Antimicrobial resistance in Helicobacter pylori in Barbados

OBJECTIVE: Helicobacter pylori eradication is essential in patients with peptic ulcer who are infected with the organism. The rate of eradication is related to the level of antimicrobial resistance to metronidazole, clarithromycin, amoxycillin and tetracycline in H pylori in this community. DESIGN AND METHODS: Gastric biopsies from all patients undergoing upper gastrointestinal endoscopy were cultured. Isolation was done on Thayer-Martin medium under microaerophilic conditions and isolates were sub-cultured on chocolate agar. MICs were determined using the E-test. RESULTS: 64 isolates were available for testing. Metronidazole resistance (MIC > 8mg/l) was observed in 39 percent (25/64), clarithromycin resistance (MIC > 2mg/l) in 4.7 percent (3/64), amoxycillin resistance (MIC > 8mg/l) in 4.7 percent (3/64) and tetracycline resistance (MIC > 4mg/l) in 3.1 percent (2/64). CONCLUSIONS: The high level of metronidazole resistance precludes the use of this antibiotic as first line therapy for H pylori in Barbados. It is recommended that a proton pump inhibitor, amoxycillin and clarithromycin be the combination of choice for eradication of H pylori in patients in Barbados.(Au)

Aetiology of vaginal infections in pregnant and non-pregnant women in Barbados

The aetiology of vaginal discharge was studied in 175 Barbadian women. Pregnant women accounted for 52 percent (91) of the population studied. Candida albicans was detected in 45 percent of the women, bacterial vaginosis in 28 percent and Trichomonas vaginalis in 8.6 percent. Bacterial vaginosis was more common in non-pregnant women (33 percent vs 23 per cent) whereas C. albicans was more common in pregnant women. Mixed infections were found in 10 women and an aetiological agent was detected in 75 percent of the women studied. These data emphasize the need for laboratory investigation of vaginal discharge since each of these infections can be treated effectively with specific agents (AU)

The Kingston Project. III. the effects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: morbidity and growth

In the Kingston Project malnourished children referred from public health clinics to a metabolic ward were treated at home using community health aides within the existing health service. We have previously provided anthropometric results showing significantly greater gains in weight and length for groups given a high energy supplement (3.31 MJ daily) for 3 months during treatment, and greatest gains for a group treated with metronidazole at the beginning of supplementation [Heikens et al., Eur. J. Clin. Nutr. 43, 145-160 (1989); 47, 160-173 (1993)]. We now present findings on morbidity and relate these to the separate interventions and to growth velocities. Although referral was solely on nutritional criteria, 65 percent of the sample were found to have additional illnesses at enrolment. During the study period (6 months) upper respiratory tract infections (URTI) were the commonest illness in all groups; there were significantly more gastroenteric infections in the group given the supplement, but not the antibiotic treatment; the children who received only the standard health service care were ill more often and for longer periods than children in the other groups. Diarrhoea, fever and dysentery prevalences were all found to relate significantly to weight velocity, and although prevalences differed between treatment groups, the detrimental effect on velocity was similar whichever the group (AU)

The Kingston Project. II. the efects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: anthropometry

Malnourished children (mean age 1.2 years) referred from public health clinics to a paediatric metabolic ward in Kingston, Jamaica, were enrolled for treatment in a community-based health care project and were randomly allocated to one of two groups. The first group was treated at home with metronidazole and then for 6 months using the standard health care provided from local clinics by community health aides. The second group was given the same drug and home treatment, but in addition received a high energy supplement of 3.31 MJ daily for 3 months. We have previously shown a significant advantage in both weght and height gain for a group given the same supplement in contrast with standard health care controls (Heikens et al., 1989, Eur. J. Clin. Nutr. 43, 145-160), and in this study test the addition of a drug treatment aimed at reducing malabsorbtion due to a possible microbial overgrowth of the small bowel in malnourished children. This paper reports anthropometric findings showing significant benefits from both the drug and nutritional treatments. Greatest gains were by the group given both treatments, but the group given the antibiotic treatment, without energy supplementation, also made better growth recovery than did controls. Only 8 percent of the children treated with metronidazole failed to respond to community-based intervention and were admitted to hospital, compared with 19 percent for the other groups (P<0.05). These findings support targetted high-energy supplementation for the rehabilitation of moderately malnourished children receiving health clinics care, and suggest further that such programs should include antibiotic treatment directed at SBBO (AU)

Metronidazole - a review

Metronidazole (Flagyl) is a 5-nitroimidazole extensively used in many countries in the treatment of several protozoan infections (trichomoniasis, giardiasis, amoebiasis) and obligate anaerobic infections. It is well tolerated orally and parenterally with minimal untoward effects. Metronidazole is rapidly replacing clindamycin in many countries, as resistance to clindamycin has been reported. Metronidazole crosses the blood-brain barrrier readily, difuses well into pus and is therefore very effective in the treatment of brain abscess due to anaerobes. In combination with an aminoglycoside, metronidazole provides good prophylaxis perioperatively in intra-abdominal surgery. Metronidazole is also useful in the managemnent of other disease such as pseudomembranous colitis and rosacea. Metronidazole is inexpensive when compared with other antibotics used to treat anaerobic infections, (for example clindamycin)(AU)

Pelvic inflammatory disease in Montserrat - abstract

During the period, January 1989 to December 1990, 41 women or 25 percent of all female patients between the ages of 15 and 50 years who presented to a private family practice were diagnosed as having pelvic inflammatory disease (PID). Seventy-eight per cent were between the ages of 20 and 40 years, 83 percent presented with pain, 56 percent with vaginal discharge and 15 were infertile. Fifty-one percent were treated with a combination of tetracyline and metronidazole and 22 percent with cotrimoxazole. Seventy-four per cent obtained a symptomatic cure and 26 percent continued with persistent pain. Forty-five per cent of 11 patients presenting with rupture tubal pregnancy gave a history of previous PID. A review of the results of bacteriological investigation of women with PID over the period January 1989 to December 1990 showed that 49.7 percent had no pathogens, 26.4 percent had candida albicans, 8.2 percent trichomonas, 46 percent E. Coli, 4.6 percent haemophilus, 4.4 percent streptococcus, 15 percent N. Gonorrhea and 10.4 percent other organisms (AU)

Metronidazole: a review

Metronidazole (Flagyl) is a 5-nitroimidazole extensively used in many countries in the treatment of several protozoan infections (trichomoniasis, giardiasis, amoebiasis) and obligate anaerobic infections. It is well tolerated orally and parentally with minimal untoward effects. Metronidazole is rapidly replacing clindamycin in many countries, as resistance to clindamycin has been reported. Metronidazole crosses the blood-brain barrier readily, diffuses well into pus and is therefore very effective in the treatment of brain abscess due to anaerobes. In combination with an aminoglycoside, metronidazole provides grood prophlaxis perioperatively in intra-abdominal surgery. Metronidazole is also useful in the management of other diseases such as pseudomembranous colitis and rosacea. Metronidazole is inexpensive when compared with other antibiotics used to treat anaerobic infections, (for example clindamycin). (Summary)

Infective arthritis due to Blastocystis hominis

A patient with rheumatoid arthritis taking prednisone developed Blastocystis hominis acute diarrhoea, which was associated with increased inflammation and effusion of the left knee. B. hominis organisms were found in synovial fluid from the left knee. The patient responded dramatically to metronidazole treatment. B. hominis may become disseminated in immunosuppressed patients with diarrhoea and may cause infective arthritis. (AU)

The Kingston Project: VII. The point prevalence of helminths and parasites, and morbidity in malnourished children failing ambulatory treatment with a high energy supplement and a course of metronidazole - abstract

In a prospective study, 163 moderately malnourished children, living in the slums of Kingston, were followed up for one year. The anthropometric measurements in weight and length in those children receiving a High Energy Supplement (HES), and in wasting in those receiving, additionally, a course of metronidazole (MET) have been previously reported. The point prevalence as assessed by positive stool tests for helminths and parasites of the children treated with metronidazole, and if deemed necessary with mebendazole, increased significantly over the period of one year concurrent with improvement of their nutritional status (chi-2 = 13.57; p < .001). A significant increase was observed in both the supplemented and unsupplemented group (chi-2 = 3.98; p < .05 and chi-2 = 5.31; p < .05 respectively). Children receiving health care (HC) only, or health care and a high energy supplement (HC/HES) failed more than twice (17 per cent) as often the community-based management as those receiving additional metronidazole (HC/MET and HC/HES/MET) (8 per cent). Admissions to hospital for full nutritional and clinical recovery in the HC/HES group were mostly for enteric infections and septicaemia, while children in the MET groups were admitted for respiratory tract infections leading to anorexia. Malnourished children, managed in the community, are less likely to be admitted for failure if a course of metronidazole and mebendazole is given combined with their rehabilitation, using HES. This treatment reduces social and nutritional costs to the child, as well as costs to the public health service (AU)

Blastocystis hominis in two children of one family

Two apparently healthy children from the same family were found to have moderate to heavy Blastocytis hominis in their stools samples whilst being investigated for intestinal symptoms: sporadic, painless, rectal bleeding in one and persistant diarrhoea in the other. After treatment with metronidazole, they had no further signs and stool samples became negative. Eighteen months later, both were asymptomic, and stool samples continued to be negative for the parasite (AU)

Bacterial vaginosis

Bacterial vaginosis is a common, non-inflammatory infection of the vagina. It is characterised by the presence of a thin, homogenous, greyish-white discharge. The differential diagnosis includes infection with Trichomonas vaginalis and Candida albicans. A diagnosis of bacterial vaginosis maybe made by the detection of three of the following: characteristic discharge, pH of 5 or greater, clue cells and a positive KOH amine test. Culture of vaginal discharge is not necessary to effect a diagnosis. Bacterial vaginosis responds readily to treatment with metronidazole at a dosage of 400 mg twice daily for seven days, although a proportion of patients suffer a recurrence of symptoms. Treatment of sexual partners may be necessary in such cases. Bacterial vaginosis results from the synergistic interaction of Gardnerella vaginalis and obligateanaerobes, including Bacteroides and Mobiluncus speciess. The pathogenesis, laboratory diagnosis, treatment, and the mechanisms by which these organisms produce the symptoms of bacterial vaginosis are discussed (AU)

Small bowel overgrowth in malnourished children as measured by the breadth hydrogen test - abstract

Overgrowth of the small intestine with bacteria has been implicated in the chronic diarrhoea associated with severe malnutrition. The hydrogen breath test has been introduced as a simple non-invasive technique to assess bacterial fermentation in the bowel. An increase in breath hydrogen in excess of 20 ppm within 60 minutes of the oral presentation of substrate is taken as evidence of small bowel overgrowth (SBO). The hydrogen breath test was used in 30 children admitted with severe protein energy malnutrition. Of the 19 children tested on admission and at intervals during recovery, 5 were positive on admission and a further 3 became positive at varying times after admission. Of these 8 with positive results, 5 were treated with metronidazole and all were negative on subsequent testing. Of the 3 children who were not treated one improved, but 2 had persistently positive breath hydrogen. Eleven (11) children had breath hydrogen measured at some time during recovery. In 6 the test was positive; all received metronidazole and became negative. In 2 children who had received metronidazole and were negative, the test became positive at a later date. Three children had a positive test with lactose specifically, one was treated with metronidazole and became negative. Therefore, of 30 children studied, 14 had a positive test at some time, which became negative in the 11 treated with metronidazole. We conclude that small bowel overgrowth as measured by the breath hydrogen test is a frequent accompaniment of severe malnutrition and responds to treatment with metronidazole (AU)