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Antimicrobial Surveillance in Idiopathic Parkinsonism: Indication‐Specific Improvement in Hypokinesia Following H elicobacter pylori Eradication and Non‐Specific Effect of Antimicrobials for Other Indications in Worsening Rigidity
Author(s) -
Dobbs Sylvia M.,
Charlett André,
John Dobbs R.,
Weller Clive,
Iguodala Owens,
Smee Cori,
Lawson Andrew J.,
Taylor David,
Bjarnason Ingvar
Publication year - 2013
Publication title -
helicobacter
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 79
eISSN - 1523-5378
pISSN - 1083-4389
DOI - 10.1111/hel.12035
Subject(s) - medicine , hypokinesia , parkinsonism , placebo , interquartile range , gastroenterology , antimicrobial , disease , pathology , chemistry , alternative medicine , organic chemistry
Background Following H elicobacter pylori eradication in a placebo‐controlled trial, the hypokinesia of idiopathic parkinsonism improved but flexor rigidity worsened. Methods We surveyed the effect of all antimicrobial prescriptions in 66 patients with idiopathic parkinsonism over a median of 1.9 (interquartile range 0.4, 3.5) years. Initial H elicobacter screening was followed (where positive) by gastric biopsy. Serial lactulose hydrogen breath tests (364 tests) for small intestinal bacterial overgrowth monitored the need to encourage fluid intake and bulk/osmotic laxatives. We measured hypokinesia (401 assessments of mean stride length at free walking speed in 58 patients) and upper limb flexor rigidity (396 assessments in 49). Results Following successful H . pylori eradication (12 cases) but not failed (2), stride increased in entire group (including those receiving levodopa), core group (those receiving only longer‐t½ antiparkinsonian medication or untreated) and untreated ( p = .001 each case). The effect was greater with less antiparkinsonian medication (19 (95% CI , 14, 25) cm/year in untreated). Flexor rigidity was unchanged. Following antimicrobials for other indications (75 courses), hypokinesia was unchanged. However, flexor rigidity increased cumulatively. It increased in core group only after a first course (by (10 (0, 20)%/year, p = .05)), but then in entire, core and untreated after a second course (18 (6, 31), 33 (19, 48) and 29 (12, 48)%/year respectively; p = .002, .001 and .001) and further still after a third (17 (2, 34), 23 (8, 41) and 38 (15, 65)%/year; p = .02, .003 and .001). Initially, 40/66 were lactulose hydrogen breath test positive. Odds for positivity fell with time (by 59 (46, 75)%/year, p = .001) and tended to be lower with H elicobacter positivity (28 (8, 104)%, p = .06), but were unrelated to other antimicrobial interventions. Conclusions Improved hypokinesia following antimicrobials appeared unique to H elicobacter eradication. Rigidity increased following successive antimicrobial exposures for other indications, despite diminishing lactulose hydrogen breath test positivity.