Antibiotic efficacy in small intestinal bacterial overgrowth–related chronic diarrhea: A crossover, randomized trial

doi:10.1016/S0016-5085(99)70336-7

Gastroenterology

Volume 117, Issue 4, October 1999, Pages 794-797

https://doi.org/10.1016/S0016-5085(99)70336-7 Get rights and content

Abstract

Background & Aims: No controlled trial has examined the clinical efficacy of antibiotics in small bowel bacterial overgrowth. Methods: Ten patients with bacterial overgrowth–related diarrhea underwent the following five 7-day treatment periods: untreated (control period), then placebo, and subsequently, in random order and blinded fashion, norfloxacin (800 mg/day), amoxicillin-clavulanic acid (1500 mg/day), and Saccharomyces boulardii (1500 mg/day). A hydrogen breath test was performed on the first and last day of each period. Results: Daily stool frequency was similar during the control and placebo periods (4.2 ± 0.6 vs. 3.9 ± 0.6 [mean ± SEM], respectively). Norfloxacin and amoxicillin-clavulanic acid led to a significant reduction in daily stool frequency (2.3 ± 0.4 and 3.0 ± 0.5, respectively; P < 0.01 vs. placebo period) after 2.0 ± 1.4 and 1.2 ± 0.4 days, which was maintained for 6.1 ± 3.7 and 6.0 ± 9.6 days, respectively. Breath-expired H₂ volume decreased with norfloxacin (37 ± 8 to 12 ± 5 mL per 2 hours; P < 0.01) and amoxicillin-clavulanic acid (24 ± 6 to 8 ± 4 mL per 2 hours, respectively; P = 0.01), but H₂ breath test result was negative in only 3 and 5 patients. Conclusions: Norfloxacin and amoxicillin-clavulanic acid are effective in the treatment of bacterial overgrowth–related diarrhea.

GASTROENTEROLOGY 1999;117:794-797

Section snippets

Patients

From 1993 to 1995, all patients presenting with chronic diarrhea (defined as more than 3 stools per day for more than 3 months), a predisposition to bacterial overgrowth, and a positive glucose ingestion hydrogen breath test (H₂-BT) result were included in the trial. Informed written consent was obtained from all patients under the guidelines established by the ethics committee of Saint Louis Hospital, Paris, France.

Treatment

Placebo, amoxicillin-clavulanic acid (1500 mg/day), norfloxacin (800 mg/day),

Patients

From August 1993 to January 1995, 20 consecutive patients with chronic diarrhea and a predisposition to bacterial overgrowth were referred to Saint Lazare Hospital. Seven with a negative H₂-BT result were not included in the trial. Of the remaining 13 patients, 3 were withdrawn during the placebo period because of adverse events consisting of hypoglycemia in a diabetic patient, urinary infection requiring antibiotics, and noncompliance. Ten patients completed the study. Mean age was 62 years

Discussion

Previous therapeutic trials in bacterial overgrowth have generally not been controlled.1, 4, 7, 17, 18, 19, 20 This randomized crossover study indicates the efficacy of norfloxacin and amoxicillin-clavulanic acid for the treatment of bacterial overgrowth–related diarrhea because the reductions achieved in the mean daily number of stools, 45% and 29%, respectively, are significant.

We chose reduction in the number of stools as an objective and clinically relevant end point. No absorptive tests

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^☆: Address requests for reprints to: Alain Attar, M.D., Département de Gastroentérologie, Hôpital Lariboisière Saint Lazare, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France. e-mail: [email protected]; fax: (33) 1-4995-2577.

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Alimentary TractAntibiotic efficacy in small intestinal bacterial overgrowth–related chronic diarrhea: A crossover, randomized trial☆

Abstract

Section snippets

Patients

Treatment

Patients

Discussion

Gastroenterology

Gastroenterology

Am J Gastroenterol

Gastroenterology

Gastroenterology

Gastroenterology

J Pediatr

Gastroenterology

The blind-loop syndrome and its variants. Microbiologic aspects of diagnosis and treatment

Am J Gastroenterol

Bacterial overgrowth

Enteric bacterial flora and bacterial overgrowth syndrome

The pathophysiological role of small intestinal bacterial flora

Scand J Gastroenterol

Alimentary Tract
Antibiotic efficacy in small intestinal bacterial overgrowth–related chronic diarrhea: A crossover, randomized trial☆