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Metronidazole in treatment of amebiasis
Volume 88 Number 4, part 1
Letters to the Editor
REFERENCES 1. Chrispin AR: Abnormalities ofoesophageal function: some radiological aspects, In: Wilkinson AW, editor: Recent advances in Pediatric surgery, New York, 1969, Grune & Stratton, Inc, p 137. 2. Chrispin AR, Friedland GW, and Wright DE: Some functional characteristics of the oesophageal vestibule in infants and children, Thorax 22:188, 1967. 3. Edwards DAW: The "raspberry" or "flutter" valve in the antireflux mechanism, In Smith AN, editor: Surgical physiology of the gastrointestinal tract: Proceedings of a symposium, Royal College of Surgeons of Edinburgh, 1962, pp 24-28. 4. Herbst JJ, and Johnson D J: Gastroesophageal manometry in children with gastroesophageal reflux, Pediatric Res 8:382, 1974. 5. Chrispin AR, and Friedland GW: Functional disturbance in hiatal hernia in infants and children, Thorax 22:422, 1967.
Metronidazole in treatment of amebiasis To the Editor: In his interesting review of parasitic infections 1 Dr Michael Katz commented that there had been no reported experience of metronidazole in the treatment of nonhepatic extraintestinal amebiasis. A case report from this hospitaF is thus of interest, since a young adult with an amebic hepatic abscess and cutaneous amebiasis of the overlying skin was treated with metronidazole, 2.4 gm orally, on two successive days, resulting in satisfactory resolution of the lesion. Perhaps therefore, metronidazole should remain the drug of first choice even in the uncommon manifestations of amebiasis.
D. G. Human, M.R.C.P. Senior Registrar Department of Paediatrics Mpilo Central Hospital P.O. Box 2096 Bulawayo Rhodesia REFERENCES 1. Katz M: Parasitic infections, J PEDIATR 87:165, 1975. 2. Thomas JEP: Cutaneous amoebiasis due to liver abscess, Cent Air J Med 18:190, 1972.
Reply To the Editor: I am grateful to Dr. Human for calling my attention to a report with which I was unfamiliar. There have been other, single case reports about the effectiveness of metronidazole in the treatment of non-hepatic extra-intestinal amebiasis, but all of them have
695
dealt with individual cases. My statement that there has not been "reported experience" was meant to convey that a critical study has not yet been published.
Michael Katz, M.D. Division of Tropical Medicine College of Physicians and Surgeons of Columbia University New York, N.Y. 10032
Diuretic therapy in infants and children To the Editor: Dr. Loggie and colleagues ~confined their discussion of diuretic therapy to treatment of fluid retention due to heart and kidney disease. They failed to discuss fluid retention in chronic liver disease which presents certain special problems. Extrahepatic biliary atresia is by far the most frequent cause of cirrhosis leading to fluid retention in infants and young children. A few other children develop ascites and edema in the course of progressive forms of hepatic parenchymal damage with cirrhosis. In both these situations the effective treatment of ascites can alleviate a very uncomfortable symptom in a dismal progressive disease. Ascites and edema can also be present at the time of presentation in children with treatable forms of liver disease (e.g., Wilson disease) and incorrect use of diuretics can be life threatening in these situations. There are two special features to the fluid retention of liver disease. (1) Hyperaldosteronism and renal tubular damage are both commonly present in liver disease and both lead to potassium loss and hypokalemia. Overenthusiastic use of diuretics like furosemide or thiazides can be quite dangerous. (2) The fluid accumulates predominantly in the peritoneal cavity from which it can be reabsorbed for excretion only fairly slowly. This makes it rather easy to cause dehydration by overzealous use of any diuretic. An aldosterone antagonist like spironolactone is the logical first diuretic to use in fluid retention of liver disease. I have followed this course o f action since 1960 and during this period have treated over 60 children with fluid retention due to liver disease. In at least three-quarters o f these patients spironolactone alone has produced a satisfactory diuresis within 24 to 36 hours after first administration. I have used an initial dose of 25 mg twice a day in infants under 12 months or 25 mg three times a day in infants 12 months to 2 years o f age. Serious disturbances of serum electrolytes have been so rare that I come to regard it as quite safe to start this treatment at home provided that the baby is not very ill. In infants with terminal liver failure hyponatremia is usually also present and spironolactone can aggravate this. However, the hypokalemia, which is more usually present alone in earlier cases, is usually corrected by this drug w i ~ o u t additional potassium. In about 25% of infants diuresis has not followed the use of spironolactone alone. The addition of a small dose of furosemide
Letters to the Editor
REFERENCES 1. Chrispin AR: Abnormalities ofoesophageal function: some radiological aspects, In: Wilkinson AW, editor: Recent advances in Pediatric surgery, New York, 1969, Grune & Stratton, Inc, p 137. 2. Chrispin AR, Friedland GW, and Wright DE: Some functional characteristics of the oesophageal vestibule in infants and children, Thorax 22:188, 1967. 3. Edwards DAW: The "raspberry" or "flutter" valve in the antireflux mechanism, In Smith AN, editor: Surgical physiology of the gastrointestinal tract: Proceedings of a symposium, Royal College of Surgeons of Edinburgh, 1962, pp 24-28. 4. Herbst JJ, and Johnson D J: Gastroesophageal manometry in children with gastroesophageal reflux, Pediatric Res 8:382, 1974. 5. Chrispin AR, and Friedland GW: Functional disturbance in hiatal hernia in infants and children, Thorax 22:422, 1967.
Metronidazole in treatment of amebiasis To the Editor: In his interesting review of parasitic infections 1 Dr Michael Katz commented that there had been no reported experience of metronidazole in the treatment of nonhepatic extraintestinal amebiasis. A case report from this hospitaF is thus of interest, since a young adult with an amebic hepatic abscess and cutaneous amebiasis of the overlying skin was treated with metronidazole, 2.4 gm orally, on two successive days, resulting in satisfactory resolution of the lesion. Perhaps therefore, metronidazole should remain the drug of first choice even in the uncommon manifestations of amebiasis.
D. G. Human, M.R.C.P. Senior Registrar Department of Paediatrics Mpilo Central Hospital P.O. Box 2096 Bulawayo Rhodesia REFERENCES 1. Katz M: Parasitic infections, J PEDIATR 87:165, 1975. 2. Thomas JEP: Cutaneous amoebiasis due to liver abscess, Cent Air J Med 18:190, 1972.
Reply To the Editor: I am grateful to Dr. Human for calling my attention to a report with which I was unfamiliar. There have been other, single case reports about the effectiveness of metronidazole in the treatment of non-hepatic extra-intestinal amebiasis, but all of them have
695
dealt with individual cases. My statement that there has not been "reported experience" was meant to convey that a critical study has not yet been published.
Michael Katz, M.D. Division of Tropical Medicine College of Physicians and Surgeons of Columbia University New York, N.Y. 10032
Diuretic therapy in infants and children To the Editor: Dr. Loggie and colleagues ~confined their discussion of diuretic therapy to treatment of fluid retention due to heart and kidney disease. They failed to discuss fluid retention in chronic liver disease which presents certain special problems. Extrahepatic biliary atresia is by far the most frequent cause of cirrhosis leading to fluid retention in infants and young children. A few other children develop ascites and edema in the course of progressive forms of hepatic parenchymal damage with cirrhosis. In both these situations the effective treatment of ascites can alleviate a very uncomfortable symptom in a dismal progressive disease. Ascites and edema can also be present at the time of presentation in children with treatable forms of liver disease (e.g., Wilson disease) and incorrect use of diuretics can be life threatening in these situations. There are two special features to the fluid retention of liver disease. (1) Hyperaldosteronism and renal tubular damage are both commonly present in liver disease and both lead to potassium loss and hypokalemia. Overenthusiastic use of diuretics like furosemide or thiazides can be quite dangerous. (2) The fluid accumulates predominantly in the peritoneal cavity from which it can be reabsorbed for excretion only fairly slowly. This makes it rather easy to cause dehydration by overzealous use of any diuretic. An aldosterone antagonist like spironolactone is the logical first diuretic to use in fluid retention of liver disease. I have followed this course o f action since 1960 and during this period have treated over 60 children with fluid retention due to liver disease. In at least three-quarters o f these patients spironolactone alone has produced a satisfactory diuresis within 24 to 36 hours after first administration. I have used an initial dose of 25 mg twice a day in infants under 12 months or 25 mg three times a day in infants 12 months to 2 years o f age. Serious disturbances of serum electrolytes have been so rare that I come to regard it as quite safe to start this treatment at home provided that the baby is not very ill. In infants with terminal liver failure hyponatremia is usually also present and spironolactone can aggravate this. However, the hypokalemia, which is more usually present alone in earlier cases, is usually corrected by this drug w i ~ o u t additional potassium. In about 25% of infants diuresis has not followed the use of spironolactone alone. The addition of a small dose of furosemide