Management Of Infectious Diarrhea Research Articles

A Multidisciplinary Approach in the Management of Infectious Diarrhea in the Emergency Department.

Background Globally, infectious diarrhea poses a serious threat to public health, especially in emergency department (ED) settings where timely and efficient treatment is essential. The primary objective of this study was to explore and evaluate the efficacy of a multidisciplinary approach (MDA) in the management of infectious diarrhea within the ED setting. Methodology This prospective cohort study was conducted from January to December 2023 at the Lady Reading Hospital ED in Peshawar, Pakistan. Individuals 18 years of age or older with a confirmed diagnosis of infectious diarrhea were included in the study. Those who refused to participate or had non-infectious reasons were excluded from the study. Through successive sampling, 650 patients comprised the study sample. Using a standardized form, demographic information, clinical presentations, test results, treatment methods, and patient outcomes were collected. Descriptive statistics and logistic regression were used in statistical studies to assess treatment outcomes and complications. Results Of the 650 patients, the majority (203 patients, 31.23%) were between the ages of 30 and 39 years. The gender distribution was about equal (332 men, 51.08%; 318 females, 48.92%). Abdominal pain (383 patients, 58.92%) was the most common presenting complaint. In 310 instances, bacterial pathogens were found, 160 had viral infections, and 110 had parasitic infections. There were notable complications, such as sepsis (37 patients, 5.69%), although the response to treatment effectiveness was notably high (593 patients, 91.08%). Upon follow-up, 590 (90.77%) patients had symptom and sign resolution, while 80 (12.31%) patients had a low recurrence rate. Longer symptom duration (odds ratio (OR) = 1.45, 95% confidence interval (CI) 1.12-1.88, p = 0.005) and specific antibiotics (OR = 1.68, 95% CI = 1.25-2.25, p = 0.001) were found to improve treatment success using logistic regression, whereas the risks of complications increased with age (OR = 1.05, 95% CI = 1.01-1.09, p = 0.012) and severe dehydration (OR = 1.75, 95% CI = 1.32-2.31, p < 0.001). Conclusions The MDA to manage infectious diarrhea in the ED significantly improved patient outcomes and reduced complications.

Percentage Destabilization Effect of Some West African Medicinal Plants on the Outer Membrane of Various Bacteria Involved in Infectious Diarrhea.

Previous work stated that Khaya senegalensis, Anacardium ouest L., Pterocarpus erinaceus, Diospyros mespiliformis, Ocimum gratissimum, Manihot esculenta, Vernonia amygdalina Delile, and Daniellia oliveri have a great potential for the fight against infectious diarrhea. However, data on their antibacterial activity on strains of bacteria responsible for infectious diarrhea are not available. This study is aimed at elucidating the mechanism of action of the antibacterial effect of these plants on some bacterial strains responsible for diarrheal infections. The design of the study included first evaluating the degree of sensitivity of Salmonella typhimurium 14028, Escherichia coli ATCC 25922, Shigella spp., and Salmonella spp. strains to aqueous and hydroethanolic extracts of each plant, followed by the determination of minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and antibiotic power (Pa). This screening was completed with the evaluation of the possible mode of action of the extracts by testing the membrane permeability of these bacterial strains. The data collected indicate that the bacterial strains tested were sensitive to the extracts to varying degrees, except Cassia sieberiana DC and Pseudocedrela kotschyi extracts. For the active extracts, inhibition diameters ranged from 18.33 mm to 7 mm. With the exception of Escherichia coli, all strains were sensitive to the aqueous and hydroethanolic extracts of Anacardium occidentale. MICs vary between 3.37 and 25 mg/ml. Membrane permeability test data show that all active extracts affect the bacterial strains tested by attacking the stability of their outer membrane. For all active extracts, the high percentage of membrane destabilization of the bacteria is significantly (p < 0.05) better than that of cefixime used as a reference. Thus, it appears that these extracts can destroy Gram-negative bacteria and increase the fluidity and permeability of their cytoplasmic membrane. The knowledge of the mechanism of action of these extracts is an interesting contribution to the fundamental knowledge on the alternative that medicinal plants represent to antibiotics. These extracts can be used in the management of infectious diarrhea.

Infectious diarrhea, mechanisms of infections and clinical management: a review

Infectious diarrhea (ID), caused by an infectious pathogen, is often accompanied by vomiting, nausea, and abdominal cramps. Diarrhea is associated with malnutrition, impaired cognitive, and physical development. There are several pathogens involved in ID, including Salmonella, Shigella, and Escherichia coli. The current study aimed to highlight the mechanism and management of ID. The articles involved in this review were obtained from scientific websites using several keywords. A total of 15 studies are included in the current review. The exact mechanism of ID varies based on causative agents; however, some pathogenic mechanisms are unknown. The management of ID includes replacing the loss of solution and electrolytes with rehydrating solutions and effective nutrients for the patient and the usage of antimicrobial agents against the pathogens.

Protective effect of SKB_Gutbiotic against castor oil and E.coli induced diarrhea in laboratory animals

The aim of this study is to evaluate antidiarrheal activity of SKB_Gutbiotic against Castor oil and E.coli induced diarrhea in Swiss albino mice and Sprague Dawley rats. In present study three doses of SKB_Gutbiotic were tested against castor oil induced diarrhea in mice. Its effect on co-administration with l-arginine was studied. SKB_Gutbiotic delayed onset of diarrhea, reduced fecal output and fecal weight. In Gastrointestinal transit time and Castor oil induced enteropooling, SKB_Gutbiotic significantly reduced peristaltic index and volume of intestinal content respectively. In E.coli induced diarrhea model, E.coli suspension was administered for 3 days for inducing diarrhea. SKB_Gutbiotic significantly and dose dependently reduced fecal output, improved fecal consistency, reduced fecal water content and improved WBC count. Histopathological images showed improvement in damage caused to the mucosal epithelium due to E.coli and also improved complete crypt cell architecture and integrity of goblet cells. These results indicated that SKB_Gutbiotic can be used as an antidiarrheal agent against castor oil and E.coli induced diarrhea. It inhibits colonization of E.coli bacteria on colonic epithelium which results into decreased intestinal hypersecretion and motility which is very useful in the management of infectious diarrhea. Thus SKB_Gutbiotic could be an effective alternative to standard antidiarrheal drugs.

&amp;lt;i&amp;gt;In-Vitro&amp;lt;/i&amp;gt; Comparison of Antimicrobial Actions of Probiotics (&amp;lt;i&amp;gt;Lactobacilli&amp;lt;/i&amp;gt; Species and &amp;lt;i&amp;gt;Saccharomyces boulardii&amp;lt;/i&amp;gt;) with Standard Antibiotics for the Treatment of Diarrhea in Pediatric Population

Background and objectives: Irrational and repeated use of broad spectrum antibiotics for infectious diarrhea in children has resulted in their increased resistance along with several systemic toxic effects. Probiotics are also used in the management of infectious diarrhea as these are supposed to be favorable in promoting overall health benefits including stability of the intestinal flora. However, these agents are not used as an alternative to antibiotics as their exact bactericidal/bacteriostatic effects have not been evaluated on the basis of any clinical or in-vitro samples (Culture and Sensitivity test). Hence the aim of our study was to compare the culture and sensitivity patterns of standard antibiotics and two probiotics, Lactobacilli (Lactobacillus paracasei/Lactobacillus acidophilus) and Saccharomyces boulardii used for the treatment of infectious diarrhea in children less than 5 years of age in a tertiary care hospital of Karachi, Pakistan. Methodology: This prospective quasi experimental study was conducted for a period of six months. After getting informed consent from parents/guardians, the stool samples were obtained from children of ages, 6 months to 5 years, presented with signs and symptoms of diarrhea in outpatient department (OPD) or being referred to microbiology department for stool C/S (culture and sensitivity). The sensitivity patterns of the cultured isolates were assessed for standard antibiotics according to the CLSI guidelines (2018), while the two probiotics (Lactobacilli and Saccharomyces boulardii) were evaluated by means of Dried Modification method. The data was analyzed using statistical software SPSS version 19.0. Results: A total number of 325 stool samples were collected, out of which 152 samples were positive for pathogens i.e. E. coli, Klebsiella and Salmonella typhi. The sensitivity of combination of Lactobacilli for E. coli, Klebsiella and Salmonella typhi was 28.3%, 25% and 25% respectively. While, for Saccharomyces boulardii the sensitivity for E. coli, Klebsiella and Salmonella typhi was 37%, 32.1% and 25% respectively, which were slightly higher or equivalent to commonly prescribed antibiotics such as Amoxicillin/Clavulanic acid, Ceftazidime, Ampicillin, Cefotaxime, Cefuroxime, Ceftriaxone, Aztreonam, Trimethoprim/ Sulfmethoxazole and Nalidixic acid. In comparison, the antibiotics which are not frequently used for infectious diarrhea showed higher sensitivities for all isolated organisms; as for E. coli the highest sensitivity was observed for Amikacin (96.7%), Gentamycin (95.7%) Imipenim (95.7%) and Piperacillin/Tazobactam (84.8%). Moreover, for Klebsiella the highest sensitivity was observed for Imipenim (98.2%), followed by Amikacin (94.6%), Piperacillin/Tazobactam (92.9%) and Gentamycin (89.3%). Conclusion: On in-vitro cultured samples, the two probiotics Lactobacilli and Saccharomyces boulardii have shown slightly higher or equivalent sensitivity in comparison to the most commonly prescribed antibiotics (Amoxicillin/Clavulanic acid, Ceftazidime, Ampicillin, Cefotaxime, Cefuroxime Ceftriaxone, Aztreonam, Trimethoprim/Sulfmethoxazole and Nalidixic acid). However, both probiotics displayed lower sensitivity in comparison to some broad spectrum but less commonly prescribed antibiotics (Amikacin, Gentamycin, Imipenim and Piperacillin/Tazobactam) in our clinical settings.

2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea.

These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. They are not intended to replace physician judgement regarding specific patients or clinical or public health situations. This document does not provide detailed recommendations on infection prevention and control aspects related to infectious diarrhea.

2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea.

These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. They are not intended to replace physician judgement regarding specific patients or clinical or public health situations. This document does not provide detailed recommendations on infection prevention and control aspects related to infectious diarrhea.

Follow-Up Trends of Bacterial Etiology of Diarrhoea and Antimicrobial Resistance in Urban Areas of Bangladesh

Background: Diarrhoea is considered as the most widespread illness occurring in Bangladesh. In addition, the growing antimicrobial resistance of diarrhoeal pathogens in this developing country hardens physicians to supervise patients effectively. Objectives: In our study, we retrospectively analysed the data of a diarrhoeal pathogens and their antimicrobial resistant patterns isolated from diarrhoeal patients attending Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka and domiciliary patients of Dhaka city of Bangladesh. Patients and Methods: During a six-year period (2009 - 2014), a total of 90207 diarrhoeal specimens were collected from patients to screen bacterial etiology by standard culture methods. Antimicrobial susceptibility testing was performed for culture-positive selected diarrhoeal pathogens using disk diffusion method. Results: One or more potential pathogens were identified in 20467 (23%) patients, more often from under-five children. The most predominant etiological agent was Vibrio spp. (33.23%), followed by Campylobacter spp. (26.04%), Shigella spp. (19.12%), Aeromonas spp. (12.21%), Salmonella spp. (6.74%) and Plesiomonas shigelloides (2.66%). Among children under the age of five, Campylobacter spp., Vibrio spp. and Shigella spp. were more common. V. cholerae O1 El Tor biotype was the predominant pathogen (90.75%) among all the Vibrio spp. isolated. High prevalence of multiple antibiotic resistances towards ampicillin (AM), ciprofloxacin (CIP) and co-trimoxazole (SXT) was common among Vibrio spp., Shigella spp. and Campylobacter spp. Beside, correlation with previous data from 2005 - 2008 showed that resistant percentages of Shigella spp., Campylobacter spp., Salmonella spp. to these antibiotics are increasing with time (P < 0.001). Conclusions: These findings underscored the importance of monitoring and developing guidelines for better management of infectious diarrhoea in Bangladesh and elsewhere.

A Review on the Biochemical, Antimicrobial and Organoleptic Studies on the Germination Profile of Finger Millet (Eleusine coracana

Finger millets (or ragi) are cereals and the staple food of the millions residing in the arid and semi-arid tropics of the world. The grains of finger millets, being nutritionally superior to wheat provide Carbohydrates, dietary fibers, minerals and vitamins to poorest of the poor where the need is essential. Finger millet can be regarded as a functional food, to be taken as part of the usual diet in order to have ben- eficial effects that go beyond basic nutritional function, thus helping to reduce the risk of obesity, malnutrition, and premature aging. An important factor of the functional food which is required to reduce the risk of chronic illnesses is 'proper intake and antibacterial activity'. Antibacterial is used to treat bacterial infections, Germinated finger millet seeds extract (12hour sample) has a bactericidal property against Escherichia coli and can be consumed for management of infectious diarrhoea. However prolonged use of certain antibacterial can decrease the number of gut flora, which may have a negative impact on health. Results indicate that potential exists to utilize finger millet as an alternative natural antioxidant and food preservative. Sensory evaluation was carried out to project the organoleptic appeal, which proved that ragi sample was very well accepted.

In-Hospital Costs of Laparoscopy and/or Fast Track Multimodal Management Versus Open and/or Standard Care in Colonic Surgery (LAFA-Trial)

Introduction: Antimicrobial peptides represent an important component of the innate defense of organisms ranging from plants to insects to humans. They are broad-spectrum, surface acting agents secreted by the epithelial cells of the body including intestine and respiratory tract, which kill microbes. Most such peptides possess activities against bacteria, viruses and fungi. Recently, L-isoleucine and its analogues have been found to induce antimicrobial peptides.Therefore, L-isoleucine might have therapeutic potentials in the management of infectious diarrhea. Vitamin D is another organic molecule in addition to its effect on calcium metabolism, induces antimicrobial peptides secretion through activating the toll like receptor of macrophages and leading to induction of antimicrobial peptides, and killing of bacteria. Bacterial resistance to antibiotics is a growing concern in both nosocomial and community acquired infections. Development and recommendation of newer antimicrobials are much slower than the emergence of bacterial resistance. The use of L-isoleucine and vitamin D might have beneficial effect in the treatment of acute diarrhea in children. Objectives: The objectives of this study were to examine if addition of L-isoleucine and/or vitamin D to a liquid diet reduces the stool weight and/or duration of acute diarrhea in children. Methods: This was a double blind randomized controlled clinical trial in 107 children aged 6 to 36 months attending the ICDDRB hospital with acute diarrhea: 28 children received a) Lisoleucine (2 g/d) added to milk suji(mixture of milk and rice powder, 70 Kcal/100 ml) ; b) 27 received Vitamin D 1000 IU/d added to Milk suji; c) 26 children received L-isoleucine (2g/d) plus vitamin D 1000 IU/d added to milk Suji; d) Milk suji without L-isoleucine and vitamin D. Other managements were similar in all treatment groups. The children remained in the study until recovery from diarrhea but up to a maximum of 5 days. Stool weight and time to resolution of diarrhea were the primary outcomes. Results: Baseline clinical characteristics of the children are comparable between the groups. There is a trend in stool weight (g) reduction in the groups receiving L-isoleucine and the reduction is significant on day 2 (mean ±SD; Control, 447 ± 325 vs. L-isoleucine gr, 276 ± 228 vs. L-isoleucine + Vit. D gr, 301 ± 181 vs. Vit. D gr, 386 ± 302, p=0.039) and day3 (mean ± SD, Control, 341 ± 292 vs. L-isoleucine gr, 176 ± 157 vs. L-isoleucine + Vit. D gr, 267 ± 169 vs. Vit. D gr, 321 ± 273, p=0.045). However, the duration of recovery from diarrhea was similar in four treatment groups. Conclusion: L-isoleucine supplemented food reduces stool weight in children with acute diarrhea. Further large study is recommended to establish the beneficial effect of L-isoleucine supplemented food.

Efficacy of L-Isoleucine Supplemented Food and Vitamin D in the Treatment of Acute Diarrhea in Children

Introduction: Antimicrobial peptides represent an important component of the innate defense of organisms ranging from plants to insects to humans. They are broad-spectrum, surface acting agents secreted by the epithelial cells of the body including intestine and respiratory tract, which kill microbes. Most such peptides possess activities against bacteria, viruses and fungi. Recently, L-isoleucine and its analogues have been found to induce antimicrobial peptides.Therefore, L-isoleucine might have therapeutic potentials in the management of infectious diarrhea. Vitamin D is another organic molecule in addition to its effect on calcium metabolism, induces antimicrobial peptides secretion through activating the toll like receptor of macrophages and leading to induction of antimicrobial peptides, and killing of bacteria. Bacterial resistance to antibiotics is a growing concern in both nosocomial and community acquired infections. Development and recommendation of newer antimicrobials are much slower than the emergence of bacterial resistance. The use of L-isoleucine and vitamin D might have beneficial effect in the treatment of acute diarrhea in children. Objectives: The objectives of this study were to examine if addition of L-isoleucine and/or vitamin D to a liquid diet reduces the stool weight and/or duration of acute diarrhea in children. Methods: This was a double blind randomized controlled clinical trial in 107 children aged 6 to 36 months attending the ICDDRB hospital with acute diarrhea: 28 children received a) Lisoleucine (2 g/d) added to milk suji(mixture of milk and rice powder, 70 Kcal/100 ml) ; b) 27 received Vitamin D 1000 IU/d added to Milk suji; c) 26 children received L-isoleucine (2g/d) plus vitamin D 1000 IU/d added to milk Suji; d) Milk suji without L-isoleucine and vitamin D. Other managements were similar in all treatment groups. The children remained in the study until recovery from diarrhea but up to a maximum of 5 days. Stool weight and time to resolution of diarrhea were the primary outcomes. Results: Baseline clinical characteristics of the children are comparable between the groups. There is a trend in stool weight (g) reduction in the groups receiving L-isoleucine and the reduction is significant on day 2 (mean ±SD; Control, 447 ± 325 vs. L-isoleucine gr, 276 ± 228 vs. L-isoleucine + Vit. D gr, 301 ± 181 vs. Vit. D gr, 386 ± 302, p=0.039) and day3 (mean ± SD, Control, 341 ± 292 vs. L-isoleucine gr, 176 ± 157 vs. L-isoleucine + Vit. D gr, 267 ± 169 vs. Vit. D gr, 321 ± 273, p=0.045). However, the duration of recovery from diarrhea was similar in four treatment groups. Conclusion: L-isoleucine supplemented food reduces stool weight in children with acute diarrhea. Further large study is recommended to establish the beneficial effect of L-isoleucine supplemented food.

S1026 The use of 2L Polyethylene Glycol With Electrolytes and Ascorbate Components for Bowel Cleansing Prior to Colonoscopy in 50 to 74 Year Olds in France

Introduction: Antimicrobial peptides act as innate defense of organisms ranging from plants to insects to humans. They are surface acting agents secreted by all epithelial cells including intestine, which kill microbes. Such peptides possess activities against bacteria, viruses and fungi. As pharmacological induction of these antimicrobial peptides could have potential therapeutic utility, a search for novel molecules that induces production of epithelial antimicrobial peptides has long been sought. Recently, L-isoleucine and its analogues have been found to induce antimicrobial peptides in epithelial surfaces of intestine. So, L-isoleucine might have therapeutic potentials in the management of infectious diarrhea. Aim: The aims of this study were to examine if addition of L-isoleucine to currently recommended (WHO) oral rehydration solution (ORS) reduces the stool weight and/or duration of acute diarrhea. Methods: This was a double blind randomized clinical trial in 51 male children aged 6 to 36 months attending the ICDDRB hospital with acute diarrhea; 26 children received Lisoleucine (2 g/L) added ORS (study) and 25 received ORS without L-isoleucine(control). Other managements were similar. The children remained in the study until recovery from diarrhea but up to a maximum of 5 days. Time to resolution of diarrhea and stool weight were the primary outcomes. Results: Baseline clinical characteristics of the children were comparable between the groups. There was a trend in reduction of stool weight (g) from day 2 ( day1 to day3, study vs. control, stool wt, mean ±SD, 560±240 vs. 563±409, p= 0.93; 407±284 vs. 515±316, p=0.24; 363±284 vs. 651±445, p=0.03 respectively) in the groups receiving ORS with L-isoleucine and the difference was significant on day3. ORS intake (ml) also showed similar trend (day1 to day3 mean ±SD, 410±169 vs. 564±301, p= 0.14; 330±245 vs. 401±226, p=0.33; 312±233 vs. 454±260, p=0.09 respectively), however, the differences were not statistically significant. Duration of diarrhea (hr) was similar in both groups (study vs. control, mean ±SD, 74±38 vs. 75 ±42, p=0.96). Conclusion: Lisoleucine supplemented ORS reduces stool weight and ORS intake in children with acute diarrhea. Further large study is warranted to establish the beneficial effect of L-isoleucine supplemented ORS.

S1025 Efficacy, Safety and Acceptability of a 2L Polyethylene Glycol With Electrolytes and Ascorbate Components Solution Versus 4L Polyethylene Glycol and Electrolytes Solution for Bowel Cleansing Prior to Colonoscopy

Introduction: Antimicrobial peptides act as innate defense of organisms ranging from plants to insects to humans. They are surface acting agents secreted by all epithelial cells including intestine, which kill microbes. Such peptides possess activities against bacteria, viruses and fungi. As pharmacological induction of these antimicrobial peptides could have potential therapeutic utility, a search for novel molecules that induces production of epithelial antimicrobial peptides has long been sought. Recently, L-isoleucine and its analogues have been found to induce antimicrobial peptides in epithelial surfaces of intestine. So, L-isoleucine might have therapeutic potentials in the management of infectious diarrhea. Aim: The aims of this study were to examine if addition of L-isoleucine to currently recommended (WHO) oral rehydration solution (ORS) reduces the stool weight and/or duration of acute diarrhea. Methods: This was a double blind randomized clinical trial in 51 male children aged 6 to 36 months attending the ICDDRB hospital with acute diarrhea; 26 children received Lisoleucine (2 g/L) added ORS (study) and 25 received ORS without L-isoleucine(control). Other managements were similar. The children remained in the study until recovery from diarrhea but up to a maximum of 5 days. Time to resolution of diarrhea and stool weight were the primary outcomes. Results: Baseline clinical characteristics of the children were comparable between the groups. There was a trend in reduction of stool weight (g) from day 2 ( day1 to day3, study vs. control, stool wt, mean ±SD, 560±240 vs. 563±409, p= 0.93; 407±284 vs. 515±316, p=0.24; 363±284 vs. 651±445, p=0.03 respectively) in the groups receiving ORS with L-isoleucine and the difference was significant on day3. ORS intake (ml) also showed similar trend (day1 to day3 mean ±SD, 410±169 vs. 564±301, p= 0.14; 330±245 vs. 401±226, p=0.33; 312±233 vs. 454±260, p=0.09 respectively), however, the differences were not statistically significant. Duration of diarrhea (hr) was similar in both groups (study vs. control, mean ±SD, 74±38 vs. 75 ±42, p=0.96). Conclusion: Lisoleucine supplemented ORS reduces stool weight and ORS intake in children with acute diarrhea. Further large study is warranted to establish the beneficial effect of L-isoleucine supplemented ORS.

S1024 Evaluation of the Efficacy of L-Isoleucine Supplemented Oral Rehydration Solution in the Treatment of Acute Diarrhea in Children

Introduction: Antimicrobial peptides act as innate defense of organisms ranging from plants to insects to humans. They are surface acting agents secreted by all epithelial cells including intestine, which kill microbes. Such peptides possess activities against bacteria, viruses and fungi. As pharmacological induction of these antimicrobial peptides could have potential therapeutic utility, a search for novel molecules that induces production of epithelial antimicrobial peptides has long been sought. Recently, L-isoleucine and its analogues have been found to induce antimicrobial peptides in epithelial surfaces of intestine. So, L-isoleucine might have therapeutic potentials in the management of infectious diarrhea. Aim: The aims of this study were to examine if addition of L-isoleucine to currently recommended (WHO) oral rehydration solution (ORS) reduces the stool weight and/or duration of acute diarrhea. Methods: This was a double blind randomized clinical trial in 51 male children aged 6 to 36 months attending the ICDDRB hospital with acute diarrhea; 26 children received Lisoleucine (2 g/L) added ORS (study) and 25 received ORS without L-isoleucine(control). Other managements were similar. The children remained in the study until recovery from diarrhea but up to a maximum of 5 days. Time to resolution of diarrhea and stool weight were the primary outcomes. Results: Baseline clinical characteristics of the children were comparable between the groups. There was a trend in reduction of stool weight (g) from day 2 ( day1 to day3, study vs. control, stool wt, mean ±SD, 560±240 vs. 563±409, p= 0.93; 407±284 vs. 515±316, p=0.24; 363±284 vs. 651±445, p=0.03 respectively) in the groups receiving ORS with L-isoleucine and the difference was significant on day3. ORS intake (ml) also showed similar trend (day1 to day3 mean ±SD, 410±169 vs. 564±301, p= 0.14; 330±245 vs. 401±226, p=0.33; 312±233 vs. 454±260, p=0.09 respectively), however, the differences were not statistically significant. Duration of diarrhea (hr) was similar in both groups (study vs. control, mean ±SD, 74±38 vs. 75 ±42, p=0.96). Conclusion: Lisoleucine supplemented ORS reduces stool weight and ORS intake in children with acute diarrhea. Further large study is warranted to establish the beneficial effect of L-isoleucine supplemented ORS.

Guidance for Substantiating the Evidence for Beneficial Effects of Probiotics: Prevention and Management of Infections by Probiotics1–3

The rationale for the use of probiotics in the management of infectious diseases is supported by their potential to influence and stabilize the composition of gut microbiota, enhance colonization resistance, and modulate immune function parameters. A literature review was conducted to determine the efficacy of using probiotics in selected infections: 1) infectious diarrhea in infants and children, 2) traveler's diarrhea, 3) necrotizing enterocolitis in infants, 4) Helicobacter pylori infection, 5) respiratory tract infections in adults and children, 6) ear, nose, and throat infections, and 7) infectious complications in surgical and critically ill patients. The different types of infections that have been subject to clinical studies with different probiotics obviously prevent any generic conclusions. Furthermore, the lack of consistency among studies focusing on 1 specific infection, in study design, applied probiotic strains, outcome parameters, and study population, along with the still limited number of studies, preclude clear and definite conclusions on the efficacy of probiotics and illustrate the need for better-aligned study designs and methodology. Exceptions were the management of infectious diarrhea in infants and traveler's diarrhea, antibiotic-associated diarrhea, and necrotizing enterocolitis. Sufficient consistent data exist for these applications to conclude that certain probiotics, under certain conditions, and in certain target populations, are beneficial in reducing the risk of infection. In addition, some evidence exists, although conclusions are premature, for the management of Helicobacter pylori infection and possible reduction of treatment side effects. Certain probiotics may also reduce the risk of various symptoms of respiratory tract infections in adults and children, including ear, nose, and throat infections, although data are currently far too limited to distill any clinical recommendations in this area. Positive but also negative results have been obtained in prevention of infectious complications in surgical and critically ill patients. For future studies it is recommended that researchers provide adequate power, identify pathogens, and report both clinical outcomes and immune biomarkers relating to putative underlying mechanisms.

Treatment of Infectious Diarrhea in Children

Diarrheal diseases remain an important cause of childhood morbidity and death in developing countries, although diarrheal deaths have significantly declined in recent years, mostly due to successes in the implementation of oral rehydration therapy (ORT), which is the principal treatment modality.Diarrhea may occur for varied reasons; however, most episodes of diarrhea in developing countries are infectious in origin. Three clinical forms of diarrhea (acute watery diarrhea, invasive diarrhea, and persistent diarrhea) have been identified to formulate a management plan. Acute diarrhea may be watery (where features of dehydration are prominent) or dysenteric (where stools contain blood and mucus).Rehydration therapy is the key to management of acute watery diarrhea, whereas antimicrobial agents play a vital role in the management of acute invasive diarrhea, particularly shigellosis and amebiasis. In persistent diarrhea, nutritional therapy, including dietary manipulations, is a very important aspect in its management, in addition to rehydration therapy. Rehydration may be carried out either by the oral or intravenous route, depending upon the degree of dehydration. Oral rehydration salts (ORS) solution (World Health Organization formula) is recommended for ORT. Intravenous fluid is recommended for initial management of severe dehydration due to diarrhea, followed by ORT with ORS solution for correction of ongoing fluid losses. Antimicrobial therapy is beneficial for cholera and shigellosis. Antiparasitic agents are indicated only if amebiasis and giardiasis are present.Appropriate feeding during diarrhea is recommended for nutritional recovery and to prevent bodyweight loss. Antidiarrheal agents do not provide additional benefit in the management of infectious diarrhea. Although some probiotics have been shown to be beneficial in the treatment of acute diarrhea due to rotavirus, their use in the treatment of diarrhea is yet to be recommended, even in developed countries. The children of developing countries might benefit from zinc supplementation during the diarrheal illness, but its mode of delivery and cost effectiveness are yet to be decided.

Treatment of infectious diarrhea in children.

Diarrheal diseases remain an important cause of childhood morbidity and death in developing countries, although diarrheal deaths have significantly declined in recent years, mostly due to successes in the implementation of oral rehydration therapy (ORT), which is the principal treatment modality. Diarrhea may occur for varied reasons; however, most episodes of diarrhea in developing countries are infectious in origin. Three clinical forms of diarrhea (acute watery diarrhea, invasive diarrhea, and persistent diarrhea) have been identified to formulate a management plan. Acute diarrhea may be watery (where features of dehydration are prominent) or dysenteric (where stools contain blood and mucus). Rehydration therapy is the key to management of acute watery diarrhea, whereas antimicrobial agents play a vital role in the management of acute invasive diarrhea, particularly shigellosis and amebiasis. In persistent diarrhea, nutritional therapy, including dietary manipulations, is a very important aspect in its management, in addition to rehydration therapy. Rehydration may be carried out either by the oral or intravenous route, depending upon the degree of dehydration. Oral rehydration salts (ORS) solution (World Health Organization formula) is recommended for ORT. Intravenous fluid is recommended for initial management of severe dehydration due to diarrhea, followed by ORT with ORS solution for correction of ongoing fluid losses. Antimicrobial therapy is beneficial for cholera and shigellosis. Antiparasitic agents are indicated only if amebiasis and giardiasis are present. Appropriate feeding during diarrhea is recommended for nutritional recovery and to prevent bodyweight loss. Antidiarrheal agents do not provide additional benefit in the management of infectious diarrhea. Although some probiotics have been shown to be beneficial in the treatment of acute diarrhea due to rotavirus, their use in the treatment of diarrhea is yet to be recommended, even in developed countries. The children of developing countries might benefit from zinc supplementation during the diarrheal illness, but its mode of delivery and cost effectiveness are yet to be decided.

Guidelines for the management of infectious diarrhoea

Guidelines for the management of infectious diarrhoea

Guidelines for the management of infectious diarrhoea

Guidelines for the management of infectious diarrhoea

Infections of the Gastrointestinal Tract: Microbiology, Pathophysiology, and Clinical Features

Diarrhea is a common complaint and a book discussing the mechanisms and clinical management of infectious diarrhea would be a useful addition to the clinician's library; Drs DuPont and Pickering have written such a monograph. The title is more inclusive than the contents: they have not discussed antibiotic associated pseudomembranous colitis, infestation of the gastrointestinal (GI) tract by metazoan parasites, or infections of the GI tract by sexually transmitted organisms or tuberculosis. The book has a succinct discussion of host-factors influencing susceptibility to, and expression of, infectious diarrhea. The reviews of diarrhea caused by enterotoxin-producing organisms and viruses are comprehensive and accompanied by excellent reference lists. Food-borne diarrheal syndromes and recently recognized agents such as Campylobacter and Yersinia are only briefly discussed in the chapter on epidemiology. In many parts of the world, the physician responsible for the investigation of epidemic diarrhea has no special training in infectious diseases and