Pietilä Jukka-Pekka, Häkkinen Tuuve A, Pakarinen Laura, Ollgren Jukka, Kantele Anu
Meilahti Vaccine Research Center MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
New Microbes New Infect. 2023 Sep 23;54:101179. doi: 10.1016/j.nmni.2023.101179. eCollection 2023 Sep.
(), the most common intestinal protozoal pathogen in affluent countries, causes asymptomatic or symptomatic infections with severity ranging from mild to disabling. Currently, many studies of treatment options only have small sample sizes and report results that are partly contradictory.
Investigating data retrieved from Helsinki University Hospital and Helsinki City patient records, we searched for the most effective antiprotozoal in treating infections. To study microbiological clearance of , we collected laboratory results of control samples from patients given one of four commonly used antiprotozoals: doxycycline, metronidazole, paromomycin, or secnidazole. For patients symptomatic prior to antiprotozoal treatment, we also retrieved data on clinical outcomes. Furthermore, we explored factors associated with faecal clearance and clinical cure.
A total of 369 patients (median age 38) and 492 treatment episodes were included. Paromomycin (n = 297) proved effective (clearance rate 83%), showing strong association with faecal clearance (aOR 18.08 [7.24-45.16], p < 0.001). For metronidazole the rate was 42% (n = 84), for secnidazole 37% (n = 79), and doxycycline 22% (n = 32). In pairwise comparisons, paromomycin outdid the three other regimens (p < 0.001, test). Faecal clearance was associated with clinical cure (aOR 5.85 [3.02-11.32], p < 0.001).
Faecal clearance, strongly associated with clinical cure, is most effectively achieved with a course of paromomycin, followed by metronidazole, secnidazole and doxycycline. Our findings will be useful in devising treatment guidelines for adults with symptomatic infection.
（）是富裕国家最常见的肠道原生动物病原体，可导致无症状或有症状感染，严重程度从轻度到致残不等。目前，许多关于治疗方案的研究样本量较小，报告的结果部分相互矛盾。
通过调查从赫尔辛基大学医院和赫尔辛基市患者记录中检索到的数据，我们寻找治疗（）感染最有效的抗原生动物药物。为了研究（）的微生物清除情况，我们收集了接受四种常用抗原生动物药物之一（强力霉素、甲硝唑、巴龙霉素或塞克硝唑）治疗的患者对照样本的实验室结果。对于在抗原生动物治疗前有症状的患者，我们还检索了临床结果数据。此外，我们探讨了与粪便清除和临床治愈相关的因素。
共纳入369例患者（中位年龄38岁）和492个治疗疗程。巴龙霉素（n = 297）被证明有效（清除率83%），与粪便清除有很强的相关性（校正优势比18.08 [7.24 - 45.16]，p < 0.001）。甲硝唑的清除率为42%（n = 84），塞克硝唑为37%（n = 79），强力霉素为22%（n = 32）。在两两比较中，巴龙霉素优于其他三种治疗方案（p < 0.001，检验）。粪便清除与临床治愈相关（校正优势比5.85 [3.02 - 11.32]，p < 0.001）。
粪便清除与临床治愈密切相关，使用一个疗程的巴龙霉素最有效地实现了粪便清除，其次是甲硝唑、塞克硝唑和强力霉素。我们的研究结果将有助于制定有症状（）感染成人的治疗指南。
