The efficacy of trimethoprim-sulfamethoxazole treatment in children with acute bloody diarrhea

Abstract

Background The etiologies of bloody diarrhea are shigella, amoeba, enterocolitis, trichuriasis, and other causes i.e, EIEC, Campylobacter jejuni or rotavirus. In developing countries, trimetroprim-sulfamethoxazole (TMP-SMP) is effective in 80% of children with bloody diarrhea. Objective To determine the efficacy of trimethoprim-sulfa- methoxazole (TMP-SMX) treatment in children with acute bloody diarrhea. Methods A randomized double blind clinical trial was conducted in Adam Malik Hospital and Dr. Pirngadi Hospital Medan during September 2003-March 2004. Children aged 2-24 months old with diagnosis of acute bloody diarrhea were randomized into two groups to either receive TMP-SMX or placebo for 5 days. Microscopic fecal analysis was performed on the first, second, fifth and twelfth day, and the results were compared. Results A total of 68 children consisted of 48 (71%) boys and 20 (29%) girls were enrolled. Each group had 34 participants. Analysis of the first day showed leukocyte and erythrocyte in the stool specimens, which were all absent on the twelfth day in both groups. There was no difference in stool analysis between TMP- SMX and placebo group in day two (P=0.758), day five (P=0.341) and day twelve. Diarrhea duration in TMP-SMX and placebo group was 7.18 days and 6.65 days, respectively. This different was statistically not significant (P=0.385). Conclusion There is no difference in the efficacy of trimethoprim- sulfamethoxazole treatment compared to placebo in children with acute bloody diarrhea.

Keywords

• acute bloody diarrhea
• trimethoprim- sulfamethoxazole
• fecal analysis
• bloody stool