EFFICACY OF ANTIMICROBIAL TREATMENT IN NON-DYSENTERIC PERSISTENT DIARRHEA IN A COMMUNITY SETTING

Objectives: To determine the efficacy of antimicrobial treatment in no n-dysenteric persistent diarrhoea in a community setting. Methods: In this double-blind field trial. 156 children aged 4-36 months with pers istent diarrhoea not associated with Giardia lamblia infestation seeki ng treatment in a community outpatient clinic, were randomized to rece ive a combination of nalidixic acid and metronidazole, metronidazole a lone. or placebo for 7 days. Results: In comparison with placebo, metr onidazole treatment did not result in a significant reduction in the m ean post-enrolment diarrhoeal duration and stool frequency. increase i n the proportion of patients recovered bq days 3, 5 and 7 of treatment , and increase in weight gain at days 7 and 14. Comparing the combinat ion of nalidixic acid and metronidazole with metronidazole alone, 17.5 % more children treated with the combination recovered by day 3 of tre atment (p = 0.08) and the mean stool frequency ascertained on day 7 fo r the previous 24 h was 26.8% less in them (p = 0.05). The weight gain s at days 7 and 14 were similar in the two groups. Conclusions: These findings indicate that metronidazole offers no therapeutic benefit in persistent diarrhoea not associated with Giardia lamblia and nalidixic acid has only a modest clinical benefit, which is not substantial eno ugh to warrant its routine use.