Oral therapy for acute diarrhea: the underused simple solution

Article Abstract:

Diarrhea is a major contributor to infant and childhood mortality in developing countries, and it should not be assumed that it is no longer a serious health problem in the United States. While the threat of dehydration due to diarrhea cannot be compared in magnitude to that in developing countries, the condition may nonetheless contribute to as much as 10 percent of preventable deaths of children in the United States. The World Health Organization recommends that fluids for rehydration in cases of diarrhea contain carbohydrates and sodium in a ratio of less than 1.4 to 1. Nevertheless, children with diarrhea in the United States are likely to be given fruit juices or soft drinks, whose high carbohydrate to sodium ratio makes them inappropriate for rehydration. Curiously, many American physicians continue to hold to the now discredited practice of withholding solid foods during cases of diarrhea. With few exceptions, such as cholera, shigellosis, and infection with Clostridium difficile, diarrhea is usually self-limiting. Antibiotics and drugs that act on the intestinal system are usually inappropriate for children. There seems, however, to be a reticence among physicians to recognize that an older, simpler solution can be superior to more modern complex ones. In the United States, several manufacturers distribute packets of rehydration salts, which may be dissolved in the appropriate amount of water in a convenient container. These packets, which approximate the recommended formulation of the World Health Organization, are just as important for children in the United States as for children in developing nations, and they should be used. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Oral rehydration therapy, Child health services, Diarrhea, Infantile

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Can bismuth improve the simple solution for diarrhea?

Article Abstract:

Bismuth compounds may be an effective treatment for diarrhea in combination with oral therapy. Oral therapy was developed during the 1960s to treat severe diarrhea. It involves oral rehydration therapy with glucose (sugar) and electrolytes and early feeding with different types of cereal. This type of therapy has not included treatment with antidiarrheal drugs. Many of these drugs have not proven to be effective, and many have side effects. A research study found that bismuth subsalicylate was an effective treatment for children with diarrhea in combination with oral therapy. Children treated with bismuth subsalicylate were less likely to have diarrhea five days after being admitted to the hospital than those who were not treated. The treatment did not cause any severe side effects. Bismuth subsalicylate needs to be taken every four hours, which may sometimes be hard for patients to do. The treatment may also be expensive, especially for people in developing countries.

Editorial, Bismuth subsalicylate

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Acute infectious diarrhea

Article Abstract:

The treatment of diarrhea caused by an infection is reviewed. Topics include microbiology, diagnostic testing, rehydration and nutrition, symptomatic therapy, antimicrobial therapy, community-acquired pathogens, empirical antibiotic treatment, traveler's diarrhea, nosocomial diarrhea, and persistent diarrhea. More than two million people worldwide die from chronic diarrhea each year.

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