Acute Diarrhea In Children Research Articles

Prescription of medications for acute diarrhea in infants in Antananarivo, Madagascar.

To evaluate the professional practices of physicians in Antananarivo in managing acute diarrhea in infants. This prospective study was conducted from March 19 to April 21, 2012, as an anonymous survey of randomly selected general practitioners and pediatricians working in the public or private sector in the city of Antananarivo. The survey included 125 physicians: 105 general practitioners, 11 pediatricians, and 9 other specialist physicians (7.2%) with pediatric activity. Only 4.8% of the physicians questioned had not received training about diarrhea in the previous two years. One doctor in 4 (25.6%) did not prescribe oral rehydration solution. The reasons given were lack of signs of dehydration (50%) and recommendation of other beverages (15.5%). Zinc prescription was rare (9.6%). Early refeeding was recommended by 41.6% of physicians. Almost half (47.2%) routinely use antibiotics, and 86.4% prescribe antidiarrheal medications. The WHO recommendations for the treatment of acute diarrhea in children are not followed. Continuing and repeated medical education is necessary.

Cost utility, budget impact, and scenario analysis of racecadotril in addition to oral rehydration for acute diarrhea in children in Malaysia.

ObjectiveTo perform cost utility (CU) and budget impact (BI) analyses augmented by scenario analyses of critical model structure components to evaluate racecadotril as adjuvant to oral rehydration solution (ORS) for children under 5 years with acute diarrhea in Malaysia.MethodsA CU model was adapted to evaluate racecadotril plus ORS vs ORS alone for acute diarrhea in children younger than 5 years from a Malaysian public payer’s perspective. A bespoke BI analysis was undertaken in addition to detailed scenario analyses with respect to critical model structure components.ResultsAccording to the CU model, the intervention is less costly and more effective than comparator for the base case with a dominant incremental cost-effectiveness ratio of −RM 1,272,833/quality-adjusted life year (USD −312,726/quality-adjusted life year) in favor of the intervention. According to the BI analysis (assuming an increase of 5% market share per year for racecadotril+ORS for 5 years), the total cumulative incremental percentage reduction in health care expenditure for diarrhea in children is 0.136578%, resulting in a total potential cumulative cost savings of −RM 73,193,603 (USD −17,983,595) over a 5-year period. Results hold true across a range of plausible scenarios focused on critical model components.ConclusionAdjuvant racecadotril vs ORS alone is potentially cost-effective from a Malaysian public payer perspective subject to the assumptions and limitations of the model. BI analysis shows that this translates into potential cost savings for the Malaysian public health care system. Results hold true at evidence-based base case values and over a range of alternate scenarios.

Antibiotic treatment of acute gastroenteritis in children.

Antibiotic therapy is not necessary for acute diarrhea in children, as rehydration is the key treatment and symptoms resolve generally without specific therapy. Searching for the etiology of gastroenteritis is not usually needed; however, it may be necessary if antimicrobial treatment is considered. The latter is left to the physician evaluation in the absence of clear indications. Antimicrobial treatment should be considered in severely sick children, in those who have chronic conditions or specific risk factors or in specific settings. Traveler’s diarrhea, prolonged diarrhea, and antibiotic-associated diarrhea may also require antibiotic therapy. Depending on the severity of symptoms or based on risk of spreading, empiric therapy may be started while awaiting the results of microbiological investigations. The choice of antibiotic depends on suspected agents, host conditions, and local epidemiology. In most cases, empiric therapy should be started while awaiting such results. Empiric therapy may be started with oral co-trimoxazole or metronidazole, but in severe cases parenteral treatment with ceftriaxone or ciprofloxacin might be considered.

Prevalence of rotavirus diarrhoea among children under five years in Kaduna state, Nigeria

Rotavirus (RV) is a major etiological agent of acute infantile gastroenteritis and is associated with 20%-25% of diarrhoea cases in infants. Nigeria continues to be among the first five countries with greatest number of RV disease associated deaths per year. From September 2013-August 2014, 467 stool samples were collected from children under 5 years of age in Kaduna State, Nigeria and analysed for RV antigen using ELISA. An overall RV prevalence of 31.0% (143/467) was obtained with the infection occurring throughout the study period. Children from Kachia LGA had the highest prevalence of 53.8% (28/52), while children from Kagarko LGA had the lowest prevalence of 21.0% (10/74). The difference was significant (P=0.019). Highest prevalence of RV was recorded in March (75.0%:3/4) and the least in July (11.5%:3/26) with significant difference (P=0.003). Female children had highest prevalence of 32.1% (79/246) compared to male children (29.9%:66/221) with a non-significance difference (P=0.530). Children within 25-36 months had the highest prevalence of 36.4% (28/77), while children 49-60 months had the lowest prevalence of 17.6% (6/34) with no significant difference (P=0.517). The difference observed was not significant (P=0.477). The result showed no significant difference between the presence of RV infection with vomiting, fever, dehydration (P>0.05). The study has revealed that rotavirus remains an important cause of acute diarrhoea in children under five years in Kaduna State, Nigeria. Hence the need for the implemention of the vaccines into the childhood immunization programme in the country.Key words: Prevalence, Rotavirus, Children, Kaduna State, Nigeria

Pneumatosis intestinalis as a complication of acute diarrhoea in children

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Więcek S, Grzybowska-Chlebowczyk U, Olczak Z, Gruszczyńska K, Korecka K, Koszutski T. Pneumatosis intestinalis as a complication of acute diarrhoea in children. Pediatria Polska - Polish Journal of Paediatrics. 2018;93(4):291-297. doi:10.5114/polp.2018.77993. APA Więcek, S., Grzybowska-Chlebowczyk, U., Olczak, Z., Gruszczyńska, K., Korecka, K., & Koszutski, T. (2018). Pneumatosis intestinalis as a complication of acute diarrhoea in children. Pediatria Polska - Polish Journal of Paediatrics, 93(4), 291-297. https://doi.org/10.5114/polp.2018.77993 Chicago Więcek, Sabina, Urszula Grzybowska-Chlebowczyk, Zbigniew Olczak, Katarzyna Gruszczyńska, Klaudia Korecka, and Tomasz Koszutski. 2018. "Pneumatosis intestinalis as a complication of acute diarrhoea in children". Pediatria Polska - Polish Journal of Paediatrics 93 (4): 291-297. doi:10.5114/polp.2018.77993. Harvard Więcek, S., Grzybowska-Chlebowczyk, U., Olczak, Z., Gruszczyńska, K., Korecka, K., and Koszutski, T. (2018). Pneumatosis intestinalis as a complication of acute diarrhoea in children. Pediatria Polska - Polish Journal of Paediatrics, 93(4), pp.291-297. https://doi.org/10.5114/polp.2018.77993 MLA Więcek, Sabina et al. "Pneumatosis intestinalis as a complication of acute diarrhoea in children." Pediatria Polska - Polish Journal of Paediatrics, vol. 93, no. 4, 2018, pp. 291-297. doi:10.5114/polp.2018.77993. Vancouver Więcek S, Grzybowska-Chlebowczyk U, Olczak Z, Gruszczyńska K, Korecka K, Koszutski T. Pneumatosis intestinalis as a complication of acute diarrhoea in children. Pediatria Polska - Polish Journal of Paediatrics. 2018;93(4):291-297. doi:10.5114/polp.2018.77993.

Diarrheagenic Escherichia coli and Shigella with High Rate of Extended-Spectrum Beta-Lactamase Production: Two Predominant Etiological Agents of Acute Diarrhea in Shiraz, Iran.

This study was conducted to find the etiology of acute diarrhea in Iranian children and determine the antimicrobial resistance patterns. The pathogenic bacteria were recovered from 110/269 (40.9%) diarrheal fecal samples with the following profiles: the most predominant pathogen was diarrheagenic Escherichia coli (DEC) (43.6%), comprising enteroaggregative E. coli (23.6%), enteropathogenic E. coli (10.9%), enteroinvasive E. coli (5.5%), and enterotoxigenic E. coli (3.6%); Shigella spp. (37.3%), Salmonella spp. (12.7%) and Campylobacter jejuni (6.4%) were ranked second and fourth in terms of prevalence, respectively. The rates of extended-spectrum beta-lactamase (ESBL) production were 66.7% and 53.7% in DEC and Shigella, respectively. Resistance to ampicillin (AMP) (95.1%), trimethoprim/sulfamethoxazole (SXT) (73.2%), azithromycin (ATH) (21.9%), and ciprofloxacin (CIP) (14.6%) was observed among Shigella isolates. Multidrug resistance phenotype was observed in 24.4% (10/41) of Shigella isolates, with the most common pattern of resistance to cefotaxime, ceftriaxone, ceftazidime, AMP, SXT, and ATH. This study indicates an alarming increase in the ESBL production of DEC and Shigella spp. and identifies them as the two most prevalent diarrhea-causing enteropathogens in the region. The results show that CIP could be an alternative to third-generation cephalosporins against these two pathogens. Therefore, it is proposed that further investigation be done in the pursuit of alternative antibiotics that are effective against the resistant cases. For instance, one study could look into the comparative clinical effectiveness of third-generation cephalosporins versus CIP, the latter not being presently the drug of choice for the treatment of acute diarrhea in children in Iran.

Efficacy of a bovine colostrum and egg-based intervention in acute childhood diarrhoea in Guatemala: a randomised, double-blind, placebo-controlled trial

BackgroundTreatments for paediatric diarrhoeal disease are limited. We assessed the impact of a bovine colostrum and egg-based treatment designed to reduce diarrhoea duration through non-specific and pathogen-directed mechanisms in children.MethodsRandomised,...

Water, sanitation and hygiene interventions for acute childhood diarrhea: a systematic review to provide estimates for the Lives Saved Tool

BackgroundIn the Sustainable Development Goals (SDGs) era, there is growing recognition of the responsibilities of non-health sectors in improving the health of children. Interventions to improve access to clean water, sanitation facilities, and hygiene behaviours (WASH) represent key opportunities to improve child health and well-being by preventing the spread of infectious diseases and improving nutritional status.MethodsWe conducted a systematic review of studies evaluating the effects of WASH interventions on childhood diarrhea in children 0–5 years old. Searches were run up to September 2016. We screened the titles and abstracts of retrieved articles, followed by screening of the full-text reports of relevant studies. We abstracted study characteristics and quantitative data, and assessed study quality. Meta-analyses were performed for similar intervention and outcome pairs.ResultsPooled analyses showed diarrhea risk reductions from the following interventions: point-of-use water filtration (pooled risk ratio (RR): 0.47, 95% confidence interval (CI): 0.36–0.62), point-of-use water disinfection (pooled RR: 0.69, 95% CI: 0.60–0.79), and hygiene education with soap provision (pooled RR: 0.73, 95% CI: 0.57–0.94). Quality ratings were low or very low for most studies, and heterogeneity was high in pooled analyses. Improvements to the water supply and water disinfection at source did not show significant effects on diarrhea risk, nor did the one eligible study examining the effect of latrine construction.ConclusionsVarious WASH interventions show diarrhea risk reductions between 27% and 53% in children 0–5 years old, depending on intervention type, providing ample evidence to support the scale-up of WASH in low and middle-income countries (LMICs). Due to the overall low quality of the evidence and high heterogeneity, further research is required to accurately estimate the magnitude of the effects of these interventions in different contexts.

Racecadotril for Acute Diarrhoea in Children: A U.K. Prospective Case Series

Introduction: Acute diarrhoea, with or without vomiting is a very common problem presenting to paediatric secondary care units. Racecadotril is an antisecretory agent with a different mechanism of action from existing antidiarrhoeal agents, reducing hypersecretion of water and electrolytes without affecting intestinal motility/transit. Racecadotril has only been licensed since 2013 for use in children within the UK. A recent systematic review found evidence that racecadotril is more effective than placebo or no intervention in reducing the duration of illness and stool output in children with acute diarrhoea. There is no reported data of use within paediatric patients in the UK. We set out to evaluate the use of Racecadotril in a prospective case series. Methods: All patients between the ages of 3 months and 5 years were considered for inclusion. Patients were recruited on an ambulatory paediatric observation unit after direct referral from primary care or the emergency department. To be included, patients must have had greater than 3 stools per day on at least one day in the last 3 days and have successfully completed an oral fluid challenge with oral rehydration solution. Patients who were suitable for prescribing racecadotril were given an information leaflet on the service evaluation and asked if they be willing to be contacted 1 week later to capture outcome data. One of the investigators collected this data by telephone and recorded using a proforma. Results: A total of 23 consecutive eligible patients from January - April 2017 were included, with all participants consenting for contact. Seven patients were less than one year of age. There were 13 males and 10 females.Two of the patients could not be contacted and were lost to follow up. Of the remaining 21 patients, two chose not to give the medication as the symptoms were resolving. 16 of the 19 patients (84%) who took the medication stated that was effective, with five patients describing resolution within 24 hours and 11 within 72 hours. Three patients reported no acute change in symptoms with the medication. There were no reported adverse events by any participants. Conclusion: This is the first study to report the use of this medication in UK paediatric patients. Its use appears safe and acceptable to patients and this case series supports the previous high quality systematic review that confirms efficacy for acute diarrhoea. Future work should seek to assess the impact of racecadotril from an economic perspective, as well as

Probiotics in acute diarrhea: A randomized control trial

Background: Probiotics have been used for long in the treatment of acute diarrhea although their efficacy has always remains the subject of discussion. Objective: To determine the effect of probiotics in acute diarrhea among the children in rural population. Method: Double-blinded randomized control trial. We included children of age group 6 months - 5 years suffering from acute diarrhea of <48 h and fulfilling the inclusion criteria. All children were given oral rehydration salts (ORS) ad-lib till the resolution of diarrhea and zinc 20 mg/day for 14 days while intervention arm (n=101) were given probiotic sachet twice a day for 7 days containing Streptococcus faecalis 30 million, Clostridium butyricum 2 million, Bacillus mesentericus 1 million, Lactobacillus sporogenes 50 million, control group were given identical placebo apart from ORS and zinc. Duration of diarrhea in both the groups was measured as primary outcome while secondary outcome was to know the days of maximum recovery from diarrhea in both groups. Results: Totally, 207 patients were randomized to control and study group, out of which, 195 completed the study. Out of total 195 patients, 94 (48.2%) patients were treatedwith standard treatment of diarrhea without probiotics while 101 (51.8%) patients were given probiotics apart from standard treatment of diarrhea. The mean duration of diarrhea was found to be reduced in the study group (4.6 days [2.84-4.776 days]) as compared to control group (5.31 days [5.108-5.512 days]), p<0.001. Conclusion: Probiotics significantly reduced the duration of acute diarrhea in children.

Molecular Characterization of Diarrheagenic Escherichia Coli in Children Less Than 5 Years of Age with Diarrhea in Ouagadougou, Burkina Faso.

Diarrheagenic Escherichia coli (DEC) is important bacteria of children’s endemic and epidemic diarrhea worldwide. The aim of this study was to determine the prevalence of DEC isolated from stool samples collected from children with acute diarrhea living in Ouagadougou, Burkina Faso. From August 2013 to October 2015, stool samples were collected from 315 children under 5 years of age suffering from diarrhea in the “Centre Médical avec Antenne Chirurgicale (CMA)” Paul VI and the CMA of Schiphra. E. coli were isolated and identified by standard microbiological methods, and the 16-plex PCR method was used to further characterize them. Four hundred and nineteen (419) E. coli strains were characterized, of which 31 (7.4%) DEC pathotypes were identified and classified in five E. coli pathotypes: 15 enteroaggregative E. coli (EAEC) (48.4%), 8 enteropathogenic E. coli (EPEC) (25.8%) with 4 typical EPEC and 4 atypical EPEC, 4 enteroinvasive E. coli (EIEC) (12.9%), 3 enterohemorrhagic E. coli (EHEC) 9.67%, and 1 enterotoxigenic E. coli (ETEC) 3.2%. The use of multiplex PCR as a routine in clinical laboratory for the detection of DEC would be a useful mean for a rapid management of an acute diarrhea in children.

Molecular and phenotypic typing of enteropathogenic Escherichia coli isolated in childhood acute diarrhea in Abuja, Nigeria.

Enteropathogenic Escherichia coli (EPEC) causes infectious diarrhea among children in developing countries. However, in Nigeria, due to limited laboratory resources, the genetic diversity of its virulence factors, which includes its intimin subtypes remain undefined. This study aims to evaluate the serotypes, antibiotic resistance and the intimin subtypes genes associated with EPEC strains isolated from children with acute diarrhea in Abuja, Nigeria. EPEC isolates from diarrheic children aged 0-60 months in Abuja, Nigeria were analyzed. PCR for EPEC virulence gene, Hep-2 cell Adherence and serotyping were performed. EPEC strains were further subtyped by PCR reactions for the identification of intimin subtype genes: α (alpha), β (beta), γ1 (gamma-1), and έ (epsilon). Antibiotic resistance and ESBL production was determined by CLSI guidelines. Overall, 18 (4.5%) out of 400 children with acute diarrhea had EPEC infection. Typical EPEC strains were detected in 14 (3.5%) whereas 4 (1.1%) were atypical EPEC. Fifteen (83.3%) of the EPEC isolated belonged to β intimin subtype gene, while the remaining 3 EPEC isolates possessed the intimin έ subtype. No α and γ intimin subtypes were detected. Traditional EPEC serotypes O114:H14 were detected only in tEPEC strains. Marked resistant to β-lactam agents were observed but no ESBL-producing tEPEC or aEPEC was detected. This is the first report of intimin subtype genes in Abuja, Nigeria. These data will be useful in facilitating the characterization of intimin variants of EPEC and some Shiga toxin-producing E. coli (STEC) in humans and other animal species.

Epidemiology Of Diarrheal Diseases in Children Below 5 Years in Wassit Province

Diarrheal diseases are major causes of morbidity and mortality among children in developing countries. We have analyzed distribution of diarrhea in children under five years of age who resided in rural or urban environments but attended Al_Karama hospital in Al_Kut city in Wassit. In this study we have found that diarrheal disease is more common in family that their parents illiterate, there is a peak incidence at1-2 years old. The disease more in infant who use bottle feeding than in those who feed on breast of their mothers and those with mixed type of feeding.The incidence of the disease is greater in children whose mothers use tap water for feeding. As for the Residence of the parents of these children, the occurrence of the condition is nearly equal between urban and rural regions.There is no significant difference between male and female.Conclusion: During this study, important environmental risk factors were recognized. Endangered groups and mothers with children under 5 years old should be aware of these risk factors in order to prevent their children's diseases. Prevention of acute diarrhea in children can reduce massive detriments to health system.

Identifying Etiologic Agents in Acute Diarrhea in Children. Therapy with Antibiotics or Probiotics?

In infants and toddlers, acute diarrhea is the most common gastrointestinal disorder. Recent literature has shown that viruses are the most common cause and of these, Rotavirus is a major causative agent of diarrhea in children under five years old, representing a major cause of mortality in this age. Since there is no etiologic treatment for viral diseases, hydro-electrolytic rebalancing is the standard therapy and vaccination is the most effective way to prevent these diseases. The study is a retrospective one and aims at establishing the etiology and correlation with origin environment (urban or rural) of children with acute diarrhea in Sibiu area. The study included 3135 children aged 1 month - 18 years old, admitted to the Pediatric Clinic, Sibiu, between January 1, 2014 - December 31, 2016. Laboratory tests were used to determine viral and /or bacterial etiology of acute diarrhea. Viral etiology was the most common, being confirmed in 34.1% of cases, and the bacterial one was confirmed in 10.8% of cases, of which the most frequent etiological agent involved was Campylobacter jejuni (40.0%). The most frequent aetiology of acute diarrhea in children in the Sibiu area are the viral infections, Rotavirus being the first, and of bacterial aetiology, rare in frequency, Campylobacter jejuni is the leader followed by Salmonella spp., and Shigella spp. Children in urban areas were more frequently affected by acute diarrhea than those in rural areas, unlike data from the literature.

Microbial pathogens associated with acute childhood diarrhoea in Kumasi, Ghana

BackgroundDiarrhoeal diseases are among the most frequent causes of morbidity and mortality in children worldwide, especially in sub-Saharan Africa. This case–control study was conducted to investigate the bacterial, viral and parasitic pathogens associated with acute diarrhoea among children attending three health facilities in Kumasi, Ghana.MethodsStool specimens were collected from 240 children under 5 years of age visiting hospitals in Kumasi, Ghana due to acute diarrhoea and from 107 healthy controls of similar age. Both intestinal and malaria parasites were diagnosed by microscopy whereas rota- and adenoviruses were identified by stool antigen immunochromatograhic testing. Bacterial enteropathogens were detected by conventional culture techniques.ResultsOf all subjects, 23 (6.6%) were positive for malaria parasitaemia, 139 (40.1%) had at least one bacterial agent in their stool and 25 (7.2%) had ova or parasites. Subjects infected with malaria had the highest odds of having diarrhoea [12.0 (95% CI 1.56, 92.35)] followed by those with rotaviruses [4.4 (95% CI 2.05, 9.47)] and bacterial infection [4.99 (95% CI 1.45, 17.17)].ConclusionIn conclusion, this study was unique as it looked at the three groups of pathogens (parasites, viruses and bacteria) that cause acute diarrhoea in children in the Kumasi metropolis of Ghana. This study has shown for the first time since 2004 that malaria parasitaemia, rotavirus and bacterial infections still remain common pathogens associated with acute childhood diarrhoea in the Kumasi metropolis of Ghana.

The cost utility and budget impact of adjuvant racecadotril for acute diarrhea in children in Thailand.

ObjectiveTo evaluate the cost utility and the budget impact of adjuvant racecadotril for the treatment of acute diarrhea in children in Thailand.MethodsA cost utility model has been adapted to the context of Thailand to evaluate racecadotril plus oral rehydration solution (R+ORS) versus oral rehydration solution (ORS) alone for acute diarrhea in children <5 years old. The decision tree Excel model evaluates the costs and effects (quality-adjusted life years) over a 6-day time horizon from a public health care payer’s perspective in Thailand. Deterministic sensitivity analysis and budget impact analysis have been undertaken.ResultsAccording to the cost utility model, the intervention (R+ORS) is less costly and more effective than the comparator (ORS) for the base case with a dominant incremental cost-effectiveness ratio of −2,481,390฿ for the intervention. According to the budget impact analysis (assuming an increase of 5% market share for R+ORS over 5 years), the year-on-year reduction for diarrhea as a percentage of the total health care expenditure is −0.0027%, resulting in potential net cost savings of −35,632,482฿ over 5 years.ConclusionSubject to the assumptions and limitations of the models, adjuvant racecadotril versus ORS alone is potentially cost-effective for children in Thailand and uptake could translate into savings for the Thailand public health care system.

Prevalence and antimicrobial susceptibility of Salmonella and Shigella spp. among children with gastroenteritis in an Iranian referral hospital.

Gastroenteritis is one of the leading cause of illnesses through the world, especially in developing countries.Salmonella and Shigella infections are considered as the main public health problems in children. The aim of this study was to detect the prevalence and antimicrobial susceptibility of Salmonella and Shigella spp. among children with gastroenteritis in an Iranian referral hospital. During April 2013 to April 2014, all medical records of children with gastroenteritis admitted to a pediatric medical center were evaluated. Positive stool cultures of children were evaluated and frequency of Salmonella and Shigella spp. and their antimicrobial susceptibility were detected. In this study, 676 patients with the mean age of 24.94 months were enrolled. Eighty-eight (42%) Salmonella spp., 85 (40%) Shigella spp., 33 (16%) E.coli and 5(2%) candida albicans were isolated from 211 positive stool cultures. Among 85 Shigella spp. isolates, S.sonnei, S. flexneri and other Shigella spp. were isolated from 39 (46%) isolates, 36(42%) and 10(12%), respectively. Among 88 isolated Salmonella spp., 36 (41%) isolates were Salmonella Serogroup D, 26 (30%) were Salmonella Serogroup B, 20 (23%) isolates were Salmonella Serogroup C and 6 (7%) were other Salmonella spp. isolates. Thirty-eight percent of Salmonella serogroup B were resistant to nalidixic acid, while higher frequency of nalidixic acid resistant was found in Salmonella serogroup C and Salmonella serogroup D. The higher frequency of ampicillin resistant was found in Shigella spp. than Salmonella spp. High frequency of cefotaxime resistant was seen in S.sonei and S.flexneri (77% and 56%, respectively), whereas more than 90% of Salmonella serogroup B, C and D were susceptible to this antibiotic. In conclusion, Shigella and Salmonella serogroups can be considered as important etiological agents of acute diarrhea in children. Since the prevalence of antibiotic resistance is increasing in recent years in Iran, further studies on the prevalence, antimicrobial susceptibility pattern and mechanisms of antibiotic resistance in these species is highly recommended.

Evaluation of Gelatin Tannate Against Symptoms of Acute Diarrhea in Pediatric Patients

BackgroundAcute diarrhea is the second most common cause of morbidity and mortality worldwide, especially in children aged ≤3 years. Some drugs (e.g., the mucoprotector gelatin tannate) plus a reduced osmolality oral rehydration solution (ORS) may effectively reduce symptom duration and severity. The current trial was therefore designed to assess the efficacy and safety of gelatin tannate in pediatric patients with acute diarrhea.Material/MethodsThis was a randomized, controlled, double-blind, parallel-group, single-center study comparing gelatin tannate plus ORS (103 patients) with ORS plus placebo (100 patients) in children aged 3 months to 12 years with infectious or noninfectious acute diarrhea. Details about stool consistency and total time to resolution of diarrhea comprised the primary study endpoints. Secondary study endpoints included symptoms of diarrhea at 12, 24, 36, 48, and 72 hours after the first dose of study medication.ResultsFrom 12 hours onwards, the incidence of watery stools was significantly lower in the gelatin tannate group than in the ORS group (at 12 hours: 59.2% vs. 77.0%; p=0.01). The same was true for stool frequency (at 12 hours: mean 2 vs. 3 stool productions in the previous 12 hours; p<0.01). At all timepoints during the study, the proportion of patients with Stool Decrease Index improvement was significantly greater (p<0.01) in the gelatin tannate group than in the placebo group (at 12 hours: 66.6% vs. 33.3%; p<0.01).ConclusionsGelatin tannate plus ORS is an effective and safe option for the treatment of acute diarrhea in children. Significant symptom relief is evident 12 hours after starting treatment.

Efficacy of Probiotic Saccharomyces boulardii as an Adjuvant Therapy in Acute Childhood Diarrhoea

Introduction: Administration of S. boulardii in addition to rehydration therapy in diarrhea found to be beneficial in many aspects owing to a variety of causes and importantly it is was not associated with any adverse effects.Material and Methods: We conducted a prospective study of children suffering from acute diarrhoea, at a private tertiary care hospital. Children were divided into 2 groups randomly as per odd(Group 1 ) and even (Group 2) bed allotted in indoor at the time of admission: Group 1 included children on oral rehydration therapy (ORT) + Zinc + Saccharomyces boulardii (Probiotic 5 billion CFU twice daily) and Group 2 comprised of children on ORT+ Zinc. Our objective was to systematically review data on the effect of S. boulardii on acute childhood diarrhoea.Results: Out of a total of 126 children less than 2 years, 2-6 years and 6-14 years were 72 (57.14%), 42(33.33%) and 12(09.52%) respectively. The duration of diarrhoea in Group 1 was 26.31 hours and Group 2 was 47.81 hours (p&lt;0.01). The frequency of diarrhoea showed improvement within 24 and 72 hours in Group 1 and Group 2 respectively (p&lt;0.01).Similarly, the mean duration of hospital stay was 2.68 days in Group 1 and 4.8 days in Group 2.The treatment cost was INR 850 and INR 1650 while social cost was INR 1250 and 2600 in Group 1 and 2 respectively.Conclusion:This study shows that S. boulardii reduced the duration, frequency and hospital stay of diarrhoea thereby reducing the treatment and social costs.J Nepal Paediatr Soc 2016;36(3):250-255

Multiple etiologies of infectious diarrhea and concurrent infections in a pediatric outpatient-based screening study in Odisha, India

BackgroundThere are multiple etiologies responsible for infectious gastroenteritis causing acute diarrhea which are often under diagnosed. Also acute diarrhea is one of the major causes of morbidity and mortality among children less than 5 years of age.MethodsIn our study, fecal samples (n = 130) were collected from children (<5 years) presenting with symptoms of acute diarrhea. Samples were screened for viral, bacterial, and parasitic etiologies. Rotavirus and Adenovirus were screened by immunochromatographic tests. Diarrheagenic Escherichia coli (EPEC, EHEC, STEC, EAEC, O157, O111), Shigella spp., Salmonella spp., Vibrio cholera, Cryptosporidium spp., and Giardia spp. were detected by gene-specific polymerase chain reaction.ResultsEscherichia coli was detected to be the major etiological agent (30.07%) followed by Rotavirus (26.15%), Shigella (23.84%), Adenovirus (4.61%), Cryptosporidium (3.07%), and Giardia (0.77%). Concurrent infections with two or more pathogens were observed in 44 of 130 (33.84%) cases with a predominant incidence particularly in <2-year-old children (65.90%) compared to children of 2–5 years age group (34.09%). An overall result showed significantly higher detection rates among children with diarrhea in both combinations of two as well as three infections concurrently (p = 0.004915 and 0.03917, respectively).ConclusionSuspecting possible multiple infectious etiologies and diagnosis of the right causative agent(s) can aid in a better pharmacological management of acute childhood diarrhea. It is hypothesized that in cases with concurrent infections the etiological agents might be complementing each other’s strategies of pathogenesis resulting in severe diarrhea that could be studied better in experimental infections.