PEDIATRICS Vol. 48 No. 2 August 1971, pp. 248-258
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DURATION OF NEOMYCIN THERAPY FOR ENTEROPATHOGENIC ESCHERICHIA COLI DIARRHEAL DISEASE: A COMPARATIVE STUDY OF 113 CASES

John D. Nelson M.D.1

1 John A. Hartford Foundation Diarrheal Disease Study Unit, Department of Pediatrics, The University of Texas (Southwestern) Medical School at Dallas

The usually recommended 7- to 10- day course of antibiotic therapy for enteropathogenic Escherichia coli diarrheal disease might be undesirable because neomycin can cause a malabsorption syndrome. One hundred thirteen infants with E. coli arrheal disease were randomly assigned to long-term therapy of 10 days or to short-term therapy. For short-term therapy neomycin was discontinued when daily fluorescent antibody and culture tests were negative; therapy averaged 3 days with a range of 2 to 4frac12 days for all but one patient. The pathogens were susceptible to neomycin in vitro.

The initial bacteriologic response was the same in both groups. Bacteriologic relapse without return of symptoms occurred in 14 of 57 in the longterm group and in 7 of 56 babies in the short-term group. Organisms isolated during relapse remained sensitive in vitro to neomycin. In the long-term group diarrhea lasted significanfly longer with a trend to delayed onset of steady weight gain and infectious complications were twice as common. There was no significant change in indirect hemagglutinin titer between acute and convalescent sera in 91% of specimens. Current recommendations for duration of therapy should be shortened to 3 to 5 days. This study and a literature review also raise doubts about the real value of antibiotics in this disease.

Submitted on January 4, 1971
Accepted on March 4, 1971