Paediatrica Indonesiana (Jul 2007)

The benefit of co-trimoxazole treatment in the management of acute watery diarrhea caused by invasive bacterial infection

  • Bobby Setiadi Dharmawan,
  • Agus Firmansyah,
  • Imral Chair

DOI
https://doi.org/10.14238/pi47.3.2007.104-8
Journal volume & issue
Vol. 47, no. 3
pp. 104 – 8

Abstract

Read online

Background World Health Organization (WHO) states that antimicrobials 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.

Keywords