Skip to main content
SpringerLink
Log in

Current status of anti-diarrheal and anti-secretory drugs in the management of acute childhood diarrhea

  • Symposium: Gastroenterology & Hepatology
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Each year 1.8 million children die due to diarrheal diseases. Indiscriminate use of antibiotics has resulted in increasing resistance to commonly used antibiotics. Moreover the recent outbreaks of shigella and cholera have revealed multi-drug resistance strains. There is a need for review of recommended antibiotics for shigellosis. From recent data it emerges that fluoroquinolones should be the first line of therapy and cephalosporins to be used as the second line. Among the anti-cholera antibiotics, tetracyclines which were the drug of choice for adults, has the advantage of high sensitivity and low cost. Single dose doxycycline would have minimal side effects, hence can be the drug of choice even in children. We should not allow the business pressures to force usage of probiotics and racecadotril as their role in the management of acute diarrhea is yet to be established. Nitazoxanide has high efficacy against Cryptosporodial diarrhea only. Strict adherence to the recommendations for the management of acute childhood diarrhea is needed or else we dilute the effect of standard management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bhatnagar S, Bhandari N, Mouli UC, Bhan MK. Consensus statement of IAP National Task Force: Status report on management of acute diarrhea.Indian Pediatrics 2004; 41: 4:335–348.

    PubMed  Google Scholar 

  2. Sarkar K, Ghosh S, Niyogi SK, Bhattacharya SK.Shigella dysenteriae type 1 with reduced susceptibility to fluoroquinolones.Lancet 2003; 361: 785.

    Article  PubMed  CAS  Google Scholar 

  3. Sur D, Niyogi SK, Sur S, Datta KK, Takeda Y, Nair GBet al. Multidrug-resistantShigella dysenteriae type 1: forerunners of a new epidemic strain in eastern India.J Emerg Infect Dis 2003; 9: 404–405.

    Google Scholar 

  4. Dutta S, Ghosh A, Ghosh K, Dutta D, Bhattacharya SK, Nair GB, Yoshida S. Newly Emerged Multiple-Antibiotic-ResistantShigella dysenteriae type 1 Strains in and around Kolkata, India, Are Clonal.Journal of Clinical Microbiology 2003; 42: 5833–5834.

    Article  Google Scholar 

  5. Dutta S, Dutta D, Dutta P, Matsushita S, Bhattacharya SK, Yoshida S. Shigella dysenteriae Serotype 1, Kolkata, India.Emerging Infectious Diseases 2003; 9: 11: 1471–1474.

    PubMed  Google Scholar 

  6. Pazhani GP, Sarkar B, Ramamurthy T, Bhattacharya SK, Takeda Y, Niyogi SK. Clonal Multidrug-ResistantShigella dysenteriae type 1 Strains Associated with Epidemic and Sporadic Dysenteries in Eastern India.Antmicrob Agents Chemother 2004; 48: 2: 681–684.

    Article  CAS  Google Scholar 

  7. Niyogi SK, Pazhani GP. Multiresistant Shigella species isolated from childhood cases from Kolkatta, India.Jpn J Inf Dis 2003; 56: 33–34.

    Google Scholar 

  8. Niyogi SK, Sarkar K, Lalmalsawma P, Pallai N, Bhattacharya SK. An Outbreak of Bacillary Dysentery Caused by Quinolone-resistant Shigella dysenteriae type 1 in a Northeastern State of India.J Health Popul Nutr 2004 Mar; 22(1): 97.

    PubMed  CAS  Google Scholar 

  9. Talukder KA, Islam AM, Khajanchi BK, Dutta DK, Islam Z, Safa A, Alam K, Hossain A, Nair GB, Sack DA. Temporal Shifts in the Dominance of Serotypes ofShigella dysenteriae from 1999 to 2002 in Dhaka, Bangladesh.J Clin Microbiol 2003; 41: 11: 5053–5058.

    Article  PubMed  CAS  Google Scholar 

  10. Talukder KA, Islam Z, Islam MA, Dutta DK, Safa A, Ansaruzzaman M, Faruque ASG, Shahed SN, Nair GB, Sack DA. Phenotypic and genotypic characterization of provisional serotypeShigella flexneri 1c and clonal relationships with1a and1b strains isolated in Bangladesh.J Clin Microbiol 2003; 41: 1: 110–117.

    Article  PubMed  CAS  Google Scholar 

  11. Zafar A, Sabir N, Bhutta ZA. Frequency of isolation of shigella serogroups/serotypes and their antimicrobial susceptibility pattern in children from slum areas in Karachi.J Pak Med Assoc 2005; 55(5): 184–188.

    PubMed  Google Scholar 

  12. Ahmed K, Shakoori FR, Shakoori AR. Aetiology of Shigellosis in Northern Pakistan.J Health Popul Nutr 2003; 21: 1: 32–39.

    PubMed  Google Scholar 

  13. Taneja N, Mohan B, Khurana S, Sharma M. Antimicrobial resistance in selected bacterial enteropathogens in north India.Indian J Med Res 2004; 120: 39–43.

    PubMed  CAS  Google Scholar 

  14. Jesudason MV. Shigella isolation in Vellore, south India (1997–2001).Indian J Med Res 2002; 115: 11–13.

    PubMed  Google Scholar 

  15. International Note—Antibiotics in the management of shigellosis.WHO Weekly Epidemiological Record 2004; 79: 24.

  16. Sengupta PG, Niyogi SK, Bhattacharya SK. An outbreak ofEl tor cholera in Aizwal town of Mizoram, India.J Commun Dis 2000 Sep; 32(3): 207–211.

    PubMed  CAS  Google Scholar 

  17. Samal B, Ghosh SK, Mohanty SK, Patnaik K. Epidemic ofVibrio cholerae serogroup O139 in Berhampur, Orissa.Indian J Med Res 2001; Jul; 114: 10–11.

    PubMed  CAS  Google Scholar 

  18. Garg P, Chakraborty S, Basu I, Datta S, Rajendran K, Bhattacharya T, Yamasaki S, Bhattacharya SK, Takeda Y, Nair GB, Ramamurthy T. Expanding multiple antibiotic resistance among clinical strains ofVibrio cholerae isolated from 1992–7 in Calcutta, India.Epidemiol Infect 2000 Jun; 124(3): 393–399.

    Article  PubMed  CAS  Google Scholar 

  19. Taneja N, Biswal M, Tarai B, Sharma M. Emergence ofVibrio cholerae O1 Biotype El Tor serotype Inaba in north India.Jpn J Infect Dis 2005 Aug; 58(4): 238–240.

    PubMed  Google Scholar 

  20. Alam S, Afzal K, Maheshwari M, Shukla I. Controlled trial of hyposmolar versus World Health Organization Oral Rehydration Solution.Indian Pediatr 2000; 37: 952–960.

    PubMed  CAS  Google Scholar 

  21. Das S, Gupta S. Diversity ofVibrio cholerae strains isolated in Delhi, India, during 1992–2000.J Health Popul Nutr 2005 Mar; 23(1): 44–51.

    PubMed  Google Scholar 

  22. Saha D, Khan WA, Karim MM, Chowdhury HR, Salam MA, Bennish ML. Single-dose ciprofloxacin versus 12-dose erythromycin for childhood cholera: a randomised controlled trial.Lancet 2005 Sep 24–30; 366(9491): 1054–1055.

    Article  CAS  Google Scholar 

  23. Bhattacharya MK, Dutta D, Ramamurthy T, Sarkar D, Singharoy A, Bhattacharya SK. Azithromycin in the treatment of cholera in children.Acta Pediatr 2003; 92(6): 676–678.

    Article  CAS  Google Scholar 

  24. Huang JS, Bousvaros A, Lee JW, Diaz A, Davidson EJ. Efficacy of probiotic use in acute diarrhea in children: a meta-analysis.Dig Dis Sci 2002; 47(11): 2625–2634.

    Article  PubMed  CAS  Google Scholar 

  25. Van Niel CW, Feudtner C, Garrison MM, Christakis DA, Van Niel CW, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis.Pediatrics 2002; 109(4): 678–684.

    Article  PubMed  Google Scholar 

  26. Szajewska H, Mrukowicz JZ. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double blind, placebo-controlled trials.J Pediatr Gastroenterol Nutr 2001; 33 Suppl 2: S17–25.

    Article  Google Scholar 

  27. Costa-Ribeiro H, Ribeiro TC, Mattos AP, Valois SS, Neri DA, Almeida P, Cerqueira CM, Ramos E, Young RJ, Vanderhoof JA. Limitations of probiotic therapy in acute, severe dehydrating diarrhea.J Pediatr Gastroenterol Nutr 2003; 36(1): 112–115.

    Article  PubMed  Google Scholar 

  28. Salazar-Lindo E, Miranda-Langschwager P, Campos-Sanchez M, Chea-Wool E and Bradley Sack R. Lactobacillus casei, strain GG in the treatment of infants with acute watery diarrhea: A randomized, double-blind, placebo controlled clinical trial [ISRCTN673048]BMC Pediatrics 2004, 4: 18.

    Article  PubMed  Google Scholar 

  29. Khanna V, Alam S, Malik A, Malik A. Efficacy of TyndalizedLactobacillus acidophilus in Acute Diarrhea.Indian J Pediatr 2005; 72: 935–938.

    Article  PubMed  Google Scholar 

  30. Salazar-Lindo E, Santisteban-Ponce J, Chea-Woo E, Gutierrez M. Racecadotril in the treatment of acute watery diarrhea in children.N Engl J Med 2000; 343: 463–467.

    Article  PubMed  CAS  Google Scholar 

  31. Cezard JP, Duhamel JF, Meyer M, Pharaon I, Bellaiche M, Maurage C.et al. Efficacy and tolerability of racecadotril in acute diarrhea in children.Gastroenterology 2001; 120: 799–805.

    Article  PubMed  CAS  Google Scholar 

  32. Alam NH, Ashraf H, Khan WA, Karim MM, Fuchs GJ. Efficacy and tolerability of racecadotril in the treatment of cholera in adults: A double blind, randomized, controlled clinical trial.Gut 2003; 52: 1419–1423.

    Article  PubMed  CAS  Google Scholar 

  33. Wang H-H, Shieh M-J, Liao K-F. A blind, randomized comparison of racecadotril and loperamide for stopping acute diarrhea in adults.World J Gastroenterol 2005; 11(10): 1540–1543.

    PubMed  CAS  Google Scholar 

  34. Cezard JP, Salazar-Lindo E, Racecadotril in Acute Diarrhea.Indian Pediatr 2005; 42: 502–503.

    PubMed  CAS  Google Scholar 

  35. Bhan MK. Racedadotril. Is There Enough Evidence to Recomment it for Treatment of Acute Diarrhea? Editorial.Indian Pediatr 2004; 41: 1203–1204.

    PubMed  CAS  Google Scholar 

  36. Rossignol J-F A, Ayoub A, Ayers M S Treatment of Diarrhea caused byCrytosporidium parvum: A Prospective Randomized Double-Blind Placebo-Controlled Study of Nitazoxanide.J Inf Dis 2001; 184: 103–106.

    Article  CAS  Google Scholar 

  37. Elvia D, Jaime M, Enrique R, Rosamaria B. Epidemiology and control of intestinal parasites with Nitazoxanide in children in Mexico.Am J Trop Med Hyg 2003; 68(4): 384–385.

    Google Scholar 

  38. Amadi B, Mwiya M, Musuku J, Watuka RN A, Sianongo S, Ayoub A, Kelly P. Effect of Nitazoxanide on morbidity and mortality in Zambian children with Cryptosporidiosis: a randomised controlled trial.Lancet 2002; 360(9343): 1375–1380.

    Article  PubMed  Google Scholar 

  39. Davila-Gutierrez CE, Vasquez C, Trujillo-Hernaandez B, Miguel H. Nitazoxanide Compared With Quinfamide And Mebendazole In The Treatment Of Helminthic Infections And Intestinal Protozoa in Children.Am J Trop Med Hyg 2002; 66(3): 251–254.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Gastroenterology Section, Department of Pediatrics, JNMC, AMU, Aligarh, UP, India

    Seema Alam (Reader) & Shrish Bhatnagar

Authors
  1. Seema Alam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shrish Bhatnagar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seema Alam.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alam, S., Bhatnagar, S. Current status of anti-diarrheal and anti-secretory drugs in the management of acute childhood diarrhea. Indian J Pediatr 73, 693–696 (2006). https://doi.org/10.1007/BF02898447

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02898447

Key words

Search

Navigation