(Oral Session) Superior Efficacy of Paromomycin for Eradication of Dientamoeba Fragilis in Adults J.J

O335 Abstract (oral session) Superior efficacy of paromomycin for eradication of Dientamoeba fragilis in adults J.J. van Hellemond*, N. Molhoek, R. Koelewijn, P. Wismans, P.J.J. van Genderen (Rotterdam, NL) Objectives: Dientamoeba fragilis was originally described as an a-pathogenic protozoan organism, but over the years many reports have provided evidence for the pathogenic potential of this protozoa. Patients with a D. fragilis infection suffering from chronic gastro-intestinal complaints that remain unexplained after thorough investigation are therefore often treated with the intention to eradicate the D. fragilis infection from the gut. Since no consensus exists about treatment for dientamoebiasis, we performed a retrospective follow-up study to compare the efficacy of paromomycin, clioquinol and metronidazole. Methods: Patients were included when between January 2004 and January 2011 D. fragilis was demonstrated in a stool sample and results of a follow- up stool sample were available. Paromomycin (3 daily doses of 500 mg for 7-10 days), clioquinol (3 daily doses of 250 mg for 7 days), metronidazole (3 daily doses of 500 mg for 7-10 days), were prescribed off-label and after informed consent of the patient. Other patients received no treatment; a wait and see policy. D. fragilis was demonstrated in stools of 451 patients (8%), of which 127 cases could be included in this study, because for these patients follow up TFT results were available. Results: Treatment with paromomycin (n=63) resulted in parasitological cure of D. fragilis in 98% of cases and in 1 patient the parasite load was reduced by 16%. Treatment with clioquinol (n=15) eradicated D. fragilis in 87% of cases and in two patients the parasite load was reduced after treatment by 50 and 83%. Treatment with metronidazole (n=10) resulted in parasitological cure of D. fragilis in 70% of cases, but in 3 patients in the parasite load was not reduced and even increased in two of them. When patients received no treatment (wait and see policy, n=39), D. fragilis was spontaneously cleared in 46% of cases. The parasite load in untreated patients not clearing D. fragilis was rather variable; in most patients a decrease in parasite load was noted but substantial increases were also observed. Conclusion: Our results showed that D. fragilis infections were spontaneously cleared in 46% but increased in 25% of untreated cases. Although metronidazole is often listed as the drug of choice, paromomycin was shown to be the most effective drug for eradication of D. fragilis in adults with a parasitological cure rate of almost 100%..

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