Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2020; 26(26): 3792-3799
Published online Jul 14, 2020. doi: 10.3748/wjg.v26.i26.3792
Two-day enema antibiotic therapy for parasite eradication and resolution of symptoms
Niloufar Roshan, Annabel Clancy, Anoja W Gunaratne, Antoinette LeBusque, Denise Pilarinos, Thomas J Borody
Niloufar Roshan, Annabel Clancy, Anoja W Gunaratne, Antoinette LeBusque, Denise Pilarinos, Thomas J Borody, Centre for Digestive Diseases, New South Wales 2046, Australia
Author contributions: Roshan N was involved in data collection, analysis and writing the original draft; Clancy A was involved in supervision, writing, review and editing; Gunaratne AW contributed to the data collection and writing review; LeBusque A performed the data collection and writing review; Pilarinos D was involved in data collection and writing review; Borody TJ contributed to the supervision, writing review and editing; All authors have read and approve the final manuscript.
Institutional review board statement: This study was approved by the institutional ethics committee (CDD19/C02).
Informed consent statement: A waiver of consent was granted for this study. Patients were not required to give informed consent for this study because the analysis used de-identified data that was obtained after each patient agreed to treatment.
Conflict-of-interest statement: : Professor Thomas J Borody has a pecuniary interest in the Centre for Digestive Diseases and has filed patents for antibiotic therapies for parasitic infections. Dr Niloufar Roshan, Dr Annabel Clancy, Dr Anoja Gunaratne, Ms Antoinette LeBusque and Ms Denise Pilarinos have no disclosures.
Data sharing statement: All data requests should be submitted to the corresponding author for consideration.
STROBE statement: The authors have read the STROBE statement-checklist of items, the manuscript was prepared according to the STROBE statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Niloufar Roshan, PhD, Research Fellow, Research, Centre for Digestive Diseases, Level 1, 229 Great North Road, New South Wales 2046, Australia.
Received: November 19, 2020
Peer-review started: November 19, 2020
First decision: April 2, 2020
Revised: May 9, 2020
Accepted: June 20, 2020
Article in press: June 20, 2020
Published online: July 14, 2020
Research background

Blastocystis hominis (B. hominis) and Dientamoeba fragilis (D. fragilis) are the two anaerobic protozoa which can be found in the intestinal tract of humans and can be transmitted via faecal-oral contact. Patients infected with these parasites can experience symptoms similar to those with irritable bowel syndrome such as abdominal pain, constipation, bloating or diarrhoea. The infections caused by the intestinal protozoa are global problems in both developed and developing countries and can cause considerable morbidity in the younger population.

Research motivation

A high failure rate has been observed with use of single drugs such as metronidazole in the treatment of B. hominis and D. fragilis parasitic infections, thus this has led to the development of novel combination therapies.

Research objectives

This study aimed to investigate the effect of combined antibiotics administered via enema infusion to eradicate D. fragilis and B. hominis and to determine their effect on resolution of symptoms.

Research methods

A retrospective, single centre longitudinal study was conducted between 2017-2018 on patients 18 years or older, who were positive for D. fragilis, B. hominis or both. Triple antibiotics were infused over two days through rectal enema. Faecal specimens were screened for parasites from patients at baseline and six weeks after completion of treatment. Symptoms were recorded at three days, seven days and six weeks after the treatment. Patient demographic data were also collected to identify any confounding variables within the study population.

Research results

The results showed that the majority of patients (79%) showed complete clearance of parasites post-antibiotic enema infusion treatment. Improvement was observed in major clinical symptoms such as abdominal pain post-treatment. The most common side effects experienced were urine discolouration, which improved following the treatment.

Research conclusions

A significant achievement in both parasitic eradication and improvement of clinical outcomes were observed, with minimal side effects. These points to the use of combination therapies via enema as a potential first line of therapy for parasite eradication.

Research perspectives

In order to better understand the effect of antibiotic combinations and mode of administration in eradication of B. hominis or D. fragilis infections, further prospective randomised studies are required.