Course Of Acute Diarrhea Research Articles

Comparative analysis of the clinic and the course of acute diarrhea in children with HIV infection

Comparative analysis of the clinic and the course of acute diarrhea in children with HIV infection

Acute diarrhea: evidence‐based management

ObjectivesTo describe the current recommendations on the best management of pediatric patients with acute diarrheal disease. Data sourcePubMed, Scopus, Google Scholar. Data summaryThere has been little progress in the use of oral rehydration salts (ORS) in recent decades, despite being widely reported by international guidelines. Several studies have been performed to improve the effectiveness of ORS. Intravenous hydration with isotonic saline solution, quickly infused, should be given in cases of severe dehydration. Nutrition should be ensured after the dehydration resolution, and is essential for intestinal and immune health. Dietary restrictions are usually not beneficial and may be harmful. Symptomatic medications have limited indication and antibiotics are indicated in specific cases, such as cholera and moderate to severe shigellosis. ConclusionsHydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea.

Acute diarrhea: evidence-based management

ObjectivesTo describe the current recommendations on the best management of pediatric patients with acute diarrheal disease. Data sourcePubMed, Scopus, Google Scholar. Data summaryThere has been little progress in the use of oral rehydration salts (ORS) in recent decades, despite being widely reported by international guidelines. Several studies have been performed to improve the effectiveness of ORS. Intravenous hydration with isotonic saline solution, quickly infused, should be given in cases of severe dehydration. Nutrition should be ensured after the dehydration resolution, and is essential for intestinal and immune health. Dietary restrictions are usually not beneficial and may be harmful. Symptomatic medications have limited indication and antibiotics are indicated in specific cases, such as cholera and moderate to severe shigellosis. ConclusionsHydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea.

Effect of zinc supplementation on clinical course of acute diarrhea in patients admitted in Ali Asghar Children Hospital Medical Center Iran University of Medical SciencesTehran Iran

Effect of zinc supplementation on clinical course of acute diarrhea in patients admitted in Ali Asghar Children Hospital Medical Center Iran University of Medical SciencesTehran Iran

Effect of Zinc Supplementation in Children with Acute Diarrhea: Randomized Double Blind Controlled Trial.

BackgroundTo test the hypothesis that daily supplementation of zinc has any effect on clinical course of acute diarrhea, i.e. frequency of stool, on stool amount and duration of acute diarrhea.MethodsIn a randomized double blind placebo controlled trial, 117 children aged 6 months to 59 months in a medical college hospital, with acute diarrhea of less than 14 days were assigned by permuted block design 1:1 to receive intervention of zinc supplemented syrup (n = 60) or placebo syrup (n = 57).ResultsBaseline characteristics were similar in both the groups. Mean age in zinc supplemented group was 22.14 ± 16.68 months and in placebo group 25.66 ± 17.02 months. Reduction in stool frequency per day was found 62% in zinc supplemented group and 26% reduction was found in placebo supplemented group with obvious difference of 36% between these two groups from day 1 to day 3 and day 5, which was found statistically highly significant. Similarly, significant difference was observed for reduction in amount of stool per day from day 1 to day 3 and day 5 with obvious difference of 45% between the study groups.ConclusionsOral zinc administration in acute diarrhea reduces the frequency of diarrhea and output of stool by changing the natural course of acute diarrheal disease, causes early normalization of stool consistency, early recovery and decreases total duration of hospital stay. Zinc supplementation is simple, acceptable and affordable strategy which should be considered in management of acute diarrhea.

Therapeutic value of a Lactobacillus gasseri and Bifidobacterium longum fixed bacterium combination in acute diarrhea: a randomized, double-blind, controlled clinical trial

A multicenter, parallel-group, randomized, double-blind, active-controlled clinical trial, involving 169 outpatients at 9 centers, was conducted to assess the efficacy of a fixed bacterium combination of Lactobacillus gasseri and Bifidobacterium longum in the therapy of acute diarrhea. In particular, this clinical trial was designed to prove equivalent therapeutic efficacy of a fixed bacterium combination versus an exhaustive investigated mono-bacterium medicinal product. All patients, free to carry on usual daily activities, received 1 capsule 3 times a day of either a fixed bacterium combination of Lactobacillus gasseri and Bifidobacterium longum or Enterococcus faecium mono-bacterium. All treatments were continued for a maximum of 6 days in line with the normal course of acute diarrhea. Primary efficacy criterion was the severity and duration of diarrhea assessed by the ensemble of stool frequency as change from baseline and stool consistency at trial Day 2, 3 and 4, and time in days until normal bowel function (recovery). The median duration of diarrhea was 2.70 days versus 2.67 days (fixed bacterium combination of Lactobacillus gasseri and Bifidobacterium longum versus mono-bacterium Enterococcus feacium). The total mean difference of duration of diarrhea was 0.072 days. This result can be considered equivalent. However, the proportion of patients with complete recovery tended to be higher in the fixed bacterium combination group (92.6% versus 87.1%) resulting in a number needed to treat (NNT) of 18.1. The fixed bacterium combination reduced the number of unformed stools by 80% and the mono-bacterium by 75% during the first 2 days of treatment. Both treatments were well tolerated. Oral therapy with a fixed combination of Lactobacillus gasseri and Bifidobacterium longum shortens the duration and decreases the severity of acute self-limiting diarrhea in adults comparable to an effective mono-bacterium medicinal product. It therefore appears to be a useful and safe treatment for this disease.

Effects of Saccharomyces boulardii in children with acute diarrhoea

Certain probiotic agents, e.g. Lactobacillus GG, have shown efficacy in clinical trials for the treatment of acute childhood diarrhoea, but few studies have examined the effect of Saccharomyces boulardii. We evaluated the effect of S. boulardii in children with acute diarrhoea. Two hundred children were randomized to receive S. boulardii in a granulated form in a daily dose of 250 mg (S. boulardii group) or placebo (placebo group) for 5 d. Clinical and demographic characteristics on admission were similar between the study groups. The medians of the average stool frequency after the second day of the treatment were significantly lower in the S. boulardii group than in the placebo group (p = 0.003). The duration of diarrhoea significantly reduced in the S. boulardii group compared with the placebo group (4.7 vs 5.5 d, p = 0.03). The effect of S. boulardii on watery diarrhoea became apparent after the second day of the treatment. The duration of hospital stay was shorter in the S. boulardii group than in the placebo group (2.9 vs 3.9 d, p < 0.001). Four children from the placebo group versus only one child from the S. boulardii group had persisting diarrhoea. The placebo-controlled study suggested that S. boulardii significantly reduced the duration of acute diarrhoea and the duration of hospital stay. S. boulardii seems to be a promising agent for the amelioration of the course of acute diarrhoea in children when used therapeutically.

Probiotics and infectious diarrhea

Numerous probiotic agents have been studied for the management of diarrheal disease. In particular, the prevention and management of acute viral diarrhea, the treatment of recurrent Clostridium difficile diarrhea, as well as the control of antibiotic-associated diarrhea seem to be areas of significant potential benefit. A few agents, including Lactobacillus GG, Lactobacillus reuteri, and Saccharomyces boulardii, seem to be promising agents for the amelioration of the course of acute diarrhea in children when used therapeutically. The use of other agents, particularly Bifidobacteria, supplementing the regular feed of infants may have an effect as prophylactic agents against acute diarrheal diseases. In general, in pediatric populations, the effect of probiotic agents appears to be most significant against viral (rotaviral) diarrhea, suggesting that an immunological mechanism is responsible for the beneficial effects. The numerous agents, doses, and populations used make generalization difficult. Nevertheless, it is clear probiotic agents are becoming an important part of the armamentarium against gastrointestinal problems in infants and children.

A double-blind clinical trial comparing World Health Organization oral rehydration solution with a reduced osmolarity solution containing equal amounts of sodium and glucose

OBJECTIVE: To compare the safety and efficacy of an oral rehydration solution (ORS) containing 75 mmol/L of sodium and glucose each with the standard World Health Organization (WHO) ORS among Egyptian children with acute diarrhea. METHODS: One hundred ninety boys, ages 1 to 24 months, who were admitted to the hospital with acute diarrhea and signs of dehydration were randomly assigned to receive either standard ORS (311 mmol/L) or a reduced osmolarity ORS (245 mmol/L). Intake and output were measured every 3 hours. RESULTS: In the group treated with reduced osmolarity ORS, the mean stool output during the rehydration phase was 36% lower (95% confidence interval, 1%, 100%) than in those treated with WHO ORS. The relative risk of vomiting during the rehydration phase was significantly lower in children treated with reduced osmolarity ORS (relative risk, 2.4; 95% confidence interval, 1.2, 4.8). During the maintenance phase, stool output, mean intake of food and ORS, duration of diarrhea, and weight gain were similar in the treatment groups. The relative risk of treatment failure (need for unscheduled administration of intravenous fluids) was significantly increased in children receiving standard WHO ORS (relative risk, 7.9; 95% confidence interval, 1.1, 60.9). The mean serum sodium concentration at 24 hours was significantly lower in children receiving the reduced osmolarity ORS solution (134 ± 6 mEq/L) than in children receiving the standard WHO ORS (138 ± 7 mEq/L) ( p <0.001). The relative risk of the development or worsening of hyponatremia was not increased in children given the reduced osmolarity ORS, and urine output was similar in the treatment groups. CONCLUSION: The reduced osmolarity ORS has beneficial effects on the clinical course of acute diarrhea in children by reducing stool output, and the proportion of children with vomiting during the rehydration phase, and by reducing the need for supplemental intravenous therapy. These results provide support for the use of a reduced osmolarity ORS in children with acute noncholera diarrhea. (J P EDIATR 1996;128:45-51)

Multicentre evaluation of reduced-osmolarity oral rehydration salts solution

In developed countries, use of oral rehydration salts (ORS) solution with osmolarity lower than that of plasma has been recommended because of the risk of hypernatraemia. We compared the clinical efficacy of reduced-osmolarity ORS and standard ORS solutions in children with acute diarrhoea in four developing countries. 447 boys aged 1-24 months, admitted to hospitals in four countries with acute diarrhoea and signs of dehydration, were randomly assigned either standard ORS (311 mmol/L) or reduced-osmolarity ORS (224 mmol/L) solution. Total stool output was 39% greater (95% Cl 11-75), total ORS intake 18% greater (3-33), and duration of diarrhoea 22% longer (2-45) in the standard ORS group than in the reduced-osmolarity ORS group. The risk of requiring intravenous infusion after completion of the initial oral rehydration was greater in children given standard ORS solution than in those given reduced-osmolarity ORS solution in three of the four countries (all-country relative risk 1·4 [0·9-2·4]). This relative risk was significantly increased only in non-breastfed children (2·0 [1·0-3·8], p<0·05). In breastfed children, the relative risk of requiring intravenous infusion was not affected by the ORS solution (0·9 [0·4-2·0]). The mean sodium concentration 24 h after admission was significantly lower in the reduced-osmolarity ORS group than in the standard ORS group (135 [134-136] vs 138 [136-139] mmol/L, p<0·01). Reduced-osmolarity ORS solution has beneficial effects on the clinical course of acute diarrhoea. Our findings support the use of reduced-osmolarity ORS solution in children with acute non-cholera diarrhoea in developing countries. Further studies are needed to find the best formulation and whether such a solution would be satisfactory for the treatment of cholera.

A HUMAN LACTOBACILLUS STRAIN (LACTOBACILLUS GG) PROMOTES RECOVERY FROM ACUTE DIARRHOEA IN CHILDREN

To determine the effect of a human Lactobacillus strain GG (Gefilac™) on the clinical outcome and recovery from mucosal damage of acute diarrhoea (82 % rotavirus). 71 well-nourished children between 4 and 45 months of age were studied. After oral rehydration, the patients were randomly assigned to receive either Lactobacillus GG-fermented milk product 125 g (1010-11 CFU) twice daily (Group 1), Lactobacillus GG-freeze dried powder one dose (1010-11 CFU) twice daily (Group 2) or a placebo milk product (Group 3) with no lactic acid bacteria 125 g twice daily, each for 5 days. In addition, normal full diet otherwise free of fermented dairy products was given. Intestinal permeability was assessed by urinary recovery ratios of orally-administered lactulose (4g) and mannitol (0.8 g). The mean (SD) duration of diarrhoea after commencing the therapy was significantly shorter in Group 1, 1.4 (0.8) days, and in Group 2, 1.4 (0.8) days, than in Group 3, 2.4 (1.1) days; F= 8.70, p < 0.001. The decrease in the number of diarrhoeal stools became apparent after the first day of therapy in Group 1 and Group 2. After rehydration, each dietary group maintained a positive weight trend. The urinary lactulose/manniiol recovery ratios (means [95 % confidence intervals]) were on admission in Group 1, 0.09 [0.03,0.24]; Group 2, 0.12 [0.07, 0.22]; Group 3, 0.08 [0.04,0.18], and no significant alterations were observed at retesiing after 2 days of realimentation. The result indicates that early nutritional repletion after rehydration causes no mucosal disruption, and is beneficial for the recovery from diarrhoea. We suggest that fermented dairy products, with viable lactic acid bacteria that are able to colonize the gut, are effective in shortening the course of acute diarrhoea.