Antimicrobial Surveillance in Idiopathic Parkinsonism: Indication‐Specific Improvement in Hypokinesia Following Helicobacter pylori Eradication and Non‐Specific Effect of Antimicrobials for Other Indications in Worsening Rigidity. Issue 3 (22nd January 2013)

• Record Type: Journal Article
• Authors: Dobbs, Sylvia M.; Charlett, André; John Dobbs, R.; Weller, Clive; Iguodala, Owens; Smee, Cori; Lawson, Andrew J.; Taylor, David; Bjarnason, Ingvar
• Is Part Of: Helicobacter. Volume 18:Issue 3(2013:Jun.)
• Page Start: 187
• Page End: 196
• Publication Date: 2013-01-22
• Subjects: Helicobacter -- Periodicals; Helicobacter infections -- Periodicals; Stomach -- Diseases -- Periodicals; 616.3301405
• DOI: 10.1111/hel.12035
• Languages: English
• ISSNs: 1083-4389

Abstract

<abstract abstract-type="main" id="hel12035-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hel12035-sec-0001" sec-type="section"> <title>Background</title> <p>Following <italic>Helicobacter pylori</italic> eradication in a placebo‐controlled trial, the hypokinesia of idiopathic parkinsonism improved but flexor rigidity worsened.</p> </sec> <sec id="hel12035-sec-0002" sec-type="section"> <title>Methods</title> <p>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 <italic>Helicobacter</italic> 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).</p> </sec> <sec id="hel12035-sec-0003" sec-type="section"> <title>Results</title> <p>Following successful <italic>H. pylori</italic> 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 (<italic>p </italic>=<italic> </italic>.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, <italic>p </italic>=<italic> </italic>.05)), but then in entire, core and untreated after a second course (18 (6, 31), 33 (19, 48) and 29 (12, 48)%/year respectively; <italic>p </italic>=<italic> </italic>.002, .001 and .001) and further still after a third (17 (2, 34), 23 (8, 41) and 38 (15, 65)%/year; <italic>p </italic>=<italic> </italic>.02, .003 and .001). Initially, 40/66 were lactulose hydrogen breath test positive. Odds for positivity fell with time (by 59 (46, 75)%/year, <italic>p </italic>=<italic> </italic>.001) and tended to be lower with <italic>Helicobacter</italic> positivity (28 (8, 104)%, <italic>p </italic>=<italic> </italic>.06), but were unrelated to other antimicrobial interventions.</p> </sec> <sec id="hel12035-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Improved hypokinesia following antimicrobials appeared unique to <italic>Helicobacter</italic> eradication. Rigidity increased following successive antimicrobial exposures for other indications, despite diminishing lactulose hydrogen breath test positivity.</p> </sec> </abstract>