Oral gentamicin is not effective treatment for persistent diarrhea

Abstract

We conducted a randomized, double‐blind, placebo controlled clinical trial of oral gentamicin (10 milligrams/kilogram body weight/day for five days) in treatment of unselected cases of persistent diarrhea (duration 14‐18 days at initiation of treatment) among 3‐36‐month‐old children in a rural Guatemalan community. Following random assignment of each child to a treatment group, the appropriate dose of gentamicin or placebo was administered to the child three times daily by a study nurse; this nurse also identified the presence or absence of diarrhea on each day of treatment and for the next two days. Cure was defined as cessation of diarrhea during the five‐day treatment period, sustained through at least the two days after completion of treatment. Among 92 evaluable cases who entered the clinical trial, there was essentially no difference in cure rate between gentamicin and placebo treatment groups (42% versus 43%). Enteroadherent strains of Escherichia coli were identified in 46% of children tested in this trial; no significant difference existed between treatment groups in frequency of isolation of this or any other enteropathogen. Among 40 children having successful duodenal cultures immediately prior to beginning treatment, 104 aerobic organisms per milliliter of fluid were identified in 12 (30%); treatment groups did not differ substantially with respect to proportion of children identified with this level of duodenal microbial colonization. Failure of gentamicin treatment did not appear to be explained by emergence of resistance, although a small number of resistant enteropathogens were identified near the end of the study. We conclude that in this population and in the dose used, oral gentamicin has no value in the treatment of persistent diarrhea.

A randomized double-blind clinical trial of the effect of non-absorbable oral polymyxin on infants with severe infectious diarrhea

“…Our study confirms the lack of efficacy of antibiotics in the treatment of diarrhea as observed in those studies (15,16). Addionally, we analyzed patients with severe diarrhea, most of them in their first semester of life, characteristic that differentiates our study from the previous ones (15,16). Bhatnagar et al (16) It should be emphasized that exclusive breast-feeding may decrease the risk of acute and persistent diarrhea, since human milk has protective properties against diarrhea such as avoidance of exposure to bacteria, antimicrobial agents, anti-inflammatory and immunomodulating factors and promotion of healthy microflora (4).…”

“…However, antimicrobials may be useful in reducing associated enteric symptoms, including watery diarrhea and/or dysentery or fever in the more severe cases of illness and in the management of persistent diarrhea (37). The studies of Bartlett et al (15) and Bhatnagar et al (16), both of them controlled, demonstrated respectively the lack of clinical efficacy of gentamicin in children with persistent diarrhea in the community and in hospitalized patients with mild to moderate cases of diarrhea. Our study confirms the lack of efficacy of antibiotics in the treatment of diarrhea as observed in those studies (15,16).…”

“…The studies of Bartlett et al (15) and Bhatnagar et al (16), both of them controlled, demonstrated respectively the lack of clinical efficacy of gentamicin in children with persistent diarrhea in the community and in hospitalized patients with mild to moderate cases of diarrhea. Our study confirms the lack of efficacy of antibiotics in the treatment of diarrhea as observed in those studies (15,16). Addionally, we analyzed patients with severe diarrhea, most of them in their first semester of life, characteristic that differentiates our study from the previous ones (15,16).…”

“…However, few wellcontrolled studies have evaluated the effect of antibiotics on the treatment of these patients (12,(14)(15)(16). Studies employing gentamicin to treat children with persistent diarrhea have reported conflicting results (14)(15)(16). Alam et al (12) demonstrated that the trimethoprim-sulfamethoxazole combination reduced the duration of diarrhea and the number of hospital infections in infants hospitalized with persistent diarrhea.…”

“…For example, an expert group has recommended the use of antimicrobial therapy in selected circumstances such as EPEC diarrhea with a prolonged course (13). However, few wellcontrolled studies have evaluated the effect of antibiotics on the treatment of these patients (12,(14)(15)(16). Studies employing gentamicin to treat children with persistent diarrhea have reported conflicting results (14)(15)(16).…”