PDF(Pubmed)
Abstract：
BACKGROUND: Early childhood enteric infection with Shigella/EIEC, enteroaggregative E. coli (EAEC), Campylobacter, and Giardia has been associated with reduced child growth, yet a recent randomized trial of antimicrobial therapy to reduce these infections did not improve growth outcomes. To interrogate this discrepancy, we measured the enteric infections from this study.
METHODS: We leveraged the Early Life Interventions for Childhood Growth and Development in Tanzania (ELICIT) trial, a randomized double-blind placebo-controlled trial of antimicrobial therapy with azithromycin and nitazoxanide provided quarterly to infants from 6 to 15 months of age. We tested 5,479 stool samples at time points across the study for 34 enteropathogens using quantitative PCR.
RESULTS: There was substantial carriage of enteropathogens in stool. Azithromycin administration led to reductions in Campylobacter jejuni/coli, enteroaggregative E. coli, and Shigella/EIEC (absolute risk difference ranged from -0.06 to 0.24) 2 weeks after treatment however there was no effect after 3 months. There was no difference in Giardia after nitazoxanide administration (ARR 0.03 at the 12 month administration). When examining the effect of azithromycin versus placebo on the subset of children infected with specific pathogens at the time of treatment, a small increase in weight-for-age Z score was seen only in those infected with Campylobacter jejuni/coli (0.10 Z score, 95% CI -0.01-0.20; length-for-age Z score 0.07, 95% CI -0.06-0.20).
CONCLUSIONS: The antimicrobial intervention of quarterly azithromycin plus or minus nitazoxanide led to only transient decreases in enteric infections with Shigella/EIEC, enteroaggregative E. coli (EAEC), Campylobacter, and Giardia. There was a trend towards improved growth in children infected with Campylobacter that received quarterly azithromycin.
METHODS: We leveraged the Early Life Interventions for Childhood Growth and Development in Tanzania (ELICIT) trial, a randomized double-blind placebo-controlled trial of antimicrobial therapy with azithromycin and nitazoxanide provided quarterly to infants from 6 to 15 months of age. We tested 5,479 stool samples at time points across the study for 34 enteropathogens using quantitative PCR.
RESULTS: There was substantial carriage of enteropathogens in stool. Azithromycin administration led to reductions in Campylobacter jejuni/coli, enteroaggregative E. coli, and Shigella/EIEC (absolute risk difference ranged from -0.06 to 0.24) 2 weeks after treatment however there was no effect after 3 months. There was no difference in Giardia after nitazoxanide administration (ARR 0.03 at the 12 month administration). When examining the effect of azithromycin versus placebo on the subset of children infected with specific pathogens at the time of treatment, a small increase in weight-for-age Z score was seen only in those infected with Campylobacter jejuni/coli (0.10 Z score, 95% CI -0.01-0.20; length-for-age Z score 0.07, 95% CI -0.06-0.20).
CONCLUSIONS: The antimicrobial intervention of quarterly azithromycin plus or minus nitazoxanide led to only transient decreases in enteric infections with Shigella/EIEC, enteroaggregative E. coli (EAEC), Campylobacter, and Giardia. There was a trend towards improved growth in children infected with Campylobacter that received quarterly azithromycin.
摘要：
背景：志贺氏菌/EIEC的早期儿童肠道感染，肠聚集性大肠杆菌（EAEC），弯曲杆菌,贾第鞭毛虫与儿童生长减少有关，然而,最近一项减少这些感染的抗菌治疗的随机试验并未改善生长结局.为了询问这个差异，我们从这项研究中测量了肠道感染。
方法：我们利用早期生命干预措施促进坦桑尼亚儿童生长发育（ELICIT）试验，一项阿奇霉素和硝唑尼特抗菌治疗的随机双盲安慰剂对照试验每季度向6~15月龄婴儿提供.我们使用定量PCR在整个研究的时间点测试了5,479个粪便样品中的34种肠病原体。
结果：粪便中有大量携带肠病原体。阿奇霉素给药导致空肠弯曲杆菌/大肠杆菌减少，肠聚集性大肠杆菌，治疗后2周，志贺氏菌/EIEC（绝对风险差异为-0.06至0.24），但3个月后没有效果。硝唑尼特给药后贾第鞭毛虫没有差异（12个月给药后ARR0.03）。在检查阿奇霉素与安慰剂对治疗时感染特定病原体的儿童亚组的影响时，仅在空肠弯曲杆菌/大肠杆菌感染的患者中观察到年龄Z评分的体重略有增加（0.10Z评分，95%CI-0.01-0.20；年龄Z评分0.07，95%CI-0.06-0.20）。
结论：每季度阿奇霉素加或减硝唑尼特的抗菌干预仅导致志贺氏菌/EIEC肠道感染的短暂减少，肠聚集性大肠杆菌（EAEC），弯曲杆菌,还有贾第虫.每季度接受阿奇霉素治疗的弯曲杆菌感染儿童有改善生长的趋势。
方法：我们利用早期生命干预措施促进坦桑尼亚儿童生长发育（ELICIT）试验，一项阿奇霉素和硝唑尼特抗菌治疗的随机双盲安慰剂对照试验每季度向6~15月龄婴儿提供.我们使用定量PCR在整个研究的时间点测试了5,479个粪便样品中的34种肠病原体。
结果：粪便中有大量携带肠病原体。阿奇霉素给药导致空肠弯曲杆菌/大肠杆菌减少，肠聚集性大肠杆菌，治疗后2周，志贺氏菌/EIEC（绝对风险差异为-0.06至0.24），但3个月后没有效果。硝唑尼特给药后贾第鞭毛虫没有差异（12个月给药后ARR0.03）。在检查阿奇霉素与安慰剂对治疗时感染特定病原体的儿童亚组的影响时，仅在空肠弯曲杆菌/大肠杆菌感染的患者中观察到年龄Z评分的体重略有增加（0.10Z评分，95%CI-0.01-0.20；年龄Z评分0.07，95%CI-0.06-0.20）。
结论：每季度阿奇霉素加或减硝唑尼特的抗菌干预仅导致志贺氏菌/EIEC肠道感染的短暂减少，肠聚集性大肠杆菌（EAEC），弯曲杆菌,还有贾第虫.每季度接受阿奇霉素治疗的弯曲杆菌感染儿童有改善生长的趋势。
