Acute Watery Diarrhoea In Children Research Articles

Досвід застосування пробіотика Bacillus clausii UBBC-07 при гострій водянистій діареї в дітей раннього віку в умовах стаціонарного відділення

Acute watery diarrhea in children remains an urgent problem in pediatrics due to its high prevalence and high mortality rates at an early age. Modern treatment protocols provide for a comprehensive approach to the treatment of patients. However, the main method of treatment of diarrhea - oral rehydration, does not allow for the stoppage of the progression of gastroenteritis, of the elimination of the imbalance of microflora and intestinal dysfunction. Such tasks can be solved thanks to the use of probiotics, which are recommended as a component of auxiliary therapy for children with acute infectious diarrhea. Purpose - to conduct a comprehensive clinical and epidemiological analysis of the results of the use of the spore-forming probiotic Bacillus clausii (B. clausii) strain UBBC-07 (Lactiale Germina) in the complex treatment of hospitalized young children with acute infectious watery diarrhea syndrome. Materials and methods. 85 children with acute infectious non-inflammatory diarrhea were comprehensively examined. 2 clinical groups were formed. The Group I - 50 hospitalized children (average age 3.1±0.4 years, the proportion of boys - 64.0%), who received 1 bottle of Lactiale Germina 1 time/day in complex treatment (5 ml=2×109 CFU B. clausii endospores). The Group II included 35 patients (average age 2.4±0.4 years (p>0.05), the share of boys - 54.3% (p>0.05)); who received standard treatment according to existing standards. According to the main clinical characteristics, the comparison groups can be considered comparable. Results. The analysis of the conducted studies established that the use of Lactial Germin increased the chances of a three-fold reduction in the frequency of bowel movements on the 4th day (absolute risk increase (ARI) - 27.0%, relative risk increase (RRI) - 34.6 (95% CI: 25.4-44.8) with the minimum number of patients who need to be treated to obtain a positive result (MNP) - 2.9 (95% CI: 0.5-8.6), led to the absence of the symptom of vomiting already for the 3rd day of inpatient treatment (ARI - 9.0%, RRI - 37.5 (95% CI: 28.0-47.7) with MNP - 2.7 (95% CI: 0.4-8.1), increased the chances of a lower need for long-term (≥3 days) parenteral rehydration (ARI - 12.9%, RRI - 13.7% (95% CI: 7.6-22.1) with MNP - 7.3 (95% CI: 2.9-14.3) and reduced the risk of needing to use antidiarrheal agents (relative risk - 3.2 (95% CI: 2.6-3.9) with an odds ratio - 7.1 (95% CI: 3,4-14,7)). Conclusions. Food supplement Lactiale Germina (probiotic strain B. clausii strain UBBC-07) in the complex treatment of children with acute watery diarrhea is effective and safe with good tolerability and rapid rates of clinical recovery. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Adjunctive efficacy of Lactis XLTG11 for Acute diarrhea in children: A randomized, blinded, placebo-controlled study

ObjectiveThe aim of this study was to assess the efficacy and safety of Bifidobacterium animalis sp. Lactis XLTG11, as an adjunctive treatment for acute watery diarrhea in children, using a randomized, double-blinded, placebo-controlled study design. MethodEligible children with diarrhea were randomly assigned into one of two groups: an intervention group (IG, n = 35), which received conventional treatment plus the probiotic, and a control group (CG, n = 35), which received only conventional treatment. Fecal samples were collected from all children before and after the intervention to measure biochemical indices and analyze gut microbiome (GM) composition. ResultThe duration of diarrhea (121.3 ± 11.5 h) and hospital length of stay (3.4 ± 1.1 d) in the IG were significantly shorter than those in the CG (133.4 ± 14.1 h and 4 ± 1.3 d, respectively; P < 0.001 and P = 0.041, respectively). A higher percentage of children in the IG showed improvements compared with the CG (57.1% versus 25.7%, P < 0.001). The calprotectin level in the IG was significantly lower than that in the CG after the intervention (928.91 ± 158.90 ng/g versus 1029.86 ± 133.25 ng/g, P = 0.028). XLTG11 administration led to a higher abundance of species B. longum and < breve, increased α-diversity of the GM (P < 0.05), and upregulated the functional genes of the GM related to immunity and nutrient absorption. ConclusionsAdministration of XLTG11 at a dose of 1 × 1010 CFU/d was effective in reducing the duration of diarrhea, inducing beneficial changes in GM composition and gene functions.

Compare the Effect of Zinc–Probiotic versus Zinc Therapy in Acute Watery Diarrhea in Children

Background: Acute watery diarrhea still remains a major health problem among under 5 children worldwide. Apart from oral rehydration solution, continued feeding and oral zinc therapy the administration of adequate amounts of probiotics seems beneficial for acute diarrheal episodes in children in the developing world. Objective: To compare the efficacy of zinc-probiotic combination therapy versus zinc-only therapy in children with acute watery diarrhea. Materials and Methods: This was a hospital based randomized controlled clinical trial (RCT) conducted from July 2019 to June 2021 in the Department of Pediatrics, Khwaja Yunus Ali Medical College &amp; Hospital. Total 70 children aged 6 months to 5 years admitted in hospital with acute watery diarrhea (AWD) with severe dehydration or some dehydration with intractable vomiting were included in this study. Patients were equally divided into 2 groups. Group A received oral zinc sulfate 20 mg/day for 10 days combined with oral Bacillus clausii probiotic 4million spores/day for 5 days. Group B received only oral zinc sulfate at the same dosage as group A. We also studied the relationship between mother`s education, knowledge of ORS preparation and child’s feeding practices and nutritional status with the occurrence of diarrhea in children. Results: Frequency of diarrhoea was significantly higher in group B (Zinc only) in comparison to group A (Zinc and probiotic). Mean frequency of diarrhea, Mean duration of diarrhea and Mean length of hospital stay was significantly higher in group B (Zinc) than group A (Zinc+Probiotic). Conclusion: Compared to oral Zinc therapy only; the combination of oral zinc and probiotic therapy is clinically more effective in reducing the frequency of acute watery diarrhea in under 5 years children. KYAMC Journal Vol. 13, No. 04, January 2023: 218-222

Review of Escherichia coli O157:H7 Prevalence, Pathogenicity, Heavy Metal and Antimicrobial Resistance, African Perspective.

Escherichia coli O157:H7 is an important food-borne and water-borne pathogen that causes hemorrhagic colitis and the hemolytic-uremic syndrome in humans and may cause serious morbidity and large outbreaks worldwide. People with bloody diarrhea have an increased risk of developing serious complications such as acute renal failure and neurological damage. The hemolytic-uremic syndrome (HUS) is a serious condition, and up to 50% of HUS patients can develop long-term renal dysfunction or blood pressure-related complications. Children aged two to six years have an increased risk of developing HUS. Clinical enteropathogenic Escherichia coli (EPEC) infections show fever, vomiting, and diarrhea. The EPEC reservoir is unknown but is suggested to be an asymptomatic or symptomatic child or an asymptomatic adult carrier. Spreading is often through the fecal-oral route. The prevalence of EPEC in infants is low, and EPEC is highly contagious in children. EPEC disease in children tends to be clinically more severe than other diarrheal infections. Some children experience persistent diarrhea that lasts for more than 14 days. Enterotoxigenic Escherichia coli (ETEC) strains are a compelling cause of the problem of diarrheal disease. ETEC strains are a global concern as the bacteria are the leading cause of acute watery diarrhea in children and the leading cause of traveler’s diarrhea. It is contagious to children and can cause chronic diarrhea that can affect the development and well-being of children. Infections with diarrheagenic E. coli are more common in African countries. Antimicrobial agents should be avoided in the acute phase of the disease since studies showed that antimicrobial agents may increase the risk of HUS in children. The South African National Veterinary Surveillance and Monitoring Programme for Resistance to Antimicrobial Drugs has reported increased antimicrobial resistance in E. coli. Pathogenic bacterial strains have developed resistance to a variety of antimicrobial agents due to antimicrobial misuse. The induced heavy metal tolerance may also enhance antimicrobial resistance. The prevalence of antimicrobial resistance depends on the type of the antimicrobial agent, bacterial strain, dose, time, and mode of administration. Developing countries are severely affected by increased resistance to antimicrobial agents due to poverty, lack of proper hygiene, and clean water, which can lead to bacterial infections with limited treatment options due to resistance.

Prevalence of rotavirus isolates in the stools of under-5 children presenting with diarrhoea at University Maiduguri Teaching Hospital, Borno State.

Diarrhoea is a major cause of childhood morbidity and mortality in developing countries including Nigeria. Rotavirus is a leading cause of acute watery diarrhoea in children under 5 years of age. The aim of the study is to determine the prevalence of rotavirus diarrhoea in children less than 5 years old presenting with watery diarrhoea at the University of Maiduguri Teaching Hospital. The cross-sectional study was carried out at University of Maiduguri Teaching Hospital (UMTH), a referral tertiary centre for northeast Nigeria and neighbouring Cameroon, Chad, and Niger Republic. Study population were children under five presenting to UMTH with acute diarrhoea. Freshly passed stool was collected from each participant in a universal sterile container and transported to the department of medical microbiology laboratory UMTH, Rotavirus antigen was detected using Rota - dipstick an immunochromatographic test. The positive samples were subjected to RT-PCR to detect the VP 7 gene of the dsRNA. SPSS Version 25. The prevalence was found to be 14.5% in the population studied and was highest among children below 1 year of age. This study has confirmed that rotavirus is an important cause of childhood diarrhoea. The burden of childhood diarrhoea can be reduced by introduction of vaccines, and children of 1 year old and younger will benefit from this vaccine as most study participants have not been vaccinated. Creating awareness on prevention and control of this infection with mass vaccination will go a long way in reducing the prevalence and mortality rate of rotavirus diarrhoea.

The risk factors associated with rotavirus gastroenteritis among children under five years at university of maiduguri teaching hospital, Borno State, Nigeria

Background: Diarrhea is a major cause of childhood morbidity and mortality in both developing and developed countries. It remains a common cause of hospitalization worldwide. Rotavirus is a cause of acute watery diarrhea in children under five years of age. The incidence of diarrhea decreases with increasing age. Aim: This study aimed at finding some risk factors associated with rotavirus infection in children Patient, Materials and Methods: This is a cross-sectional study. A total of 173 children Results: The Source of water supply and presence of persons with gastroenteritis in the household were found to be risk factors for acquiring the infection with statistically significant P < 0.05. Breastfeeding was found to be protective of rotavirus gastroenteritis. Conclusion: Rotaviruses cause morbidity and mortality in children under five years of age. In view of the associated risk factors, making available safe drinking water and encouraging good personal hygiene is important. Promotion of exclusive breastfeeding and vaccination is advocated. Public health strategies like creating awareness to affected communities are a good strategy.

A Comparative Evaluation on the effect of Zinc-Probiotic combination versus Zinc alone therapy in children (3month-5year) with acute watery diarrhea attending the outpatient clinic of Sub-District hospital, Uttarakhand

Background: Diarrhea is the major cause of morbidity and mortality among children worldwide.Various studies were done on the role of zinc therapy and probiotic therapy in reducing the durationand severity of acute watery diarrhea. This study aimed to compare the effect of Zinc –probioticcombination versus Zinc only therapy in acute watery diarrhea in pediatric patients. Material andMethods: This was an open, randomized control trial in the pediatric outpatient department of Sub-District Female Hospital, Haldwani (Uttarakhand), from June 2020 till August 2020 for three months.Total 104 children aged six months to 5 years with acute diarrhea who met the inclusion criteriawere enrolled and divided into 52 patients each. 1stGroup A (n=52) received Zinc-Probioticscombination therapy, and 2ndGroup B (n=52) received Zinc only. Measurement of disease severitywas based on the frequency of diarrhea (times/day) and duration of diarrhea (hours) after initialdrug consumption. The resolution was assessed in mean remission time (time required to form solidstool from watery stool).Result: Among the study population in group A, 62% were male, 38%were female, and in group B, 65% were male &amp; 35% were female. Male predominance was observedin both groups. The mean frequency of diarrhea before treatment in Group A was 7.46 ± 4.1times/day as compared to 6.69 ± 3.6 times/day in Group B. Mean duration of diarrhea in Group Awas 53.5 ± 30.5 hours as compared to 57.6 ± 34.3 hours in Group B. Conclusion: Combinationtherapy was more effective than Zinc only therapy in early remission and resolution of acute waterydiarrhea in children.

A retrospective review on antibiotic use in acute watery diarrhea in children in a tertiary care hospital of Karachi, Pakistan.

Responsible for at least one in nine pediatric deaths, diarrheal diseases are the leading, global cause of death. Further abetted by improper antibiotic use in a hospital setting, children with acute watery diarrhea can see prolonged hospital stays, and unwanted adverse effects such as antibiotic resistance. Hence, this study is aimed to identify the association between antibiotic usage for the treatment of acute watery diarrhea in children, and the impact this line of management has on the duration of their hospital stay. A retrospective review was conducted at the department of Pediatric of Aga Khan University Hospital (AKUH) in Karachi. A total of 305 records of children aged 6 months to 5 years who were admitted with a diagnosis of acute watery diarrhea from June 2017 -December 2018 was screened, of which 175 fulfilled the eligibility criteria. A predesigned questionnaire was used to collect demographic information, comorbidities, and clinical features, severity of dehydration, clinical examination, treatment received, and laboratory investigations. The primary outcome of this study was the length of hospital stay measured against the number of hours a child stayed in hospital for treatment of acute watery diarrhea. The statistical analysis was carried out using STATA version 14 to reach conclusive results. 175 patients presented with acute watery diarrhea, out of which 106 (60.6%) did not receive antibiotics. The median (IQR) age of the group that did not receive antibiotics was 12.0 (12.0) months compared to 15.0 (12.0) months for the group that did receive antibiotics. In both groups, there were more males than females, less than 15% of the patients were severely malnourished (WHZ score -3SD) and less than 10% of the patients were severely dehydrated. The median (IQR) length of hospital stay (hours) was 32.0 (19.0) respectively for the group that did not receive antibiotic and 41.0 (32.0) for the group that did receive antibiotic therapy. The expected length of hospital stay for the group that received antibiotic therapy was 0.22 hours higher than the group that did not. Finally, as compared to females, hospital stay for males was longer by 0.25 hours. In conclusion, antibiotic use was associated with a prolonged hospital stay in children with acute watery diarrhea as compared to children who did not receive antibiotics. Large scale robust prospective studies are needed to establish this association using this observational data.

Role of saccharomyces boularii in acute watery diarrhea in children between 2 months- 5 years

Role of saccharomyces boularii in acute watery diarrhea in children between 2 months- 5 years

Acid-base and Electrolyte Disturbances in Children Presenting with Acute Watery Diarrhoea in Emergency Observation and Referral Unit of Dhaka Shishu (Children) Hospital

Background: Acute watery diarrhoea (AWD) is a leading cause of illness and death amongst children in developing countries. Electrolyte and acid-base disturbances play an important role in the associated morbidity and mortality.&#x0D; Objectives: To observe the acid-base and electrolyte changes in moderate and severe dehydration in AWD in children.&#x0D; Methods: This cross sectional study was carried out in the Observation and Referral Unit of Dhaka Shishu (Children) Hospital from July 2018 to December 2018. Children below five years of age who came with acute diarrhoea with moderate to severe dehydration were included in the study. After admission 2ml of whole blood was collected with all aseptic measures at the time of insertion of intravenous cannula before giving intravenous fluids to measure serum levels of Na and K while arterial blood was also taken for analysis. The data was analyzed by using SPSS version 20.&#x0D; Results: Total 125 AWD cases were admitted among them 98(78.4%) had moderate dehydration whereas 27(21.6%) had severe dehydration. Hyponatremic dehydration was present in 41(32.8%) cases. Among them 30(30.6%) had moderate dedydration and 11(40.4%) had severe dehydration, hypernatremic dehydration was present in 11.11% cases, hypokalemia was present in 54(43.2%) cases. Among them 42(42.86%) had moderate dedydration and 12(44.44%) had severe dehydration. Metabolic acidosis was present in 38(30.4%) cases [28(28.57%) in moderate dedydration and 10(37.04%) in severe dehydration]. The comparison of mean serum sodium and potassium value of the children with moderate and severe degrees of dehydration did not attain statistical significance, but there was a significant difference in bicarbonate concentration among moderate and severe dehydration cases (p=0.02).&#x0D; Conclusion: Hyponatremia and hypokalamia was the commonest electrolyte abnormality among moderate to severe dehydration with AWD. Mean serum sodium and potassium of the children with moderate and severe degrees of dehydration did not attain statistical significance, but bicarbonate concentration was significantly low among severe dehydration cases.&#x0D; DS (Child) H J 2020; 36(2): 120-124

Study of Saccharomyces boularii in acute watery diarrhea in children between 2 months to 5 years of age at a tertiary hospital

Study of Saccharomyces boularii in acute watery diarrhea in children between 2 months to 5 years of age at a tertiary hospital

An In silico Analysis of Some Bioactive Compounds of Psidium guajava against Target Proteins of Vibrio cholerae

Introduction: Cholera is a destructive disease that causes extreme and intense water loss in the body. It takes between 12 hours and 5 days for an individual to show symptoms after ingesting contaminated food or water. It causes acute watery diarrhea in children and adults and if left untreated, it can lead to death within hours. Unfortunately, children are the most severely affected. In this study, molecular interactions of 24 bioactive compounds of Psidium guajava leaves against Vibrio cholerae targets proteins namely: Alanine racemase (PDB ID: 4BEQ), Cholera enterotoxin, A chain (PDB ID: 1S5F) and ToxT (PDB ID: 3GBG) were evaluated.&#x0D; Methods: Molecular docking study was conducted and the 3D structures of bioactive compounds, Enzymes and the Enzyme-ligand interaction were visualized while Swiss ADME was employed to assess other physiochemical properties of these bioactive compounds.&#x0D; Results and Discussion: The results from the molecular docking revealed that five bioactive compounds showed promising inhibitory activity, which include Spathulenol (Binding energy; -7.5, -6.5 and -9.1 kcal/mol in 4BEQ, 1S5F and 3GBG ), Humulene oxide II (Binding energy; -7.1, -6.0 and -8.5 kcal/mol in 4BEQ, 1S5F and 3GBG), Globulol(-)-Globulol were -7.2, -6.5 and -9.0 kcal/mol in 4BEQ, 1S5F and 3GBG), Cadala-1(10),3,8-triene (Binding energy; -7.8, -6.8 and -9.8 kcal/mol in 4BEQ, 1S5F and 3GBG) and Bicyclo[5.3.0]decane, 2-methylene-5-(1-methylvinyl)-8-methyl (Binding energy; -6.9, -6.7 and -9.4 kcal/mol in 4BEQ, 1S5F and 3GBG) respectively.&#x0D; Conclusion: In this study, it has been revealed that the carefully chosen bioactive compounds have the potential to be used alone or in combination with other natural products for developing potent antibacterial drugs (against cholera). They can be further subjected to fractionation and isolation to confirm their activity towards in vitro and in vivo studies and can be commercialized as a potent antibacterial agent.

A double-blind placebo-controlled trial of azithromycin to reduce mortality and improve growth in high-risk young children with non-bloody diarrhoea in low resource settings: the Antibiotics for Children with Diarrhoea (ABCD) trial protocol

BackgroundAcute diarrhoea is a common cause of illness and death among children in low- to middle-income settings. World Health Organization guidelines for the clinical management of acute watery diarrhoea in children focus on oral rehydration, supplemental zinc and feeding advice. Routine use of antibiotics is not recommended except when diarrhoea is bloody or cholera is suspected. Young children who are undernourished or have a dehydrating diarrhoea are more susceptible to death at 90 days after onset of diarrhoea. Given the mortality risk associated with diarrhoea in children with malnutrition or dehydrating diarrhoea, expanding the use of antibiotics for this subset of children could be an important intervention to reduce diarrhoea-associated mortality and morbidity. We designed the Antibiotics for Childhood Diarrhoea (ABCD) trial to test this intervention.MethodsABCD is a double-blind, randomised trial recruiting 11,500 children aged 2–23 months presenting with acute non-bloody diarrhoea who are dehydrated and/or undernourished (i.e. have a high risk for mortality). Enrolled children in Bangladesh, India, Kenya, Malawi, Mali, Pakistan and Tanzania are randomised (1:1) to oral azithromycin 10 mg/kg or placebo once daily for 3 days and followed-up for 180 days. Primary efficacy endpoints are all-cause mortality during the 180 days post-enrolment and change in linear growth 90 days post-enrolment.DiscussionExpanding the treatment of acute watery diarrhoea in high-risk children to include an antibiotic may offer an opportunity to reduce deaths. These benefits may result from direct antimicrobial effects on pathogens or other incompletely understood mechanisms including improved nutrition, alterations in immune responsiveness or improved enteric function. The expansion of indications for antibiotic use raises concerns about the emergence of antimicrobial resistance both within treated children and the communities in which they live. ABCD will monitor antimicrobial resistance. The ABCD trial has important policy implications. If the trial shows significant benefits of azithromycin use, this may provide evidence to support reconsideration of antibiotic indications in the present World Health Organization diarrhoea management guidelines. Conversely, if there is no evidence of benefit, these results will support the current avoidance of antibiotics except in dysentery or cholera, thereby avoiding inappropriate use of antibiotics and reaffirming the current guidelines.Trial registrationClinicaltrials.gov, NCT03130114. Registered on April 26 2017.

The Clinical Efficacy of Multi-strain Probiotics in the Management of Acute Watery Diarrhoea of Children aged 2 Months to 5 Years-a Randomized Controlled Trial

Background: Acute gastroenteritis is considered as one of the most common causes of under-five morbidity and mortality worldwide. Standard treatment is the use of oral rehydration solution (ORS), intravenous fluid if indicated, and zinc supplement. Recently, the use of probiotics has been introduced as an adjunct to the treatment of acute gastroenteritis. The aim of this study is to determine the clinical efficacy of multi-strain probiotics as adjunct treatment of acute gastroenteritis.&#x0D; Methodology: A randomized controlled trial was done in 250 bed district Sadar Hospital, Brahmanbaria, Bangladesh from January 2016 to June 2017. After fulfilling the inclusion criteria, 507 children aged 2 months to 5 years were enrolled in this study. Those with dysentery, chronic diarrhea, diarrhea due to known genetic disorder, chronic illness, malnutrition, systemic infection, CNS disorder and congenital malformation were excluded. Children were divided into two groups randomly. One group was With Probiotic, zinc and standard WHO (ORS) as case and other group was Without Probiotic, zinc and standard WHO ORS as control.&#x0D; Results: Among 507 children, 257 were without probiotic while 250 were with probiotic. The mean difference in stool frequency between the two groups were 3.3 after 24 hours, 3.5 after 48 hours and 1.6 after 72 hours after hospitalization which was statistically significant (p=0.000). Reduction of stool frequency was highest after 48 hours of admission. Mean duration of hospital stay was 4.40±1.22 days in control and 4.03±.89 days in case group. Probiotic group children with exclusive breastfeeding had mean recovery time of 3.95±0.85 days and those who were not exclusively breastfeed had recovery time of 4.2±0.95 days (p=0.025).&#x0D; Conclusion: Probiotic is efficacious in reducing purging duration and frequency of acute watery diarrhea in children.&#x0D; Bangladesh J Child Health 2019; VOL 43 (2) :97-101

Diarrheal diseases among children under five years in Brong Ahafo Region, Ghana, 2016

Introduction: diarrhoea is the frequent and excessive discharge of bowels caused by a wide range of agents. Rotavirus is the most common agent that causes acute watery diarrhoea in children under five years (U5). Globally, Diarrheal Diseases (DD) account for 1 in 9 deaths in children U5. In Ghana, rotavirus vaccine is administered in two doses at six and ten weeks. DD in children U5 from Brong Ahafo Region (BAR) were analyzed to establish trends and long-term changes, describe reasons for changes, determine where cases were occurring, detect aberrations in the patterns and determine the data quality.

An overview of the aetiologic agents of diarrhoea diseases in children: How far have we gone in management and control?

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Diarrhoea disease is the second leading cause of death amongst Nigerian children (after malaria) with a prevalence rate in Nigeria of 18.8% which is one of the worst in sub-Sahara Africa. A major contributor to childhood morbidity and mortality, causes 4 million deaths each year in under-fives with each child experiencing about 5 episodes of diarrhoea yearly. We review diarrhoea diseases in children with focus on infectious diarrhoea with the aim of looking at the progress made so far in its management and control. Diarrhoea can be classified into acute and chronic; secretory, osmotic, inflammatory or due to impaired motility; infectious and non-infectious. In developing countries, infections are the most common causes of acute watery diarrhoea in children, whereas chronic diarrhoea results from non-infectious causes like inherited metabolic disorders, sensitivity to gluten orneoplasm. Diagnosis includes a careful history from the patient, examination of stool sample and examination of faecal swab samples where stool is not available. Diarrhoea in this age group is mostly of infectious origin and can be viral, bacterial, parasitic or fungi. Treatment in this environment is primarily supportive with oral or intravenous fluid and preventive measures include domestic hygiene promotion, breast-feeding promotion, improved weaning practices, probiotic use, oral rehydration therapy with additional L-glutamine, zinc supplementation and vaccination against childhood infectious diseases like rotavirus, measles and cholera. An aluminmagnesium silicate, Smectite® has been found to be of potential benefit in the management of diarrhoea. Use of Rotavirus vaccines, probiotics and Smectite® is being advocated.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Efficacy and safety of racecadotril as an adjunct to oral rehydration therapy for acute watery diarrhea in children

Background: Racecadotril, an enkephalinase inhibitor with antisecretory action is a safe and effective treatment for acute diarrhea for children and adults. As an adjunct to oral rehydration therapy (ORT) in Indian children, its efficacy and safety data are scarce. Methods: A total of 117 children with acute watery diarrhea for not more than 7 days were randomized into two groups. Group A (control group) received ORT and zinc only while Group B (study group) received a combination of racecadotril (1.5 mg/kg q8 h), zinc and ORT. Primary end point was the number of loose stools during first 48 h of treatment. Time to cure as well as total volumeof oral rehydration solution (ORS) consumed was also measured. Results: Baseline characteristics were not significantly different between the groups. Mean 48 h stool frequency in the study group was 10.47±3.2 episodes and that in control group was 15.87±4.6 episodes indicating a significant reduction of 34.1% with racecadotril (p=0.00016). The mean time for recovery in the study group was 37.98±6.1 h and 51.02±9.4 h in control group indicating a significant reduction of 25.6% with racecadotril (p=0.002). The mean volume of ORS consumed before recovery in the study group was 162.72 ml as compared to 232.68 ml in control grouppointing to a significant reduction of 30.1% in the study group. Conclusions: Racecadotril is effective as an adjunct to ORT and early continued feeding in infants and children with acute watery diarrhea.

Racecadotril for the treatment of severe acute watery diarrhoea in children admitted to a tertiary hospital in Kenya

BackgroundDiarrhoea is the second most common cause of death in children under 5 years of age in Kenya. It is usually treated with oral rehydration, zinc and continued feeding. Racecadotril...

Comparison of Regular and Probiotic Yogurts in Treatment of Acute Watery Diarrhea in Children

Diarrhea is among the leading causes of morbidity and mortality in children under five years of age, especially in developing countries. Due to dehydration and imbalance of water and electrolytes in the body. There is a need to introduce alternative ways for management of this common health problem. The aim of this study was to evaluate and compare the effects of regular and probiotic yogurt on duration and frequency of diarrhea in children aged one to five with acute watery diarrhea. Ninety patients were randomly assigned to three groups, two intervention groups, including regular and probiotic yogurt groups, and a control group. In the regular yogurt group, the first significant decrease in frequency of diarrhea was 2.15 ± 0.61 days and in the probiotic group was 2.65 ± 0.72 days after admission to the hospital.

Selenium for acute watery diarrhea in children

Background Acute watery diarrhea remains a major health problem affecting infants and children in developing countries. Selenium deficiency may be a risk factor for diarrhea and vice versa. Few studies have been conducted on the effectiveness of selenium for the treatment of diarrhea in children.Objective To determine the effectiveness of selenium in reducing the severity of acute watery diarrhea in children.Methods A single-blind, randomized clinical trial was done in children with acute watery diarrhea, aged six months to two years, and who visited the community health center in Simalungun from May to August 2012. Children were randomized into either the selenium or placebo (maltodextrin) group. We monitored diarrheal frequency, stool consistency, and duration of diarrhea. Mann-Whitney, Fisher’s, and Kolmogorov-Smirnov tests were used to compare the two groups.Results Sixty-five children were recruited into the study, of whom 36 children received selenium and 29 children received a placebo. The selenium group had significantly lower frequency of diarrhea (bouts per day) than the placebo group on days 2, 3, and 4 after treatment onset [day 2: 3.5 vs. 4.1, respectively (P=0.016); day 3: 2.7 vs. 3.4, respectively (P=0.002); day 4: 2.1 vs. 2.8, respectively (P&lt;0.001)]. On day 2, stool consistency had significantly improved in the selenium group compared to the placebo group (P=0.034). In addition, the median duration of diarrhea was significantly lower in the selenium group than in the placebo group (60 vs. 72 hours, respectively; P=0.001). Median recovery time from the the first day of diarrhea was also significantly lower in the selenium group than in the placebo group (108 vs. 120 hours, respectively; P=0.009).Conclusion In children with acute watery diarrhea, those treated with selenium have decreased frequency of diarrhea, improved stool consistency, as well as shorter duration of diarrhea and recovery time than those treated with a placebo. [Paediatr Indones. 2016;56:139-43.].