You have found gut infection and now are considering antibiotics for Blastocystis. There has been a debate in the literature as to whether Blastocystis is pathogenic or not. Some consider it pathogenic and others list the huge amount of infected individuals that show no symptoms. The truth of the matter may be somewhere in the middle with the subtype or strain of bug and the host immunity.
One paper summed it up quite nicely. ‘The infection’s onset depends on the interaction between the virulence of parasites and host’s immune competence (1)’
While there are many cases of infected people showing no symptoms the evidence that Blastocystis can take on a pathogenic role is growing. Along with nonspecific symptoms including
- Abdominal pain
There is also the cancer concern to consider as well. Blastocystis subtypes in certain environments have been shown to increase the proliferation of colorectal cancer cells (2). Now we also need to consider the gut’s environment and diet in the progression of cancer as well so don’t take this evidence as a sure thing.
Other pathogenic tendencies have been observed including the production of proteases (3). Proteases are enzymes that cleave our immunoglobulin A (IgA) antibodies which we produce to protect ourselves from these pathogens. Many parasites share this trait and produce a range of protease enzymes that damage the host including Entamoeba histolytica and Giardia duodenalis (4).
- Herbal treatment for Blastocystis
- Blastocystis hominis – A Protozoan Gut Parasite
- Blastocystis hominis – Probiotic Treatment
Efficacy of Antibiotics for Blastocystis – Metronidazole
There are a number of recommended antibiotics for Blastocystis but the front line therapy for Blastocystis is a drug called metronidazole, brand name flagyl. Some doctors I have seen swear by this antibiotic and almost don’t believe me when I tell them it didn’t work. Who can blame them. If you haven’t been keeping up with the literature coming out then it is understandable not to know that there has been a massive increase in antibiotic resistance among a number of different pathogens. As I’ve written about before Helicobacter pylori is a great example of this idea with a sharp rise in antibiotic resistant strains emerging (5).
A clinical trial published back in 2001 showed that metronidazole seemed reasonably effective looking at different antibiotics for Blastocystis. Even then, when you looked a bit closer at the results you might scratch your head. They showed 80% of the patients treated with the antibiotic had cleared it in the first month compared to only 3% in the placebo arm. When they did a follow up 6 months after the antibiotic treatment they found that the number of cleared patients dropped from 80% down to 48%. There are two scenarios that could explain this massive drop.
- Using the recommendedantibiotics for Blastocystis the patient had cleared the infection with metronidazole. They were then reinfected at a later date and came back positive on the stool test.
- The stool tests actually missed the Blastocystis infection the first time, possibly due to the low numbers, and caught it the second time. This is known as a false negative and can really confuse the situation, sending you down the wrong track.
Just last week a paper was published in Parasitology Research covering two different case studies. In these case studies patients were administered the standard metronidazole for Blastocystis sp. infections. To me it wasn’t surprising that the antibiotics didn’t work. Here in Byron Bay, Australia, where Blastocystis is rampant I have heard more cases of failed eradication with antibiotics than I care to count. The interesting and concerning aspect of this study was the effect that metronidazole had on the cyst count of the Blastocystis population. These two case studies reported a higher cyst count and more severe symptoms after taking flagyl. Here I would start to question certain antibiotics for Blastocystis as this happened to me quite dramatically.
The paper concluded ‘The two studies uniquely demonstrate for the first time a cyst count as high as fivefold more than the original cyst count before treatment and show an exacerbation of GI symptoms despite treatment’
To Treat or Not to Treat?
This is the major debate in the scientific community. One paper suggested that patients with no symptoms and a low cyst count should skip treatment and that those experiencing gastrointestinal symptoms or skin issues with a higher cyst count should attempt to treat the infection (6). There may even be a link between the different forms that Blastocystis spp. can take with one study showing that the amoeboid form producing more protease enzymes thus being more pathogenic.
With that said it is important to stop and take stock. If you have come back with a positive stool test for Blastocystis as I did then take a moment to consider a few points.
- Gastrointestinal symptoms – bloating/flatulence/diarrhoea/distention
- Skin issues – urticaria/hives/rashes
- Possible wheat, fructose or dairy sensitivities
- Nutrient deficiencies
- Sleep quality
All of these points and more can be contributing to your symptom profile and each one must be ruled in our ruled out.
All of my gastrointestinal symptoms have resolved even though my stool tests still come back positive for a Blastocystis infection. I attribute this to the two herbal antimicrobial treatments I’ve been through, the probiotics and prebiotics I’ve been working with to improve my gut flora and some herbal medicines (Chinese medicine and western herbal medicine) designed to support my immune system.
Have you tried antibiotics for Blastocystis? What were your results? Share your thoughts below.
References and Resources
- Eradication of Blastocystis in humans: Really necessary for all?
- Blastocystis sp. subtype 3 triggers higher proliferation of human colorectal cancer cells, HCT116
- Degradation of human secretory immunoglobulin A by Blastocystis
- Giardia duodenalis: INTER-STRAIN VARIABILITY OF PROTEINS, ANTIGENS, PROTEASES, ISOENZYMES AND NUCLEIC ACIDS
- Antibiotic treatment for Helicobacter pylori: Is the end coming?
- A Placebo-Controlled Treatment Trial of Blastocystis hominis Infection with Metronidazole
- Exacerbated symptoms in Blastocystis sp.-infected patients treated with metronidazole: two case studies
- Blastocystis: To Treat or Not to Treat.
- Amoebic forms of Blastocystis spp. – evidence for a pathogenic role