STUDY OF EFFECT OF THE DOSE AND DURATION OF METRONIDAZOLE ON AMEBIC COLITIS AND PLATELETS
Abstract
Background and Objective : Amebiasis caused by Entamoeba Histolytica (E.H) is a common problem in areas with poor hygiene . Metronidazole is abroad antiprotoza agent used in symptomatic or asymptomatic infection . Aim of Study : To findout which idial course duration 7 or 10 days and which logical effective dose 30 mg / kg or 50 mg / kg for treatment of amebiasis beside effect the dose on platelets . Method : Prospective study was conducted on ( 171 ) hospitalized patient at Bint – Al-Huda hospital during the period from the 1st of May 2010 to the 1st of May 2011 , suffering from amebic colitis . The patients divided for four groups . Group A ( 45 ) patient treated by 30 mg/kg and group B ( 47 ) patient treated by 50 mg/ kg for 7 days . Group C ( 38) patient treated by 30 mg/ kg and group D ( 41 ) treated by 50 mg / Kg for 10 days . The diagnosis of amebiasis depend on positive fresh stool sample for E.H trophozoites and followed more than once . Platelets count performed for all patient at the end of each course . Result : The 7 days treatment course cure ( 86.6 % ) of patient from group A and ( 89.4% ) for group B, while 10 days treatment course cure (94.4%) of group C and (96 %) for group D. Duration of bloody diarrhea in group A was (89. + 14 hrs), group B (86.+ 21.98hrs) , group C ( 85.2 + 17.76 hrs ) and group D was (83. + 14.97) . So the dose difference 30 mg/ kg or 50 mg / kg not affect the duration of bloody diarrhea significantly . P value > 0.05 . One patient from group D develop thrombocytopenia , four patients develop dark urine in presence of normal heamostasis . Conclusion : Amebiasis is a great problem in our locality and 30 mg / kg for 10 days of metronidazole course so effective equally to that 50 mg/kg , therefore the former course looked more logical unless the infection so severe , because the less dose administration the least side effects . Effect the dose and duration of metronidazole on platelets need to be investigated more .References
Bradly Haward Kessler : Entamoeba Histolytica . In : Oski's Essential paediatrics . Michael Crocetti , Michael A. Barone 2nd ed . 2004 : 351 – 2 .
Adriana Werinberg, MD, Myron J Levin, MD: Parasitic Infection. In: Current Diagnosis and Treatment in Pediatrics . William W. Hay , JR , Myron J. Levin , Judith M. Sondheimer . 18th ed . 2007 : 1225 – 7 .
Chandy C. John and Robert A. Salata : Amebiasis . In : Nelson textbook of Pediatrics . Robert M. Kliegman MD , Richard E. Behrman MD , Hal . B. Jenson , MD . 18th ed . 2007 : 1460 – 2 .
Trol , H. , H. Marti and N. Weiss : Simple differential detection of Entamoeba Histolytica and Entamaeba Dispar in Fresh stool specimens by Sodium acetate-acetic acid – formalin concentration and PCR. J. Clin . Microbiology 1997 . 35 ; 1701 – 1705 .
Stanley , S. L. , Amobeiasis . The Lancet . 2003 . 36 : 1025 – 1034 .
Voigot H , Olivo JC , Sansonettip , Guillen N. Mysin IB From Entamaeba Histolytica involved in phagocytosis of human erythrocytes . 1999 . J cell science 112 : 1191 – 1201 .
Nahed Abdel-Hag, MD: Pimparada chearskul MD , Yaseen Rafee ; Parasitic infections : In American Academy of pediatrics Textbook of pediatrics care. Thomas K. McInerny , Hery M. Adam , Dehorah E. Campbell . 2009 : 2372 – 73 .
A. G. M. Campbell : Infection . In : Forfar and Arneil's textbook of pediatrics . A G. M Campbell , Neil McIntosh . 5th ed . 1998 : 1467 – 69 .
Brain Coulter . Tropical Paediatrics Medication . In : Practical paediatric problems . Jim Beattie , Robert Carachi . 5th ed . 2005 : 635 – 6 .
Bradly . Howard Kessler : Entamoeba Histoytica . In : Oski's pediatrics . Julia A. McMillan , Ralph D. Feigin , Catherine D. Angelis . 4th ed 2006 : 1321 – 135 .
Hal B . Jenson and Robert B. Baltimore : Infections Disease . In : Nelson Essential of pediatrics . Robert M. Kliegman , Karen J . Marcdante , Hal . B. Jenson . 5th ed . 2006 : 513 – 18 .
Artizabal H , Acevedo J , Batero M ; Clinical Features Fulminant Amebic Colitis . World J Surg . 1991 ; 15 : 216 – 221.
Kat Zenstein D, Rickerson V , Braude A. Liver abscess . New Cancepts of amebic liver abscess derived from hepatic imaging . Serodiagnosis , San Diago , 1982 ; 243 – 246 .
Tanyaskel , M. , and W. A. Petri Jr., Diagnosis Laboratory Diagnosis of Amebiasis . Clin . Microbilog Rev, 2003 , 16 ; 713 – 729 .
Pillai, D. R. and K. C. Kain ; Immunchromatographic strip-based detection of Entameba Histolytica , Entamoeba Dispar and Giardia lamblia coproantigen . J. Clin . Rev. , 2003 : 37 ; 3017 – 3019 .
Heckendron F , N'Goran EK , Felger I , Vounatson P , Yapi A , et al Species – specific testing of Entamoeba Histolytica . Spp . in an area of endemicity . Trans R Soc. Trop Med Hyg . 2007 . 96 ; 521 – 528 .
Dupony – Camet : New drugs for the treatment for human parasitic protozaa . parasitology . 2004 . 46 ; 81 – 84 .
Blassmann J . Tannich E. Treatment of asymptomatic intestinal Entamooeba Histolytica infection . N Engl J Med . 2002 ; 15 : 335 – 337 .
ManSour – Ghanaei F, Dehbashi N Yazdan Parast K , Sh'afaghi A , . Efficacy of succharomyces boulardii with antibiotics in acute amebiasis . World Gastroenterol . 2003 . 9 ; 1832 – 1833 .
Abid M. et al , European Journal of Medicinal Chemistry 43 ( 2008 ) 2035 – 2039 .
Powell SJ, Macleod I , Wilmot AL , Elson- Dew E . Metronidazole in amebic dysentery and amebic liver abscess .
