Treatment Of Acute Diarrhea Research Articles

Racecadotril for acute diarrhoea in children: systematic review and meta-analyses

ObjectiveRacecadotril is an antisecretory agent that can prevent fluid/electrolyte depletion from the bowel as a result of acute diarrhoea without affecting intestinal motility. An up-to-date systematic review is indicated to...

Treatment of Acute Diarrhoea: Past and Now

Context: Since ancient times diarrhoea has been a highly fatal disease and even today diarrhoea, the topic of this review, is a problem affecting millions of people around the world despite the efforts of governments and professionals from the medical area. Worldwide the most common cause of children’s death is diarrhoea. Evidence Acquisition: Diarrhoea disorders generally appear with watery stools, sometimes mixed with blood, accompanied by abdominal pain, vomiting and fever. The symptoms depend on the content and distribution of body fluid, daily water requirements and physiological water loss in connection with age through sweating, urination and breathing, the degree of fluid and electrolyte loss in the liquid stool. Results: Several effective interventions have been introduced as part of diarrhoea management in the last two decades such as rehydration solution, zinc supplementation, vitamin A supplementation and administration of antibiotics and vaccines. To reduce the mortality rate, control of safe drinking water, good sanitation and vaccination against typhoid and cholera are recommended, especially in high-risk populations. Probiotics have been proposed, after more than a half of century, as additional therapy in the treatment of acute diarrhoea. Several probiotic strains showed benefit in meta-analyses of randomised controlled trials. Conclusions: Due to the high level of evidence available, the term oral bacterio therapy, used for decades in the prevention and the rapyof gastroenteritis in the growing age and adults, has expanded, but probiotics are acquiring significant scientific value based on theresults from human trials. The future of probiotics depends on further explanation/elucidation of basic mechanisms, allowing scientists and physicians to maximize their health benefits.

Xyloglucan for the treatment of acute diarrhea: results of a randomized, controlled, open-label, parallel group, multicentre, national clinical trial.

BackgroundThere is a strong rationale for the use of agents with film-forming protective properties, like xyloglucan, for the treatment of acute diarrhea. However, few data from clinical trials are available.MethodsA randomized, controlled, open-label, parallel group, multicentre, clinical trial was performed to evaluate the efficacy and safety of xyloglucan, in comparison with diosmectite and Saccharomyces in adult patients with acute diarrhea due to different causes.Patients were randomized to receive a 3-day treatment. Symptoms (stools type, nausea, vomiting, abdominal pain and flatulence) were assessed by a self-administered ad-hoc questionnaire 1, 3, 6, 12, 24, 48 and 72 h following the first dose administration. Adverse events were also recorded.ResultsA total of 150 patients (69.3 % women and 30.7 % men, mean age 47.3 ± 14.7 years) were included (n = 50 in each group). A faster onset of action was observed in the xyloglucan group compared with the diosmectite and S. bouliardii groups. At 6 h xyloglucan produced a statistically significant higher decrease in the mean number of type 6 and 7 stools compared with diosmectite (p = 0.031). Xyloglucan was the most efficient treatment in reducing the percentage of patients with nausea throughout the study period, particularly during the first hours (from 26 % at baseline to 4 % after 6 and 12 h). An important improvement of vomiting was observed in all three treatment groups.Xyloglucan was more effective than diosmectite and S. bouliardii in reducing abdominal pain, with a constant improvement observed throughout the study. The clinical evolution of flatulence followed similar patterns in the three groups, with continuous improvement of the symptom. All treatments were well tolerated, without reported adverse events.ConclusionsXyloglucan is a fast, efficacious and safe option for the treatment of acute diarrhea.Trial registrationEudraCT number 2014-001814-24 (date: 2014-04-28)ISRCTN number: 90311828

Cost‐Effectiveness Analysis of Zinc Supplementation for Treatment of Acute Diarrhea in Children Younger Than 5 Years in Colombia

The objective of this study was to determine the cost-effectiveness of zinc supplementation for the treatment of acute diarrhea (AD) in children younger than 5 years in Colombia. The cost-effectiveness analysis was performed from the perspective of the Colombian health system. The standard treatment with the addition of zinc was compared with the standard treatment without zinc in children younger than 5 years. The time horizon was 1 month. Effectiveness was extracted from a systematic review of literature. The specific data for Colombia were taken from local databases and observational studies. To determine the costs, a typical case was constructed by reviewing guidelines and medical records and validated by experts. To evaluate the resources consumed, Colombian tariff manuals were used. Costs were stated in Colombian pesos (COP) and US dollar (USD) for 2010. Deterministic sensitivity analysis was performed to evaluate the impact of changes in cost and effectiveness of the strategies on the results from the model. The results from the model indicate that zinc supplementation is a dominant strategy; it is less costly and more effective than standard treatment without zinc (reduction of $15,210 COP [8.14 USD] per child). The results are sensitive to changes in the probability of hospitalization and of persistent diarrhea. Zinc for the treatment of AD is a highly cost-effective strategy and is recommended for inclusion in the benefit plan of the Colombian health system. This intervention is more cost-effective in children with a higher risk of persistent diarrhea and hospitalization.

Efficacy and safety of diosmectite in acute childhood diarrhoea: a meta-analysis

ObjectiveWe evaluated the role of diosmectite as an add-on treatment to the ‘recommended treatment’ of acute diarrhoea in children.MethodsWe searched all published literature through the major databases: Medline via Ovid,...

ACUTE DIARRHEA

Acute diarrhea is the fourth-ranking cause of death in children under the ageof 5 years. after neonatal causes, malaria, and acute respiratory infections. Objectives: Todetermine the role of Saccharomyces boulardii in the treatment of acute diarrhea. Design:Comparative study. Period: Six months, Mar to Aug 2013. Setting: Pediatric Unit II- LiaquatUniversity Hospital Jamshoro/ Hyderabad. Patients and methods: It consisted of 100 patients,of acute diarrhea with age between 3 months to 5 years reported to pediatric unit and fulfilledthe inclusion criteria. Cases were given low osmolar ORS, Zinc & Saccharomyces boulardii250mg twice daily for three days and controls were given low osmolar ORS and Zinc. P-value≤0.05 was considered as significant. Results: The results showed that 51 patients were maleand 49 patients were female. 27 male patients were in control and 24 were in case group. 23female patients were in control and 26 were in case group. The overall mean age of studysubjects was 26.73±12.65 months. Among reported patients most of the patients 84% werereported on 1st day. All reported patients had a complaint of loose motion with 73% also hadvomiting. All patients had watery loose motion. The mean duration was 4.20±1.70 days withthe mean frequency of 9.82±6.16 times. Among the patients 96 patients were hospitalized and97 patients were given I/V fluid. Among reported patients 10 were without dehyderation, 8 hadsome dehyderation, and 82 had severe dehyderation. 52 had acceptability of probiotics. Theresults were evaluated according to 1st, 2nd, and 3rd day post intervention. Among 50 patientsof case group, 18 patients were compliance. 49 patients had decrease in duration. The sameresults were observed in the decrease in frequency. Consistency was improved in 39 patients.The duration of hospitalization was reduced in 36 patients. It was observed that improvement inthe duration, frequency, and consistency was mostly observed on 2nd day of post intervention.Conclusions: The role of S. boulardii as a good biotherapeutic agent allowing to prevent and/ortreat several grastrointestinal diseases. In comparison to probiotic bacteria, the use of probioticyeast is beneficial when the treatment is combined to antibiotherapy.

Zinc for Acute Diarrhea and Amoxicillin for Pneumonia, Do They Work? : Delivered at the AIIMS, IJP Excellence Award for the year 2013 on 7th September 2014.

Acute diarrhea and pneumonia are the two largest killers of under-five children in the world. Zinc, used in management of acute diarrhea and Amoxicillin, used in community acquired pneumonia, feature in the list of 13 Life Saving Commodities for Women's and Children Health by the UN Commission. Zinc has caught wide scientific attention for the conceptual promise it has to offer for prevention, control and treatment of acute diarrhea. This presentation focuses on author's research on the mechanisms by which zinc might contribute to the pathogenesis of acute diarrhea and the degree of success achieved in diarrhea control and treatment by zinc supplementation including its impact on mortality. However, emerging evidence in terms of controlled studies in humans beckons a more complete understanding of the mechanistic basis for zinc supplementation. Current evidence indicates that studies specifically addressing the variability in response to zinc supplementation need to be undertaken to better comprehend these mechanisms. Similarly, the author presented her research that examined the role of oral amoxicillin in community management of severe pneumonia in children and the need to assess its universal efficacy in all children with severe pneumonia.

Role of integrons, plasmids and SXT elements in multidrug resistance of Vibrio cholerae and Providencia vermicola obtained from a clinical isolate of diarrhea.

The isolates of Vibrio cholerae and Providencia vermicola obtained from a diarrheal patient were investigated for genetic elements governing their drug resistance phenotypes. Out of 14 antibiotics tested, V. cholerae Vc IDH02365 isolate showed resistance to nine antibiotics, while P. vermicola Pv NBA2365 was found to be resistant to all the antibiotics except polymyxin B. Though SXT integrase was depicted in both the bacteria, class 1 integron was found to be associated only with Pv NBA2365. Integrons in Pv NBA2365 conferred resistance to β-lactams, aminoglycosides, and trimethoprim. Pv NBA2365 carried two transformable plasmids imparting distinct antibiotic resistance traits to their Escherichia coli transformants. In rabbit ileal loop assays, Pv NBA2365 did not show any fluid accumulation (FA) in contrast with Vc IDH02365 that showed high FA. To the best of our knowledge, this is the first report of a highly drug resistant P. vermicola and additionally co-existence of multidrug resistant V. cholerae and P. vermicola. Both the microbes appeared to possess a wide array of mobile genetic elements for a large spectrum of antimicrobial agents, some of which are being used in the treatment of acute diarrhea.

Probiotics for the treating acute diarrhea and preventing antibiotic-associated diarrhea in children

Probiotics are helpful in the treatment of acute diarrhea. Several systematic reviews show that the use of probiotics shortens the duration of diarrhea in one day and reduces by 59% the risk of diarrhea lasting longer than 4 days. Hospital stay is 24 hours shorter in children treated with probiotics. The benefitial effect of probiotics is species-specific; Lactobacillus rhamnosus GG and Saccharomyces boulardii are the two species with proven efficacy in the treatment of acute diarrhea. The use of probiotics reduces by 50% the risk of antibiotic-associated diarrhea. No significant side effects were found in the clinical trials but rare cases of invasive infections have been reported in immunosuppressed children or those with indwelling central venous catheters.

Cost effectiveness of Zinc Supplementation for the Treatment of Acute Diarrhoea in Children under 5 Years in Colombia

Cost effectiveness of Zinc Supplementation for the Treatment of Acute Diarrhoea in Children under 5 Years in Colombia

The Effect of Zinc Supplementation in Adult Patients with Acute Diarrhea

Background: Acute diarrhea is a common problem in developing country such as Indonesia with quite high morbidity andmortality rate. It was revealed that the level of zinc deficiency in adult acute diarrhea patients in several hospitals in Jakarta was 69.3%. Although zinc has been proven to be beneficial in the treatment of acute diarrhea in pediatric patients, the effect of zinc supplementation is not fully understood. The objective of this study was to discover the effectiveness of zinc supplementation as an adjuvant therapy in acute diarrhea for adult patients.Method: A double blind randomized controlled trial was done to discover the effect of zinc supplementation to the duration, signs and symptoms on acute diarrhea in hospitalized adults patients in Pertamina Central Hospital, Jakarta from January to December 2013. The data was analyzed using Chi-square test to compare the duration of diarrhea and general linear model (GLM) to assess changes of the symptoms accompanying diarrhea.Results: Data analysis from 84 patients, 30 males (19 zinc, 11 placebo) and 54 females (23 zinc, 31 placebo) with p = 0.111 showed that zinc supplementation significantly reduced the duration of acute diarrhea (p = 0.027) and nausea (p = 0.032). In addition there is a tendency of improvement in several acute diarrhea associated symptoms.Conclusion: Zinc supplementation significantly reduces the duration of diarrhea, nausea, as well as improving some symptoms accompanying acute diarrhea. Keywords: zinc supplementation, acute diarrhea, adult patient

Infectious diarrhea: an overview.

Diarrheal disease, which is most often caused by infectious pathogens, is a significant cause of morbidity and mortality worldwide, especially in children. This is particularly true in developing countries. Recent outbreaks of infectious diarrhea in developed countries, including the USA, are often attributed to food handling and distribution practices and highlight the need for continued vigilance in this area. Another common cause of infectious diarrhea, Clostridium difficile infection (CDI), has historically been associated with the use of antibiotics and exposure to a health-care setting but is now increasingly common in the community in persons who lack the typical risk factors. Recent scientific advances have also led to new and proposed new therapies for infectious diarrhea, including fecal microbiota transplant (FMT) for recurrent C. difficile infection (RCDI), probiotics for prevention of antibiotic-associated diarrhea (AAD) and CDI, and the use of zinc supplementation in the treatment of acute diarrhea in children. Other therapies that have been in use for decades, such as the oral rehydration solution (ORS), continue to be the targets of scientific advancement in an effort to improve delivery and efficacy. Finally, post-infectious irritable bowel syndrome (PI-IBS) is an increasingly recognized occurrence. Attempts to understand the mechanism behind this phenomenon are underway and may provide insight into potential treatment options.

Применение нифуроксазида в комплексном лечении диареи у детей до 1 года

Изучено прямое антимикробное действие препарата нифуроксазид в комплексном лечении диареи у детей до 1 года. При применении в терапевтических дозах нифуроксазид оказывает бактериостатическое действие, в высоких дозах — бактерицидное. Препарат не влияет на сапрофитную флору. Таким образом, при наличии острой кишечной инфекции практикующие врачи могут использовать это лекарственное средство с минимальным риском развития побочных эффектов.

Efficacy and safety of Saccharomyces boulardii for acute diarrhea.

The efficacy of Saccharomyces boulardii for treatment of childhood diarrhea remains unclear. Our objective was to systematically review data on the effect of S. boulardii on acute childhood diarrhea. Our data sources included Medline, Embase, CINAHL, Scopus, and The Cochrane Library up to September 2013 without language restrictions. Randomized controlled trials and non-randomized trials that evaluated effectiveness of S. boulardii for treatment of acute diarrhea in children were included. Two reviewers independently evaluated studies for eligibility and quality and extracted the data. In total, 1248 articles were identified, of which 22 met the inclusion criteria. Pooling data from trials showed that S. boulardii significantly reduced the duration of diarrhea (mean difference [MD], -19.7 hours; 95% confidence interval [CI], -26.05 to -13.34), stool frequency on day 2 (MD, -0.74; 95% CI, -1.38 to -0.10) and day 3 (MD, -1.24; 95% CI, -2.13 to -0.35), the risk for diarrhea on day 3 (risk ratio [RR], 0.41; 95% CI, 0.27 to 0.60) and day 4 (RR, 0.38; 95% CI, 0.24 to 0.59) after intervention compared with control. The studies included in this review were varied in the definition of diarrhea, the termination of diarrhea, inclusion and exclusion criteria, and their methodological quality. This review and meta-analysis show that S. boulardii is safe and has clear beneficial effects in children who have acute diarrhea. However, additional studies using head-to-head comparisons are needed to define the best dosage of S. boulardii for diarrhea with different causes.

Oral zinc and common childhood infections—An update

Zinc is an essential micronutrient important for growth and for normal function of the immune system. Many children in developing countries have inadequate zinc nutrition. Routine zinc supplementation reduces the risk of respiratory infections and diarrhea, the two leading causes of morbidity and mortality in young children worldwide. In childhood diarrhea oral zinc also reduces illness duration and risk of persistent episodes. Oral zinc is therefore recommended for the treatment of acute diarrhea in young children. The results from the studies that have measured the therapeutic effect of zinc on acute respiratory infections, however, are conflicting. Moreover, the results of therapeutic zinc for childhood malaria also are so far not promising.This paper gives a brief outline of the current evidence from clinical trials on therapeutic effect of oral zinc on childhood respiratory infections, pneumonia and malaria and also of new evidence of the effect on serious bacterial illness in young infants.

Oral Zinc Supplementation for the Treatment of Acute Diarrhea

Introduction: Diarrheal diseases are a serious health problem and important causes of growth retardation and death in the developing world, especially those of prolonged duration. Since diarrhea is constantly found in children with zinc deficiency, very studies supported zinc supplements beneficial on the duration and severity of diarrhea among children. We review the impact of zinc effects on diarrhea in South-West Asia to update the evidences and to assess its effect on the global burden of diarrhea. Materials and Methods: We conduct a systematic review through January 2014, for randomized controlled trials relevant to effect of zinc on diarrhea in children. We searched the MeSH terms zinc, acute gastroenteritis and children from various databases of Cochrane Library and PubMed, then clinical trials done in South-West Asia, selected for making written. Results: In recent years, several studies have reported the therapeutic effect of zinc supplementation on diarrheal diseases that was beneficial on decreased episode duration, stool output, stool frequency, hospitalization duration. In some countries in West Asia such as Lebanon, Israel, Saudi Arabia and Iran in clinical trials showed a faster improvement in acute gastroenteritis in children less than five years. But in some countries, such as Turkey, this effect was not significant. Conclusions: Oral zinc supplementation significantly decreases diarrhea duration and has a greater effect on malnourished children. Zinc supplementation seems to be an appropriate public health strategy, mainly in areas of endemic deficiencies. Global attempts should is increased to support recommended regimen of therapeutic zinc by WHO in all areas. Keywords: Acute Gastroenteritis, Children, Zinc, South-West Asia.

Cobalamin and Folate Status in 6 to 35 Months Old Children Presenting with Acute Diarrhea in Bhaktapur, Nepal

BackgroundCobalamin and folate are essential micronutrients and are important in DNA and RNA synthesis, cell proliferation, growth, hematopoiesis, and cognitive function. However, data on cobalamin and folate status are lacking particularly from young children residing in low and middle income countries.ObjectiveTo measure cobalamin and folate status and identifies their predictors among 6 to 35 months old children presenting with acute diarrhea.DesignThis was a cross-sectional study in 823 children presenting with acute diarrhea. We measured plasma cobalamin, folate, methylmalonic acid and total homocysteine who sought treatment for acute diarrhea between June 1998 and August 2000.ResultsThe mean (SD) plasma concentrations of cobalamin, folate, total homocysteine and methylmalonic acid were 206 (124) pmol/L, 55 (32) nmol/L, 11.4 (5.6) µmol/L and 0.79 (1.2) µmol/L, respectively. The prevalence of low plasma cobalamin (<150 pmol/L) was 41% but less than 2% (15) children had low folate concentration (<10 nmol/L). Plasma homocysteine and methylmalonic acid concentrations were negatively associated with cobalamin concentration but not associated with folate status. The prevalence of cobalamin deficiency was higher in breastfed than non-breastfed children (44% vs 24%; p = <0.001). The prevalence of hyperhomocysteinemia (>10 µmol/L) and elevated methylmalonic acid (>0.28 µmol/L) were 73% and 52%, respectively. In the regression analyses, the plasma cobalamin concentration was positively associated with age, and introduction of animal or formula milk.ConclusionsOur study indicated that poor cobalamin status was common particularly among breastfed children. Folate deficiency was virtually none existent. Possible consequences of cobalamin deficiency in young children need to be explored.

Secondary metabolites from roots of Geum urbanum L.

Geum urbanum L. commonly known as wood avens or St. Benedict’s herb is an herbaceous perennial plant with characteristic pinnate leaves with a very large and lobed terminal leaflet. G. urbanum belongs to the family of Rosaceae and is native to humid woods of Europe and Asia (Wichtl, 2004). Infusions from the roots and rhizomes of wood avens have been traditionally used in folk medicine in the treatment of acute diarrhea and as astringent agent for inflammations of the mucosa and gums and for treatment of hemorrhoids (Wichtl, 2004; Popovic et al., 2012). This study investigates the roots of G. urbanum collected from flowering plants growing in their natural state in Umer ( Swietokrzyskie district, Poland) in September 2011. Plant material was authenticated by Izabella Kirpluk (Botanical Garden, University of Warsaw, Poland). Voucher specimen (no. GU092011) has been deposited in the Plant Collection, Department of Pharmacognosy and Molecular Basis of Phytotherapy, Medical University of Warsaw, Poland.

Racecadotril Efficacy in the Symptomatic Treatment of Adult Acute Diarrhoea: A Systematic Review and Meta-Analysis

The efficacy of racecadotril (RC), an intestinal antisecretory drug acting via an enkephalinase inhibition, was reviewed in paediatric acute diarrhoea but not yet in adults. Objective: To estimate the effectiveness of RC in the symptomatic treatment of acute diarrhoea in adults. Data Sources: A systematic review of MedLine, Cochrane Controlled Trials Register, DARE, and Embase (up to November 2013). Additional studies were identified by contacting clinical experts and the manufacturer. Study Selection and Appraisal: Randomized Controlled Trials performed in adults suffering from acute diarrhoea using RC in one treatment arm. Independent extraction of articles using predefined data fields, and methodological quality measurement assessment. All randomised trials performed in adults suffering from acute diarrhoea with RC as the studied group. Statistics: The main efficacy endpoint was diarrhoea duration defined as time to recovery compared between groups by survival techniques and converted into hazard ratio (HR). We exclusively used a random-effect meta-analytic model. Constipation proportion was the main safety endpoint, evaluated between treatments by the Relative Risks (RR). Results: Twelve randomised trials (2619 patients) met inclusion criteria. Duration of diarrhoea was much shorter in the RC group, the proportion of patients having recovered at any time of the treatment period was 65% higher in the RC group, compared with placebo (HR = 1.65 [1.38-1.97], p p = 0.24, n = 1618). The proportions of constipated patients were similar in the RC and placebo groups 0.95 [0.24-3.68], p = 0.97), however, about 3 times more constipated patients were found in the loperamide group compared with the RC group (RR = 0.34 [0.22-0.51], p to placebo, RC is characterized by a clinically relevant earlier remission of diarrhoea. When compared to loperamide, diarrhoea duration was similar, however, significantly fewer secondary constipation adverse effects were observed.

Racecadotril in the Treatment of Acute Diarrhoea in Adults. An Individual Patient Data Based Meta-Analysis

Racecadotril is an antidiarrhoeal drug with a pure intestinal antisecretory mechanism of action. Aim: To assess racecadotril efficacy, whatever its dose, versus placebo in adult acute diarrhoea. Methods: Individual Patient Data meta-analysis following multilevel mixed models testing of the significance of the treatment effect adjusted for baseline covariates. Diarrhoea duration was the common main criteria. Results: Four randomized clinical trials (n = 669) were identified with raw data. The clinical global impression evaluated at baseline by the physician was found to be the essential predictor influencing the outcome. As compared to placebo, the 100 mg dose, the minimum effective dose, induced a 80% increase of the recovered patient proportion at anytime (Hazard Ratio = 1.8 [1.3, 2.5], p i.e. recovery within 3 days (p p .