Acute Diarrhea In Adults Research Articles

English

The concept of taking probiotic supplementation for better health and improving acute episodes of diarrhea has been well-known. Several studies have indicated that probiotic supplementation bring beneficial effects for patients with diarrhea. However, there is a striking lack of evidence on the supplementation of probiotic products in adult patients with acute diarrhea and prescribing probiotics for acute diarrhea has been underestimated. A prospective, double-blind, randomized, controlled clinical trial was conducted in adult patients who visited the study sites at three hospitals (Cipto Mangunkusumo, Koja and Tarakan Hospital) in Jakarta between 2007 and 2010. The subjects were divided into 2 groups, that is, the treatment group receiving Lactobacillusspp. product at the dose of 3 × 2 capsules for 7 days and the control group receiving placebo. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software program. The p value of < 0.05 was considered significant. The study demonstrated a significant result of faster recovery from diarrhea 1.02 ± 0.48 days sooner than the placebo group (p = 0.018). Greater improvement on clinical outcomes (frequency of stools, stool consistency, abdominal pain, nausea, vomiting, bloating, headache, fever and tenesmus) were observed in the group receivingLactobacillus spp. supplementation; however, the result was statistically significant on stool consistency only. Combined probiotic supplementation appears to be a promising therapeutic agent for treatment of acute diarrhea in adults. However, further controlled clinical studies as well as good storage, handling and distribution is essential to explore the therapeutic benefit for possible practical clinical application.   Key words: Lactobacillus rhamnosus, Lactobacillus acidophilus, probiotic supplementation, acute diarrhea, adults.

Management of acute diarrhea in adults in China: a cross-sectional survey

BackgroundThe aim of this study was to evaluate the management of acute adult diarrhea in China and assess adherence of clinical practice to national guidelines and 2012 World Gastroenterology Organization guidelines.MethodsA cross-sectional survey was carried out among physicians in 20 hospitals in two different areas of China (Beijing, 10; Shaanxi province, 10). Summary statistics were calculated for the overall study group and for each region. Between-region differences were assessed with χ2 or t-tests.ResultsData were collected for 800 patients (≥18 years; mean ± SD age 37.0 ± 16.3 years; 56.4% female). The mean ± SD time between diarrhea onset and visiting a diarrhea clinic was 2.4 ± 1.6 days; this interval was significantly shorter in Beijing than Shaanxi (2.0 ± 1.4 vs 2.8 ± 1.8 days, respectively; p < 0.001). Overall, 31.4% of patients self-medicated before visiting the clinic, most commonly with antibiotics. Routine stool examinations were ordered for 70.6% of patients, vibrio cholera stool culture for 57.5%, but non-vibrio bacteria stool culture for only 11.4%. Only 61.6% of patients received fluid and electrolyte therapy: 28.3% oral rehydration solution (ORS) and 33.4% intravenous fluids (even though only 13.8% needed). Antibiotics were the most common drugs (60.8%) and the most common antibiotics were fluoroquinolones, followed by aminoglycosides. Totally 51.3% of patients received irrational antibiotic treatment (unnecessary for 47.9%; indicated but not prescribed for 3.4%). After antibiotics, the most commonly prescribed drugs were dioctahedral smectite (59.3%); For Shaanxi compared with Beijing, less individuals received ORS (7.8% vs 48.5%,respectively; p < 0.001) and more received intravenous fluids (46.3% vs 20.5%, respectively; p < 0.001). Significantly more of the patients in Shaanxi province were administered antibiotics (64.5% vs 57%, respectively; p = 0.03), and more received intravenous antibiotics than Beijing (49.0% vs 27.0%, respectively; p < 0.001).ConclusionsAdherence to both national guidelines and 2012 World Gastroenterology Organization guidelines for the management of acute diarrhea in adult was limited among tertiary hospital physicians. The findings suggest nationwide education and effective health policies are needed to improve medical practice and reduce the unnecessary burden on the healthcare system.

Acute Diarrhea in Adults and Children

Acute Diarrhea in Adults and Children

Prolonged acute diarrhea in adults: Decades of observation from epidemiological perspective in urban Bangladesh

The study aimed to determine the epidemiological, clinical characteristics, and etiology of adults aged ≥20 years presented with prolonged acute diarrhea (≥7 days). A total of 18,210 adults aged ≥20 years were enrolled in the Diarrheal Disease Surveillance System of icddr,b between 1993-2012 and included into the analysis. Of these, 17,631 (97%) had duration of diarrhea ≤6 days, 418 (2%) diarrhea presented with a duration of 7 - 13 days and rest 161 (1%) had history of diarrhea ≥14 days. A higher proportion of adult individuals who had duration of diarrhea ≥14 days (70% vs. 56%; p male. At least 73% of all patients used oral rehydration solution; but proportion was lower among prolonged acute diarrhea groups. Use of antimicrobials was higher among those with duration 7 - 13 days (81%) and ≥14 days (81%). Diarrhea lasting ≥14 days, 47% were suffering from chronic energy deficiency and 30% had history of smoking. Individuals with diarrhea ≥7 days less frequently presented with vomiting, watery stool, frequency of stool >10 times/24 hours, drowsy or lethargy, fast breathing, some or severe dehydration, received intravenous saline for initial corrections of dehydration and stayed for longer duration in hospital (≥24 hours) but more often presented with abdominal pain. Stool microscopic examination showed less frequent presence of red blood cells (36% vs. 44%; p = 0.043) and fecal leucocytes (50% vs. 59%; p = 0.029) among individuals with diarrhea ≥14 days compared to those with ≤6 days. None was infected with Vibrio cholerae (≥14 days) (3% for 7 - 13 days); however, isolation rate of Aeromonas was higher among adults with duration for ≥14 days (11%). Only 15% with ≥14 days were positive for Shigella contrary to 19% (7 - 13 days) and 56% (≤6 days). Differences in sociodemographic, clinical presentation and etiology varied with duration of diarrhea among adults.

Gelatine Tannate for the Treatment of Acute Diarrhoea in Adults

Gelatine tannate has been recently licensed as a medical device for the treatment of acute diarrhoea. Gelatine tannate is thought to act locally on the gut wall by forming a protective protein-based film and allowing the precipitation of pro-inflammatory mucoproteins from the intestinal mucus responsible for local inflammation, and subsequently eliminated through the faeces. In order to assess safety and efficacy of gelatine tannate, one randomised, parallel, double-blinded and placebo-controlled study was conducted by general practitioners in 40 adult patients diagnosed with acute diarrhoea (test formulation: capsules containing 500 mg of gelatine tannate). Safety was evaluated by monitoring adverse events (frequency, intensity and relation of adverse events to the administered treatments), laboratory parameters and vital signs between the pre- and post-study visits (primary study endpoints). Efficacy was evaluated in terms of mean decrease of both the daily frequency of watery stools (Stool Decrease Index, SDI) and the severity of the abdominal pain assessed using a 100-mm visual analogue scale (Pain Decrease Index, PDI). Statistical analyses were performed according to the principles of intention-to-treat and perprotocol. Gelatine tannate showed a good safety profile. No adverse events were reported in either active treatment or placebo arms. Gelatine tannate was significantly more effective than placebo (p < 0.01). In fact, adult patients treated with gelatine tannate had significantly less watery stools and less abdominal pain compared to patients treated with placebo. Gelatine tannate is an effective and safe treatment for acute diarrhoea in adults. The introduction of a viable treatment option based on a mechanical action could be an alternative to existing drugs for the treatment of acute diarrhoea. In fact, gelatine tannate is not absorbed systemically and acts locally to produce its effects on the gut wall, and thus may provide greater safety and tolerability compared to existing drug therapies.

Empiric antimicrobial therapy and infectious diarrhea. Do we need local guidelines?

Background In the management of acute diarrhea, administration of antibiotics may be indicated. Appropriate antimicrobial therapy can shorten illness, reduce morbidity and can be life-saving in invasive infections. Emergence of microbial strains resistant to commonly used antibiotics means that treatment failures may become common. Because of changing patterns of resistance, knowledge of recent local patterns of susceptibility can guide the initial choice of antibiotics. Methods A retrospective study was conducted to investigate the epidemiology of infective gastroenteritis in patients over 14 years old in the region of Chania (Crete). We reviewed all positive stool cultures and susceptibilities of the pathogens recovered from patients with symptoms of acute diarrhea, from 2003 until October 2010. Results Out of 194 positive stool cultures, we observed 139 cases of Salmonella enterica and 48 cases of Campylobacter jejuni. During the last 3 years of observation there was an increased incidence of C. jejuni, especially after the tap water outbreak that occurred in our region in 2009. Discussion In the vast majority of acute diarrhea in adults, antibiotics are of no benefit and overprescription may confer to side effects, costs and emergence of resistance. Antibiotics are initiated in cases of febrile diarrheas especially those believed to have moderate to severe disease. Considering the increased incidence of C. jejuni and the resistance of the great majority of isolated strains to quinolones as well as the sensitivity of Salmonella spp. to azithromycin, administration of azithromycin empirically for acute diarrhea, when indicated, could be appropriate in our region.

Community pharmacy management of acute diarrhoea in adults

Abstract Objective To study the community pharmacy management of acute diarrhoea in adults and to explore the attitudes and beliefs of community pharmacists towards the management of this common condition. Method Data were collected over a four-week period on the incidence and presentation of acute diarrhoea in adults by pharmacy staff in 17 pharmacies who were participating in a community pharmacy research panel. A postal survey on attitudes and beliefs about the treatment of diarrhoea was sent to a random sample of 2,500 community pharmacists. Key findings A total of 1,401 community pharmacists responded to the survey (response rate 59 per cent). Their responses suggested ambiguity in the treatment of acute diarrhoea in community pharmacy, particularly in relation to attitudes to oral rehydration and anti-motility drugs. Although the majority of pharmacists surveyed were aware of recommendations to treat adult patients with acute diarrhoea with oral rehydration, in practice many stated that they often sold an anti-motility treatment, a finding borne out by the high percentage of anti-motility sales (61 per cent) in the earlier part of the study. The decision to sell or recommend an anti-motility drug was often motivated by the patient's circumstances and their need for immediate symptomatic relief. Conclusion This study suggests that the community pharmacy management of acute diarrhoea is characterised by ambiguity and pragmatism. Existing guidelines for the treatment of diarrhoea fail to take into account the social context in which pharmacists operate, particularly in relation to patient demand and the need for symptom relief.

Loperamide in adult acute diarrhea

Introduction: Decrease in duration of diarrhea significantly reduces morbidity, loss of working days, hospital bed occupancy and use of hospital resources. Loperamide is an established treatment of acute diarrhea to decrease the duration and frequency of unformed stool with only rare adverse reactions.&#x0D; Methods: This is a descriptive, cross sectional, parallel group, single centre study done in odd and even days of the month for treatment and control group. The study was conducted from 1st to 30th September 2010 in Patan Hospital Emergency Department.&#x0D; Results: Out of 104 patients, 43 patients were included in Loperamide group and 63 patients were taken in supportive treatment group. Mean duration of diarrhea was 16.3 and 41.9 hours in supportive plus Loperamide group and supportive treatment only group respectively. Mean difference in duration of diarrhea was 25.6 hours 95% CI (23.9 to 27.3) (P&lt;0.05). Similarly mean working day loss was 1.19 in group treated with Loperamide and 2.84 days in group not treated with Loperamide. Mean difference was 1.65 days CI 95% (1.45 to1.85) (P&lt;0.05). Absolute risk of complication in Loperamide group was 6.6%&#x0D; Conclusion: Loperamide significantly reduces duration of diarrhea and working days lost with low rate of complications in Adult with acute non infective diarrhea.

Clinical Trial on the Efficacy of a New Symbiotic Formulation, Flortec, in Patients With Acute Diarrhea

Few randomized studies have been carried out on adult patients affected by acute diarrhea especially in primary care, which is the natural context for this kind of disorder. Lactobacillus paracasei B 21060 is a novel strain of lactobacillus, which has been shown to be effective in relieving symptoms associated with diarrhea of irritable bowel syndrome subtype and in shortening diarrhea duration. In this study, we compared the therapeutic efficacy, safety, and tolerability of a new symbiotic formulation, Flortec, containing L. paracasei B-21060, with lactobacillus GG (FlorVis GG) in the treatment of acute presumed infectious diarrhea. Fourteen general practitioners working in the Perugia health authority district carried out a randomized controlled, parallel-group, open trial in 174 adult patients suffering from acute diarrhea (87 enrolled in the Flortec group and 87 in the FlorVis group). Both the products were administered according to their standard recommended dosage. The main efficacy criterion was the duration of diarrhea after beginning treatment. Treatment duration was 10 days. Enrolled patients kept a careful track of their symptoms noting them in a personal diary for 12 days. The 2 groups resulted to be homogeneous at baseline with regard to prognostic variables. The mean duration of diarrhea from the start of treatment in the Flortec group was 4.24 (2.73 SD) days versus 5.09 (3.72 SD) days in the FlorVis group (P=0.09).Clinical success rates in terms of absence of abdominal pain and absence of diarrhea (defined as <2 bowel movements of watery or loose stool consistency) recorded at different time-points were statistically superior in the Flortec group (Kaplan-Meyer P=0.05 for both the symptoms). The physician judged that overall efficacy was good or very good in 91.8% of the patients in the Flortec group. The corresponding value in the FlorVis group was 83.7% (P=0.003). The 2 treatments showed a very good tolerability profile, with negligible and similar adverse event rates and similar concomitant medication usage rates. Oral therapy with Flortec proved to be more effective than FlorVis GG in the treatment of acute diarrhea in adults treated at a primary care setting.

W1044 Racecadotril 175 Mg Tablet Bid Is More Efficient Than Racecadotril 100mg Capsule tid in the Treatment of Acute Diarrhea in Adults

W1044 Racecadotril 175 Mg Tablet Bid Is More Efficient Than Racecadotril 100mg Capsule tid in the Treatment of Acute Diarrhea in Adults

Detection and Characterization of Human Caliciviruses Associated with Sporadic Acute Diarrhea in Adults in Djibouti (Horn of Africa)

Recent advances in molecular diagnostics have allowed us to recognize Human caliciviruses (HuCVs) as important agents of acute diarrhea in industrialized countries. Their prevalence and genetic diversity in developing countries remains unknown. We report on the characterization of HuCVs among adults presenting acute diarrheas in Djibouti; 108 stool samples collected were screened by EIA, RTPCR, or cell cultures for the group A Rotaviruses, Adenoviruses, Astroviruses, and HuCVs, which were further characterized by genotyping. Among stool samples screened for HuCVs, 25.3% were positive. The other enteric viruses were less prevalent. The 11 HuCV strains sequenced revealed a large diversity (3 sapoviruses and 8 noroviruses). GII strains noroviruses were predominant, five were newly described genotypes, and two were recombinant with a pol gene related to GGIIb strains with the particularity to associate a unique pol gene to different capsid genes. These results could help to the knowledge of HuCV infections in Tropical Africa.

Treatment of Acute Diarrhoea in Adults with Dioctahedral Smectite (Smecta): A Prospective Randomised Study

BackgroundAcute diarrhoea is a common presenting problem to the accident and emergency department. This study aimed to assess the efficacy of dioctahedral smectite (Smecta) in altering the duration and frequency of acute diarrhoea in the adult population in Hong Kong.Material and methodsThis was a prospective, randomised controlled study carried out in the Accident and Emergency Department of Caritas Medical Centre from July 2005 to October 2005. One hundred and ninety eligible adult patients with acute diarrhoea lasting not more than 14 days were randomly assigned either (1) oral rehydration solution (ORS) one sachet three times daily and Smecta one sachet three times daily for two days; or (2) ORS one sachet three times daily for two days. The duration of diarrhoea, daily frequency of diarrhoea, presence of vomiting and fever following treatment were obtained by telephone interviews and mailed questionnaires.ResultsFor patients treated with or without Smecta, there was no statistically significant difference in the mean duration and daily frequency of diarrhoea in the first three days.ConclusionThe use of Smecta did not change the duration or frequency of acute diarrhoea in the adults in this study.

Recommendations for Probiotic Use

Probiotics are live microbial organisms that are administrated as supplements or in foods to benefit the host. It is the recommendation that they may be helpful in the prevention and treatment of acute diarrhea in adults and children, the prevention of antibiotic-associated diarrhea in adults and children, and the maintenance of remission and prevention of pouchitis. Although early results indicate that probiotics may also be useful in immunologic modulation to prevent atopy, treatment of radiation intestinal disease, vaginosis, ulcerative colitis, and the irritable bowel syndrome, the studies available are not sufficient to say they are definitely helpful. Even fewer data are available to recommend probiotics for the treatment of H pylori and Crohn disease and for the prevention of cardiovascular risk factors or other degenerative diseases. Clearly, larger and better-designed studies of probiotics are necessary, including comparative and dose-ranging trials.

Environmental temperature, cholera, and acute diarrhoea in adults in Lima, Peru.

The effects of environmental temperature, presence and severity of El Niño, presence of cholera in the community, and interactions among these variables on the number of adult diarrhoeal patients attending the Hospital Nacional Cayetano Heredia in Lima, Peru, during 1991-1998, were evaluated. During 1991-1996, an increased number of visits to the hospital due to acute diarrhoea in the warmer months was observed. This periodic pattern was altered in 1997, when rising of the environmental temperature was observed in Lima secondarily associated with a strong El Niño event. A multivariate model was built in which environmental temperature and interaction between environmental temperature and presence of cholera predicted the number of adult patients with acute diarrhoea attending the Hospital Nacional Cayetano Heredia. Monitoring of environmental temperature and presence of cholera may be used as a warning system to predict epidemics of diarrhoea in adults, which may have a tremendous impact on healthcare strategies and management of health services in general.

Etiology of acute diarrhea in adults in southwestern Nigeria.

Stool specimens from 113 adult outpatients with diarrhea in southwestern Nigeria and 63 controls were examined for bacterial and parasitic enteric pathogens. Enterohemorrhagic Escherichia coli (EHEC) (P < 0.02), enteroaggregative E. coli (EAEC) (P < 0.02), and Entamoeba histolytica (P < 0.0002) were significantly associated with diarrhea. Salmonella, Shigella, nontoxigenic Vibrio cholerae, other categories of diarrheagenic E. coli, as well as a variety of helminths were recovered more frequently from the stools of patients than from the stools of controls but did not show a significant association with disease. Multiple pathogens were recovered from 36.3% of specimens, and bloody diarrhea was commonly associated with E. histolytica and diarrheagenic E. coli infections. The majority of EHEC isolates were non-O157 strains that carried the stx(2) gene. Of the 23 EHEC-infected patients, 12 (52.2%) presented during the 10th week of the study. EHEC strains isolated within this cluster were more likely to hybridize with the enterohemolysin gene probe, to be nonmotile and sorbitol positive, and to fail to agglutinate O157 antisera. Pulsed-field gel electrophoresis demonstrated that the only strains with XbaI profiles that occurred more than once were isolated during the 10th and 11th weeks of the study, suggesting an outbreak. The study has demonstrated that E. histolytica, EHEC, and EAEC are important diarrheal pathogens within the study area and that sporadic and epidemic EHEC infections occur in developing as well as developed countries. Routine surveillance for diarrheagenic E. coli, even only at the tertiary-care level, would be useful in identifying outbreaks and assist in identifying environmental reservoirs and transmission routes.

Probiotics: "living drugs".

The uses, mechanisms of action, and safety of probiotics are discussed. Probiotics are live microorganisms or microbial mixtures administered to improve the patient's microbial balance, particularly the environment of the gastrointestinal tract and the vagina. The yeast Saccharomyces boulardii and the bacterium Lactobacillus rhamnosus, strain GG, have shown efficacy in clinical trials for the prevention of antimicrobial-associated diarrhea. Other probiotics that have demonstrated at least some promise as prophylaxis for this type of diarrhea are Lactobacillus acidophilus, Bifidobacterium longum, and Enterococcus faecium. The use of S. boulardii as an adjunctive treatment to therapy with metronidazole or vancomycin has been found in controlled studies to decrease further recurrences of Clostridium difficile-associated disease. Other gastrointestinal disorders for which probiotics have been studied include traveler's diarrhea, acute infantile diarrhea, and acute diarrhea in adults. Several Lactobacillus species given in yogurt or in tablet or suppository form have shown clinical efficacy as a treatment for vaginal infections. Lactobacillus strains have also been examined as a treatment for urinary-tract infections. Putative mechanisms of action of probiotics include production of pathogen-inhibitory substances, inhibition of pathogen attachment, inhibition of the action of microbial toxins, stimulation of immunoglobulin A, and trophic effects on intestinal mucosa. The available probiotics are considered nonpathogenic, but even benign microorganisms can be infective when a patient is severely debilitated or immunosuppressed. Probiotics have demonstrated an ability to prevent and treat some infections. Effective use of probiotics could decrease patients' exposure to antimicrobials. Additional controlled studies are needed to clearly define the safety and efficacy of these agents.

Surveillance of bacterial pathogens associated with acute diarrhea in Lima, Peru

Objectives: A study was conducted in Lima, Peru, from January to April 1995, to determine the bacterial pathogens associated with acute diarrhea in adults, their susceptibility to common antimicrobials, the risk factors involved in cholera transmission, and the best clinical predictors of cholera. Methods: A random sample of adult patients with acute diarrhea was studied. Epidemiologic and clinical data and risk factors to acquire diarrheal diseases were evaluated. Identification of bacteria and susceptibility to antimicrobials were determined. Results: The study included 336 patients. Vibrio cholerae 01 (52.7%), Shigella spp. (4.8%), and Salmonella spp (2.7%) were the pathogens most commonly isolated. No resistance to antimicrobials was observed. Patients with cholera had less access to municipal water (P = 0.0018) and were less likely to have homes connected to a sewage system (P = 0.0003) or to have indoor toilet facilities (P = 0.0001) than those without cholera. Liquid tools (odds ratio [OR] = 16.51; confidence interval [CI] = 13.71 – 19.02; P = 0.003), severe dehydration (OR = 2.48; CI = 1.57 – 3.38; P = 0.0083), generalized cramps (OR = 4.63; CI = 3.10 – 6.17, P < 0.0001), and washerwoman's hands (OR = 2.45; CI = 1.55 – 3.34; P = 0.017) were the best clinical predictors of cholera in this setting. Conclusions: Cholera is still prevalent in Lima, and people living in environments with low sanitary conditions are especially at risk. Clinical signs of severe dehydration and liquid stools were the best predictors of cholera.

Guidelines for management of acute diarrhoea in adults

Guidelines for management of acute diarrhoea in adults

Guidelines for management of acute diarrhoea in adults

Guidelines for management of acute diarrhoea in adults

81 EFFICACY AND TOLERANCE OF ACETORPHAN IN INFANT ACUTE DIARRHEA. A MULTICENTRIC DOUBLE BLIND STUDY.

Acetorphan A is an enkephalinase inhibitor efficient in adult acute diarrhea via a purely instestinal antisecretory mechanism without associated antitransit effect. The efficacy of A (1.5 mg/kg TID) versus placebo P was compared in 172 infants (1.6 mths - 3.6 yrs; mean 13 mths) with severe acute diarrhea < 3 days. Other treatments were excluded except oral rehydratation solution ORS ad libitum, normal feeding for age and paracetamol (60 mg/kg/d) in case of fever. IV rehydrated patients (IRP) were included at the end of IR if they responded to the inclusion criteria. Data were analyzed by Student t test or non parametric Wilcoxon test. There was no difference between A and P groups for age, duration of diarrhea, number of stools, IRP,% of dehydrated infants, viral or bacterial infection before inclusion. A highly significant difference was observed in group A compared to P on stool output (g/kg) during the first 24 and 48h of treatment (20 ± 3.3 A vs 45 ± 6.2 P, p = 0.004; 25 ± 3.8 A vs 76 ± 11 P, p = 0.002) the difference was even higher between groups A and P with rotavirus (46% of acute diarrhea) regarding stool output (27 ± 7 A vs 102 ± 18 P at 48h, p = 0.001). A significative difference was also observed in duration of liquid stool (6.9 h A vs 36 h P, p = 0.02) and treatment duration (35 ± 4.3 h A vs 49 ± 4.6 h P, p = 0.02). Suspicion of intolerance (mild symptoms) was found with the same frequency in A and P groups (10.1% A vs 10.9% P). This study demonstrates for the first time the efficacy and safety of Acetorphan as an adjuvant therapy to ORS in the treatment of severe acute diarrhea in infants.