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| |  DG DISPATCH - WCPGHN: Oral Polymyxin Not Effective For Infants With Severe/Persistent Diarrhea By Maria Bishop Special to DG News
BOSTON, MA -- August 9, 2000 -- For ease of treatment, it would be useful to prescribe a nonabsorbable oral antibiotic to infants with severe acute or persistent diarrhea. Unfortunately, oral polymyxin seems not to be the drug of choice in this instance, according to a poster by Brazilian researchers, presented at the first World Congress of Pediatric Gastroenterology, Hepatology and Nutrition in Boston, MA. In an effort to evaluate clinical outcome as well as the effects of polymyxin on the jejeunal microflora of children with severe or persistent diarrhea, researchers conducted a seven-day, prospective, double-blind, randomized trial. Dr. Tahan, member of the division of pediatric gastroenterology and nutrition at the Universidade de Sao Paulo and EPM Sao Paulo, in Brazil, and colleagues recruited 25 infants under one year of age. All were in-patients at the hospital's pediatric gastroenterology unit and had clinically similar cases of severe or persistent diarrhea. Duodenal and stool cultures were performed before and after the trial. Five patients were excluded during the study. The most common pathogen found in the pre-treatment cultures was enteropathogenic Eschericia coli (EPEC). All patients randomly received either oral polymyxin (10 mg/kg/day) or placebo for seven days. Both groups were fed a semi-elemental formula and received the same replacement of fluid and electrolytes. At the start of the trial, eight of the 13 patients in the polymyxin group and five of seven in the placebo group presented with bacterial overgrowth. Following treatment, nine polymyxin patients and four placebo-group patients had bacterial overgrowth. In the polymyxin group, nine of 13 patients had EPEC at baseline, which was eradicated in all 13 patients by trial's end. In the placebo group, four of seven patients began the study positive for EPEC; two were still positive at trial’s end. After the study began, the diarrhea persisted for 3.7 days (±1.5 days) for patients in the polymyxin group and for 3.8 days (±2 days) in the placebo group. The infants’ weight gain at trial’s end was 371 g (±267 g) in the polymyxin group and 276 g (±244 g) for the placebo group. Although polymyxin was highly effective in eradicating EPEC, the researchers concluded that oral polymyxin "was not effective in reducing bacterial overgrowth, [nor in] the clinical outcome of infants with severe acute or persistent diarrhea."
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