Blastocystosis - Treatment

Treatment

There is a lack of scientific study to support the efficacy of any particular treatment. An additional review published in 2009 made a similar conclusion, noting that because the diagnostics in use have been unreliable, it has been impossible to determine whether a drug has eradicated the infection, or just made the patient feel better. Historical reports, such as one from 1916, note difficulty associated with eradication of Blastocystis from patients, describing it as "an infection that is hard to get rid of."

A 1999 in vitro from Pakistan study found 40% of isolates are resistant to common antiprotozoal drugs. A study of isolates from patients diagnosed with IBS found 40% of isolates resistant to Metronidazole and 32% resistant to furazolidone. Drugs reported in studies have included Metronidazole, TMP-SMX, Doxycycline, Nitazoxanide Iodoquinol and Paromomycin. Iodoquinol has been found to be less effective in practice and in-vitro. Miconazole has been reported as an agent against Blastocystis growth in-vitro.

Physicians have described the successful use of a variety of discontinued antiprotozoals in treatment of Blastocystis infection. Emetine was reported as successful in cases in early 20th century with British soldiers who contracted Blastocystis infection while serving in Egypt. In vitro testing showed emetine was more effective than Metronidazole or furazolidone. Emetine is available in the United States through special arrangement with the Center for Disease Control. Clioquinol (Entero-vioform) was noted as successful in treatment of Blastocystis infection but removed from the market following an adverse event in Japan. Stovarsol and Narsenol, two arsenic-based antiprotozoals, were reported to be effective against the infection. Carbarsone was available as an anti-infective compound in the United States as late as 1991, and was suggested as a possible treatment. The reduction in the availability of antiprotozoal drugs has been noted as a complicating factor in treatment of other protozoal infections. For example, in Australia, production of diloxanide furoate ended in 2003, paromomycin is available under special access provisions, and the availability of iodoquinol is limited.

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