionate metabolism.
Key wordsMethylmalonic acidaemia Propionic acidaemia Metronidazole Gut bacteria Propionate
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- 2.Armitage P, Berry G (1987) Statistical methods in medical research, 2nd edn. Blackwell, OxfordGoogle Scholar
- 4.Chalmers RA, Lawson AM (1982) Organic acids in man. Chapman and Hall, LondonGoogle Scholar
- 5.Harig JM, Soergel KH, Komorowski RA, Wood CM (1989) Treatment of diversion colitis with short-chain-fatty-acid irrigation. N Eng J Med 320:23–28Google Scholar
- 6.Holdeman LV, Cato EP, Moore WEC (1977) Anaerobe laboratory manual, 4th edn. Polytechnic Institute and State University, Blacksburg, VirginiaGoogle Scholar
- 11.Rosenberg LE (1983) Disorders of propionate and methylmalonate metabolism. In: Stanbury JB, Wyngaarden JB, Frederickson DS, Goldstein JL, Brown MS (eds) The metabolic basis of inherited disease, 5th edn. McGraw-Hill, New York, pp 474–497Google Scholar
- 15.Walter JH, Leonard JV, Thompson GN, Halliday D, Bartlett K (1988) Propionate production from the gut in propionic acidaemia. Lancet II:226Google Scholar