Management Of Acute Diarrhea Research Articles

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.

International, Prospective, Observational, Multicenter Registry on the Management of Acute Diarrhea in Children (REMAD)

International, Prospective, Observational, Multicenter Registry on the Management of Acute Diarrhea in Children (REMAD)

Oral rehydration therapy in emergency departments

To describe the management of acute diarrhea in emergency departments with emphasis on the type of hydration and exploring factors associated with prescription of oral rehydration therapy vs. intravenous rehydration therapy for children with dehydration that is not severe. This was a descriptive study conducted from January to May of 2008 observing case management of children with non-severe dehydration due to acute diarrhea at two emergency units (A and B) in Recife, Brazil. Emergency unit B is affiliated to a teaching hospital. The primary variables were: 1) type of hydration prescribed, 2) associations with the characteristics of the children and emergency department (A or B). A total of 166 children took part in the study. The rates of prescription of oral rehydration therapy were similar at both services (32.2 vs. 31.6% for A and B, respectively, p = 0.93) and were lower for cases with moderate dehydration (17.6%) compared with mild dehydration (35.6%) (p = 0.07). Neither service had a dedicated oral rehydration room. Most children were given intravenous rehydration therapy, especially those with moderate dehydration, without differences according type of service: whether a teaching institution or healthcare provider only.

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.

Adherence to treatment guidelines for acute diarrhoea in children up to 12 years in Ujjain, India - a cross-sectional prescription analysis

BackgroundDiarrhoea accounts for 20% of all paediatric deaths in India. Despite WHO recommendations and IAP (Indian Academy of Paediatrics) and Government of India treatment guidelines, few children suffering from acute diarrhoea in India receive low osmolarity oral rehydration solution (ORS) and zinc from health care providers. The aim of this study was to analyse practitioners' prescriptions for acute diarrhoea for adherence to treatment guidelines and further to determine the factors affecting prescribing for diarrhoea in Ujjain, India.MethodsThis cross-sectional study was conducted in pharmacies and major hospitals of Ujjain, India. We included prescriptions from all practitioners, including those from modern medicine, Ayurveda, Homeopathy as well as informal health-care providers (IHPs). The data collection instrument was designed to include all the possible medications that are given for an episode of acute diarrhoea to children up to 12 years of age. Pharmacy assistants and resident medical officers transferred the information regarding the current diarrhoeal episode and the treatment given from the prescriptions and inpatient case sheets, respectively, to the data collection instrument.ResultsInformation was collected from 843 diarrhoea prescriptions. We found only 6 prescriptions having the recommended treatment that is ORS along with Zinc, with no additional probiotics, antibiotics, racecadotril or antiemetics (except Domperidone for vomiting). ORS alone was prescribed in 58% of the prescriptions; while ORS with zinc was prescribed in 22% of prescriptions, however these also contained other drugs not included in the guidelines. Antibiotics were prescribed in 71% of prescriptions. Broad-spectrum antibiotics were prescribed and often in illogical fixed-dose combinations. One such illogical combination, ofloxacin with ornidazole, was the most frequent oral antibiotic prescribed (22% of antibiotics prescribed). Practitioners from alternate system of medicine and IHPs are significantly less likely (OR 0.13, 95% CI 0.04-0.46, P = 0.003) to prescribe ORS and zinc than pediatricians. Practitioners from 'free' hospitals are more likely to prescribe ORS and zinc (OR 4.94, 95% CI 2.45-9.96, P < 0.001) and less likely to prescribe antibiotics (OR 0.01, 95% CI 0.01-0-04, P < 0.001) compared to practitioners from 'charitable' hospitals. Accompanying symptoms like the presence of fever, pain, blood in the stool and vomiting significantly increased antibiotic prescribing.ConclusionThis study demonstrated low adherence to standard treatment guidelines for management of acute diarrhoea in children under 12 years in Ujjain, India. Key public health concerns were the low use of zinc and the high use of antibiotics, found in prescriptions from both specialist paediatricians as well as practitioners from alternate systems of medicine and informal health-care providers. To improve case management of acute diarrhoea, continuing professional development programme targeting the practitioners of all systems of medicine is necessary.

Risk Factors and Case Management of Acute Diarrhoea in North Gondar Zone, Ethiopia

In Ethiopia, evidence is lacking about maternal care-taking and environmental risk factors that contribute to acute diarrhoea and the case management of diarrhoea. The aim of this study was to identify the risk factors and to understand the management of acute diarrhoea. A pretested structured questionnaire was used for interviewing mothers of 440 children in a prospective, matched, case-control study at the University of Gondar Referral and Teaching Hospital in Gondar, Ethiopia. Results of multivariate analysis demonstrated that children who were breastfed and not completely weaned and mothers who were farmers were protective factors; risk factors for diarrhoea included sharing drinking-water and introducing supplemental foods. Children presented with acute diarrhoea for 3.9 days with 4.3 stools per day. Mothers usually did not increase breastmilk and other fluids during diarrhoea episodes and generally did not take children with diarrhoea to traditional healers. Incorporating messages about the prevention and treatment of acute diarrhoea into child-health interventions will help reduce morbidity and mortality associated with this disease.

Home Management of Acute Diarrhoea in Czech Children

The aim of the study was to investigate home management of childhood acute diarrhoea. A cross-sectional questionnaire study was conducted in Prague, Czech Republic. The caregivers of 210 children ages 6 to 59 months were approached in public places and interviewed about the knowledge and use of oral rehydration solution (ORS) and about management of the child's last episode of diarrhoea. Maternal knowledge of ORS (27.6%) and ORS use (1.9% during the child's last episode of diarrhoea) were low. They were positively associated with education level but not with the source of advice. Small volumes of ORS given and its refusal were issues. Increased amounts of fluid offered to 60% of children were significantly associated with higher maternal education and relatives/friends (76%) as a source of advice rather than a paediatrician (57.9%), the most frequent source of advice (78.1%). Black tea was the most common fluid given (86.2%) followed by plain or mineral water (41.9%). Breast-feeding of all breast-fed children was continued; low-lactose formula was given in 1 case only. Withholding food was rare (5.2%), but the diet of 75.2% cases was modified. Drugs were given to 52.4% children, most frequently smectite and/or probiotics, and antimicrobials were given to 6.4% cases.

Knowledge and belief of nursing mothers on nutritional management of acute diarrhoea in infants, Ibadan, Nigeria.

Malnutrition continues to be a major public health problem in Nigeria, and this contributes substantially to childhood mortality. Culturally related food restriction and reduction in feeding frequency during common childhood illnesses such as diarrhoeal diseases further contributes to the burden of malnutrition and thus to childhood morbidity and mortality. This study was designed to determine the knowledge, attitudes and practices of nursing mothers with respect to food restriction during acute diarrhoea in Ibadan, South West Nigeria. This single round cross-sectional study adopted a purposive sampling procedure to select 250 nursing mothers aged between 17 and 45 years from the sick-baby and immunization clinics of two health facilities in Ibadan, between November 2003 and February 2004. Information on nutritional management of acute diarrhoea was collected with a structured intervieweradministered questionnaire and two focus group discussions exploring food withdrawal practices during acute diarrhoea. Data analysis was done using SPSS 11.0. Descriptive and inferential statistics were generated to test for associations. About half (46.8%) of the respondents had secondary education. Only 6.0% had knowledge of nutritional management of diarrhoea while 54.8% had knowledge of oral rehydration therapy. Seventy-one percent of respondents reported food withdrawal during acute diarrhoea in infants, 44% also reported reduction in breastfeeding frequency during acute diarrhoea and more than two-thirds of these (71.2%) cited cultural reasons for withholding breastfeeding. Mothers’ educational level had no significant effect on their knowledge of nutritional management of acute diarrhoea in infants (p =0.610). Mothers’ knowledge of nutritional management of acute diarrhoea had a significant effect on their attitude (p = 0.03) but not on their practice (p = 0.257). Relatives and health care providers were the sources of advice on food restriction/withdrawal during acute diarrhoea. Appropriate nutritional management during acute illness is important, and this has been found to be deficient among caregivers in the family setting. Targeting appropriate health and nutrition education to caregivers particularly mother would reduce morbidity and mortality commonly associated with childhood diarrhoea.Key words: Infants, diarrhoea, food restriction, mothers

Knowledge, Attitude and Practices of the Mothers and Doctors Regarding Feeding,

Introduction: Since it’s a common observation that most cases of acute diarrhea are not managed according to WHO guidelines. Irrational use of drugs is a major problem of present day medical practice, as well as use of ORS is underesti-mated. The mothers /grand mothers reduce or stop feeding(except for breast feeding) do not know the importance of fluid therapy or ORS and cannot prepare ORS properly. This study was designed to know the exact situation. Objective: To assess the knowledge, attitude and practices of the mothers and doctors in acute diarrhea in children ≤ 5 years of age about feeding, preparation and use of oral rehydration solution (ORS) and drugs. Design: Cross Sectional. Place and duration: ORT corner of Pediatric OPD at Sir Ganga Ram Hospital, Lahore from May, 2007 to September, 2007. Patients and Methods: Nine hundred and fifty children under 5 years of age having acute diarrhea were included in the study. Data was collected on a specified questionnaire by a doctor who entered the required information after interviewing the mothers/grandmothers accompanying the children. The information was collected regarding use of ORS and who prescribed, or they already had knowledge that it should be given, how to prepare ORS, whether or not continued feeding and used drugs during current acute diarrhea episode. The data was entered and interpreted as frequency distribution. Results: ORS was used (given) by only 464 (49.67%) of the mothers, out of which 125(27%) used it by their own know-ledge (through newspaper, television, told by neighbours or previous consultation by the doctor). 400 (42.82%) mothers knew about preparation of ORS. Feeding was continued by 697 (74.62%) of the mothers and 400 (42.82%) used drugs, prescribed by general practitioners, medical officers of government hospitals, few by paediatrician and self during acute diarrhea. Conclusion: It is concluded that ORS was given by 49.67% of the mothers, 42.8% could prepare it properly, feeding was stopped/reduced/diluted by 25% of the mothers. Drugs were used in 42.82% of the cases. Diarrhea control programme needs to be reinforced to improve existing practices regarding management of acute diarrhea in children ≤ 5 years of age. Inappro-priate use of drugs during diarrhea should be discouraged. Key Words: ORS(oral rehydration solution), acute diarrhea, ORT( oral rehydration therapy).

Management of acute diarrhea: From evidence to policy

Diarrhea remains an important contributor to childhood deaths in India, being one of the top 10 causes of deaths among infants and children of 04 year of age. About 10% of infants and 14% of 0-4 year children die due to diarrhea in India(1). Important interventions for reducing mortality due to childhood diarrhea include (i) appropriate diarrhea management; and (ii) promotion of personal and household hygiene practices. Two effective interventions have been introduced as part of the diarrhea management in the last two decades, namely low osmolarity ORS and zinc.

How do pharmacists manage acute diarrhoea in an 8-month-old baby? A simulated client study

Community pharmacists claim a role in health care based on their added value as counsellors and providers of pharmaceutical care. The aim of this study was to assess to what extent they fulfil this role with respect to the management of acute diarrhoea in an 8-month-old baby. METHODS In February 2008, two female simulated clients of 55 and 35 years old visited 101 Belgian pharmacies. Both entered the pharmacy and said: 'I'm here for my grandchild/ my sister's baby. She has diarrhoea.' They only provided more information if the pharmacist asked for it. All the questions and the verbal advice provided by the pharmacist were audio-recorded and the suggested medicines were registered. One pharmacist did not ask any questions. All the other pharmacists asked the age of the child, 19% asked how long the symptoms had been on-going, 27% asked whether the baby had a fever and 24% inquired about vomiting. Seventy-five per cent of the pharmacists emphasized the importance of sufficient fluid intake and/or the risk of dehydration, while 4% described how to recognize such dehydration symptoms. Oral rehydration solution was suggested by 30% of the pharmacists, while 86% suggested the yeast probiotic Saccharomyces boulardii. Of the 28% spontaneously giving dietary advice, no-one said that normal feeding should restart 'as soon as possible'. Thirty-one per cent advised consulting a doctor, either immediately or in the case of the symptoms not improving after a while. Apart from inquiring about the child's age, the majority of pharmacists asked too few questions to be able to analyse the situation properly. Ample information was provided on the risk of dehydration, but counselling on the suggested medicines was insufficient.

How do pharmacists manage acute diarrhoea in an 8-month-old baby? A simulated client study

Community pharmacists claim a role in health care based on their added value as counsellors and providers of pharmaceutical care. The aim of this study was to assess to what extent they fulfil this role with respect to the management of acute diarrhoea in an 8-month-old baby. In February 2008, two female simulated clients of 55 and 35 years old visited 101 Belgian pharmacies. Both entered the pharmacy and said: ‘I'm here for my grandchild/my sister's baby. She has diarrhoea.’ They only provided more information if the pharmacist asked for it. All the questions and the verbal advice provided by the pharmacist were audio-recorded and the suggested medicines were registered. One pharmacist did not ask any questions. All the other pharmacists asked the age of the child, 19% asked how long the symptoms had been on-going, 27% asked whether the baby had a fever and 24% inquired about vomiting. Seventy-five per cent of the pharmacists emphasized the importance of sufficient fluid intake and/or the risk of dehydration, while 4% described how to recognize such dehydration symptoms. Oral rehydration solution was suggested by 30% of the pharmacists, while 86% suggested the yeast probiotic Saccharomyces boulardii. Of the 28% spontaneously giving dietary advice, no-one said that normal feeding should restart ‘as soon as possible’. Thirty-one per cent advised consulting a doctor, either immediately or in the case of the symptoms not improving after a while. Apart from inquiring about the child's age, the majority of pharmacists asked too few questions to be able to analyse the situation properly. Ample information was provided on the risk of dehydration, but counselling on the suggested medicines was insufficient.

Oral Rehydration Solutions in Non-Cholera Diarrhea: A Review

The use of oral rehydration solution (ORS) has revolutionized the management of acute diarrhea. The implementation of the standard World Health Organization ORS (WHO-ORS) has resulted in decreased mortality associated with acute diarrheal illnesses in children, although in general stool volume and diarrhea durations are not reduced. Decreased morbidity and mortality have occurred because of improved hydration status. Decreased morbidity has also been described in adults who used this therapy. Various modifications to the standard ORS have been derived. These modifications have included hypo-osmolar or hyperosmolar solutions, use of rice-based ORS, zinc supplementation, and the use of amino acids, including glycine, alanine, and glutamine. Some of these variations have been successful, some have not, and others are still under investigation. ORS has been used for travelers' diarrhea and to decrease intravenous (IV) fluid requirements in patients with short bowel syndrome (SBS) who require parenteral nutrition (PN). This paper reviews the standard WHO-ORS and its mechanism of action, followed by more contemporary reduced osmolarity ORS and rice-based ORS in non-cholera diarrhea. Various modifications to improve ORS are also discussed.

Lack of effect of nucleotide-supplemented infant formula on the management of acute diarrhea in infants

Nucleotides have been identified as conditionally essential nutrients. As prevention studies, conducted with nucleotide-supplemented formula, have shown statistically significant decrease in the risk of diarrhea, we tested the hypothesis that the consumption of nucleotide-supplemented formula during an acute diarrhea episode is associated with therapeutic effects in the treatment of infants with acute diarrhea and dehydration. A randomized, double-blind, controlled clinical trial was conducted in which patients were randomly assigned to 1 of 2 treatment groups. The "test" group consumed a nucleotide-supplemented infant formula and the "control" group consumed a nonsupplemented formula. Infants were accommodated in a metabolic unit where body weight, and all intakes and outputs were recorded at 24-hour intervals during hospitalization. Laboratory parameters including blood gases and electrolytes were monitored during hospitalization. Eighty-one male infants ranging in age from older than 1 month and younger than 1 year, with acute non-cholera diarrhea and dehydration were studied. Primary outcomes were stool output and duration of diarrhea and did not differ significantly between the groups, with a stool output of 304.2 (SD 254.0) vs 350.3 (SD 269.1) g/kg and a duration of diarrhea of 83.3 (SD 44.5) vs 88.8 (SD 46.6) for the test and control groups, respectively. Anemia was highly prevalent and breast-feeding practice was not frequent in both groups. The average energy intake and weight gain were similar in the 2 groups. This study demonstrated that nucleotide supplementation of infant formula during episodes of acute diarrhea has no therapeutic advantage compared to conventional infant formula.

Causes and recommended management of acute diarrhoea

AbstractAlthough usually mild and self‐limiting, acute diarrhoea in some patients will require early medical intervention or even hospitalisation. In our Drug review, the authors discuss the aetiology and recommended management of acute diarrhoea, followed by a review of the prescription data and sources of further information. Copyright © 2009 Wiley Interface Ltd

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.

Anti-Diarrheal Effects of Diosmectite in the Treatment of Acute Diarrhea in Children

Acute diarrhea caused by an infectious organism is highly prevalent, particularly in developing countries, and is usually self-limiting. The condition is a major contributor to the global disease burden and is associated with a significant economic cost. The disease is common in children aged <5 years. It occurs as the result of exposure to a diarrheogenic agent that alters intestinal absorption and/or secretion, resulting in an increase in the volume of water that enters the colon beyond that which can be absorbed. Diarrhea almost always occurs by one or more of four mechanisms: disruption of osmotic forces in the intestine; disruption of normal secretory processes; disruption of epithelial cells or the epithelial tight junctions; or motility disorders.Oral rehydration therapy (ORT) is central to the management of acute diarrhea, and is sufficient to prevent complications due to dehydration in most patients while the disease runs its course. However, ORT has no effect on the duration of the disease or frequency of bowel motions, and any agent that could meet these needs would therefore be a useful addition to ORT.Diosmectite is a natural aluminomagnesium silicate clay with a lamellar, non-fibrous crystalline structure that gives it strong adsorbent properties. Its mechanisms of action are not yet fully understood, but are probably multiple. Diosmectite reduces inflammation, modifies mucus rheologic properties, inhibits mucolysis, and adsorbs bacteria, bacterial enterotoxins, viruses and other potentially diarrheogenic substances.A number of studies have shown that diosmectite reduces the duration of diarrhea and decreases the frequency of bowel motions after 2 days of treatment in children with mild-to-moderate acute diarrhea. Two recent trials have indicated a reduction in stool output with diosmectite. Because of its very favorable safety profile, with no serious adverse effects, diosmectite is frequently used, mainly in European countries but also in Asia and Africa. Diosmectite should be used as an adjunct, not an alternative, to ORT and, when needed, to antibacterial therapy.

Clinical benefits of probiotic canine-derived Bifidobacterium animalis strain AHC7 in dogs with acute idiopathic diarrhea.

This study evaluated the effect of supplementation with canine-derived probiotic Bifidobacterium animalis strain AHC7 (lams Prostora, Procter & Gamble Pet Care) on the resolution rate of acute idiopathic diarrhea in dogs randomly assigned to receive a placebo (n=18) or the probiotic (n=13). Nutritional management with the probiotic fed at 2 x 10(10) CFU/day significantly reduced the time to resolution (3.9 +/- 2.3 versus 6.6 +/- 2.7 days; P < .01) and reduced the percentage of dogs that were administered metronidazole (38.5% versus 50.0%) compared with placebo. Probiotic B. animalis AHC7 may provide veterinarians another tool for management of acute diarrhea in dogs.

The Management of Acute Diarrhoea in a Healthy Adult Population Deploying on Military Operations

Acute diarrhoea is consistently the number one presentation to secondary care facilities on UK military operational deployments. It can result in potentially life threatening consequences as seen on Operation Herrick...

Prise en charge des diarrhées aiguës en France : quels progrés?

The management of acute diarrhoea in France improved during the last ten years, with a large increase of oral rehydration solution (ORS) prescription in infants. Severity assessment is too often based on an uncertain evaluation of weight loss instead of a clinical determination. Telephone triage is not accurate without use of protocols and decision-making guidelines. Laboratory tests are rare in ambulatory management but still too frequent in hospital management of children with oral rehydration. ORS prescription of general practitioners regularly increased: 16 % in 1988, 29 % in 1996, 39 % in 2001; and 71% in 2005 (after their reimbursement). The quality of oral rehydration advice remains insufficient. Intravenous rehydration on admission remains still too frequent. Drugs prescriptions include 2 or 3 drugs, with a decrease of loperamide and antibiotics, and an increase of racecadotril (81%). Lactose-free milk prescriptions in infants dropped from 46 % in 1996 to 16 % in 2005. Isolation and disinfection procedures are insufficient. Rotavirus nosocomial infections incidence is high: 1,6 to 6,3 / 1000 children less than 5 years of age, contributing to high direct costs.