From the Research
For a 9-year-old with Blastocystis hominis infection, treatment with metronidazole or Saccharomyces boulardii is recommended only if the child is symptomatic with persistent gastrointestinal symptoms and other causes have been ruled out. The most recent and highest quality study 1 suggests that metronidazole or S. boulardii has potential beneficial effects in B. hominis infection, with a clinical cure rate of 77.7% in the S. boulardii group and 66.6% in the metronidazole group. Some key points to consider when treating a child with Blastocystis hominis infection include:
- Confirming the diagnosis with stool examination and ensuring symptoms are likely due to Blastocystis rather than another cause
- Monitoring for side effects such as nausea or metallic taste with metronidazole
- Considering alternative options such as trimethoprim-sulfamethoxazole (TMP-SMX) or nitazoxanide if metronidazole is not effective
- Maintaining good hydration during treatment
- Following up with stool examination if symptoms persist after treatment to confirm clearance of the parasite It's also important to note that many cases of Blastocystis are asymptomatic and don't require treatment, and treatment success rates can vary. Other studies 2, 3, 4, 5 also support the use of metronidazole as a first-line treatment, but the most recent study 1 provides the strongest evidence for its effectiveness. In particular, the study 5 highlights the low efficacy of metronidazole in eradicating B. hominis in symptomatic patients, which suggests that alternative treatments such as S. boulardii may be considered. Overall, the treatment approach should be individualized based on the child's symptoms, medical history, and response to treatment.