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The incidence and risk of morality is high under the age of five years is due to diarrhoea. In India twenty percentages of paediatric deaths is due to diarrhoeal disease. It is the second cause of leading mortality in children after acute respiratory infections. Following on from the GEMS study when we looked at the data in the management of bacterial diarrhoea the primary treatments included oral rehydration solution, oral zinc probiotics and antibiotics. Anecdotally we noted that a lot of children were treated with oral antibiotics and the majority of them were treated with fluoroquinolones like Ofloxacin and drugs like Metronidazole there are multiple side-effects associated with the usage of fluoroquinolones and a major side-effect of that is the risk to the growing cartilage. We also noticed that irrational combinations such as imidazole like metronidazole have shown more problems than solutions .usage of Ofloxacin in children should be discouraged for all the side-effects plus the infectivity in the management of bacterial diarrhoea. The duration of treatment have paved the way for usage of drugs such as new molecules in paediatric i.e. rifaximin comes under the group of oral non-absorbable GI antibiotics broad-spectrum agents with antibacterial activity against gram positive and gram negative aerobes and Anaerobes makes Rifaximin a bactericidal drug in nature. Rifaximin is particularly recommended in children above the age of two years in acute infectious diarrhoea the mechanism of action of rifaximin is by inhibition of bacterial protein synthesis by reversibly binding to bacterial DNA dependent RNA polymerase. In this review we discussed the “phrma” behind rifaximin, clinical experience of rifaximin in children and indications and dosage of rifaximin in paediatric.

Background: Although shigellosis is self-limiting, antibiotics are recommended to minimize the severity of symptoms and reduce mortality rates. However, due to the increasing reports of antibiotic resistance, alternative approaches are needed to combat shigellosis. Interest for research on medicinal plants has increased in recent years, and hence, they can be explored to treat this infectious diarrhoea. Objective: To study the effect of Psidium guajava L. (guava) leaf decoction (GLD) on the antibiotic-resistant clinical isolates of Shigella spp. Materials and Methods: A total of 43 isolated Shigella spp. from diarrhoeal patients were used in this study. The effect of GLD on the bacterial viability was initially assessed. The isolates were divided into two categories: sensitive and resistant to GLD. For sensitive isolates, antibacterial activity of GLD was evaluated while for resistant strains, the ability of GLD for reducing the bacterial invasion of the HEp-2 cell line underwent an investigation. Results: Among the 43 Shigella isolates, GLD affected the growth of 23 strains. The invasion of 9 strains from the 20 remaining resistant isolates was unaffected. Although the number of isolates was less, the data suggested that isolates belonging to S. flexneri serogroup were more sensitive to GLD in comparison with other spp (i.e., sonnei, boydii, and dysenteriae). Conclusion: The results of this study revealed the efficacy of GLD against drug-resistant Shigella spp. and thus could be considered for the treatment of diarrhoea. GLD can be a cost-effective alternative to antibiotics.

Over 3000 healthcare workers (HCW) in China are suspected of having coronavirus disease 2019 (COVID-19) and over 1700 tested positive.1 These statistics underline the need for robust preventative measures against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Endoscopy departments are fertile grounds for viral spread because aerosolisation of bodily secretions occurs during procedures. A single viral-shedding patient with a high viral load can contaminate an entire endoscopy room with the virus that remains viable for up to 3 days, putting uninfected patients and HCWs at risk.2 3 Singapore previously had the largest cohort of COVID-19 patients outside China in the early phases of the outbreak. Given its novelty, the effectiveness of new preventative measures implemented within our endoscopy services was unknown. To determine best practice, we conducted systematic searches of literature and official websites for gastroenterology and endoscopy societies (n=28) in the 15 most-affected countries to scrutinise recommendations and associated evidence. Methodology is available on request. In summary, we found careful patient selection was commonly …

Background Diarrhoea is amongst the first ten causes of death and its treatment faces an increased threat of drug resistance. Previous studies on the guava leaf decoction (GLD) revealed its suitability for use in infectious diarrhoea of unknown etiology. Objective The objective of this trial was to establish efficacy, dose and safety of GLD prepared from the Indian Sardar variety in adults with acute infectious diarrhoea. Methods The current trial was an open efficacy randomized 5-day, parallel group multi-arm interventional study. Amongst 137 adults (18–60 years) suffering with acute diarrhoea, 109 were included (57% females, 43% males). Three doses of GLD (6-leaf, 10-leaf and 14-leaf) were compared with controls receiving oral rehydration solution. Decrease in stool frequency and improvement in consistency were the outcomes measured. The data was analyzed using ANOVA, Tukey's post-hoc test, Kruscal-Wallis test and Chi-Square test where applicable. Results The trial showed that the 14-leaf (7.4 g) decoction was the most effective. Administration of the decoction, thrice daily helped the patients regain normalcy in 72 h as opposed to 120 h in controls. Safety of the intervention was reflected by normal levels of haemoglobin, liver and kidney parameters. No adverse events were reported. Conclusion The 14 leaves decoction was a safe treatment for adult acute uncomplicated diarrhoea of unknown etiology. Moreover due to component synergy and divergent mechanisms of action, it could possibly combat the generation of drug resistance and destruction of gut microbiota. Hence GLD has the potential for development as a first line treatment for diarrhoea. Trial registration Trial was registered with Clinical Trials Registry - India (CTRI registration number: CTRI/2016/07/007095). The trial was retrospectively registered.

Background Non-typhoidal salmonella (NTS) is a rare, but well-established cause of myopericarditis. Presenting symptoms may be varied, however often revolve around the dual presentation of both myopericarditis and infectious diarrhoea. Given the rarity of NTS related myopericarditis, we conducted a systematic review of the literature, identifying 41 previously reported cases. Case summary We present the case of an otherwise healthy 39-year old male, presenting with chest pain in the setting of documented Salmonella typhimurium infection. After further investigation with echocardiogram and laboratory blood tests, a diagnosis of NTS associated myopericarditis was made, and the patient received antibiotic treatment with an excellent clinical outcome. Overall, myopericarditis is rare in NTS. Although treatment for myopericarditis has not been well established, there are guidelines for the treatment of NTS infection. In our review, we found that the majority of NTS cases has been pericarditis (27/42, 64.3%), with an average age of 48.3 years, and 71.4% being male. The average mortality across all cases was 31%. Conclusion Myopericarditis is a rare, but potentially serious complication of NTS infection, associated with an increased morbidity and mortality.

Background: Infectious diarrhoea is a significant cause of morbidity worldwide. Culture and microscopy are time-consuming and have a low yield. New rapid molecular methods such as multiplex PCR, ha...

BackgroundThe COVID-19 epidemic has affected over 2.6 million people across 210 countries. Recent studies have shown that patients with COVID-19 experience relevant gastrointestinal (GI) symptoms. We aimed to perform a systematic review and meta-analysis on the GI symptoms of COVID-19.MethodsA literature search was conducted via electronic databases, including PubMed, Embase, Scopus, and Google Scholar, from inception until 20 March 2020. Data were extracted from relevant studies. A systematic review of GI symptoms and a meta-analysis comparing symptoms in severe and non-severe patients was performed using RevMan V.5.3.ResultsPooled data from 2477 patients with a reverse transcription-PCR-positive COVID-19 infection across 17 studies were analysed. Our study revealed that diarrhoea (7.8%) followed by nausea and/or vomiting (5.5 %) were the most common GI symptoms. We performed a meta-analysis comparing the odds of having GI symptoms in severe versus non-severe COVID-19-positive patients. 4 studies for nausea and/or vomiting, 5 studies for diarrhoea and 3 studies for abdominal pain were used for the analyses. There was no significant difference in the incidence of diarrhoea (OR=1.32, 95% CI 0.8 to 2.18, Z=1.07, p=0.28, I2=17%) or nausea and/or vomiting (OR=0.96, 95% CI 0.42 to 2.19, Z=0.10, p=0.92, I2=55%) between either group. However, there was seven times higher odds of having abdominal pain in patients with severe illness when compared with non-severe patients (OR=7.17, 95% CI 1.95 to 26.34, Z=2.97, p=0.003, I2=0%).ConclusionOur study has reiterated that GI symptoms are an important clinical feature of COVID-19. Patients with severe disease are more likely to have abdominal pain as compared with patients with non-severe disease.

The COVID-19 pandemic has led to an exponential increase in SARS-CoV-2 infections and associated deaths, and represents a significant challenge to healthcare professionals and facilities. Individual countries have taken several prevention and containment actions to control the spread of infection, including measures to guarantee safety of both healthcare professionals and patients who are at increased risk of infection from COVID-19. Faecal microbiota transplantation (FMT) has a well-established role in the treatment of Clostridioides difficile infection. In the time of the pandemic, FMT centres and stool banks are required to adopt a workflow that continues to ensure reliable patient access to FMT while maintaining safety and quality of procedures. In this position paper, based on the best available evidence, worldwide FMT experts provide guidance on issues relating to the impact of COVID-19 on FMT, including patient selection, donor recruitment and selection, stool manufacturing, FMT procedures, patient follow-up and research activities.

During the last decade several paediatric studies have been published with different possible indications for probiotics, leading to a global increase of probiotics’ market. Nevertheless, different study designs, multiple single/combined strains and small sample size still leave many uncertainties regarding their efficacy. In addition, different regulatory and quality control issues make still very difficult the interpretation of the clinical data. The objective of this review is to critically summarise the current evidence on probiotics’ efficacy and safety on a different number of pathologies, including necrotizing enterocolitis, acute infectious diarrhoea, allergic diseases and functional gastrointestinal disorders in order to guide paediatric healthcare professionals on using evidence-based probiotics’ strains. To identify relevant data, literature searches were performed including Medline-PubMed, the Cochrane Library and EMBASE databases. Considering probiotics strain-specific effects, the main focus was on individual probiotic strains and not on probiotics in general.

Diarrhoea remains the second leading cause of death among children under five globally (United Nations Children's Fund [UNICEF] & the World Health Organisation [WHO], 2009). Identified as an urgent cause of child mortality, a global action plan was released by WHO and UNICEF in 2013 aimed at ending preventable childhood deaths from diarrhoea and pneumonia by 2025 (WHO & UNICEF 2013). This plan highlights solutions that are effective, available and do not require technological advances, yet are not being implemented in structured and co-ordinated ways. The integrated approach to management of acute diarrhoea is underpinned by the ‘Protect, Prevent and Treat’ framework, where good health practices are established from birth, children are prevented from becoming ill and treatment for ill children is appropriate (WHO & UNICEF 2013).

ObjectiveClostridioides difficile infection (CDI) is a common healthcare-associated infection and associated with high morbidity and mortality. As current guidelines recommend treatment stratified for disease severity, this study aimed to identify predictors of 30-day mortality in order to develop a robust prediction model.DesignThis was a retrospective analysis of 207 inpatients with CDI who were treated at the Jena University Hospital between September 2011 and December 2015. In a training cohort (n=127), predictors of 30-day mortality were identified by receiver operating characteristics analysis and logistic regression. The derived model was validated in an independent cohort of 80 inpatients with CDI.ResultsWithin 30 days, 35 (28%) patients in the training cohort died from any cause. C-reactive protein (CRP) of ≥121 mg/L (OR 3.80; 95% CI 1.64 to 7.80; p=0.003) and lower systolic blood pressure of ≤104 mm Hg (OR 3.73; 95% CI 1.63 to 8.53; p=0.002) at diagnosis as well as development of renal impairment (serum creatinine >1.5×baseline; OR 5.61; 95% CI 1.94 to 16.26; p=0.035) within the first 6 days were associated with 30-day mortality in univariate analysis. The use of these parameters enabled correct mortality prediction in 73% of cases on the day of diagnosis and in 76% at day 6. In the validation cohort, 30-day mortality was 18/80 (23%). Our model enabled a 73.7% correct prediction concerning 30-day mortality on day 6 after diagnosis of CDI.ConclusionHypotension and CRP elevation on the day of diagnosis as well as occurrence of kidney dysfunction during the first 6 days are suitable parameters to predict 30-day mortality in patients with CDI who need to be treated in the hospital.

GI symptoms such as diarrhoea, nausea and vomiting are frequent coronavirus disease (COVID-19) symptoms and affect up to 28% of patients.1–5 The pathophysiology of COVID-19-associated GI symptoms is currently unclear. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-RNA was detected in the faeces in ~50% of patients with COVID-193 5 6; SARS-CoV-2 viral particles were observed by electron microscopy in stool samples from two patients without diarrhoea2; and one study reported SARS-CoV-2 infection of the oesophagus, stomach, duodenum and rectum.5 Faecal calprotectin (FC) has evolved as a reliable faecal biomarker allowing detection of intestinal inflammation in IBD and infectious colitis.7 In this pilot study, we explored a relation between GI symptoms, intestinal inflammation (determined by FC) and faecal SARS-CoV-2-RNA in hospitalised patients with COVID-19 who did not require intensive care measures. We analysed 40 patients with COVID-19 hospitalised at the University Hospital of Innsbruck, Austria. Confirmation of SARS-CoV-2 infection was performed by nasopharyngeal swab, and faecal SARS-CoV-2-RNA detection was performed using previously described real-time PCR6 as recommended by the Centers for Disease Control and Prevention (DeKalb, Georgia). Diarrhoea was defined as loose stools >3 times/day. We excluded other causes of acute GI infection by stool analysis for common viral, …

Berberine has significant antibacterial and antipyretic effects and is a commonly used drug for treating infectious diarrhoea. The current research data show that the pharmacological effects of berberine are numerous and complex, and researchers have been enthusiastic about this field. To allow researchers to quickly understand the field and to provide references for the direction of research, using bibliometrics, we analysed 1426 articles, dating from 1985 to 2018, in the field of berberine pharmacology. The research articles we found came from 69 countries/regions, 1381 institutions, 5675 authors, and 325 journals; they contained 3794 key words; they were written in 7 languages; and they were of 2 article types. This study summarizes and discusses the evolution of the historical themes of berberine pharmacology as well as the status quo and the future development directions from a holistic perspective.

Ofloxacin is an antibiotic useful for the treatment of bacterial infections. The aim of this research work was to evaluate the impact of the Trivedi Effect®-Consciousness Energy Healing Treatment on the physicochemical properties of ofloxacin using modern analytical techniques. The sample was divided into control and Biofield Energy Treated parts. The control sample did not receive the Biofield Energy Treatment; whereas, the treated part received the Biofield Treatment remotely by a famous Biofield Energy Healer, Gopal Nayak. The PXRD peak intensities and crys-tallite sizes were significantly altered ranging from -39.33% to 127.93% and -68.28% to 21%, respectively; however, the average crystallite size of the treated ofloxacin (236.59nm) was decreased by 19.48% compared with the control sample (293.83nm). The particle size values were signifi-cantly decreased at d10 (10.67%), d50 (25%), d90 (24.4%), and D (4,3) (25.12%); thus, the specific surface area was significantly increased by 9.8% in the treated sample compared to the control sample. The latent heat of fusion and the latent heat of decomposition of the treated sample were significantly increased by 11.71% and 123.52%, respectively compared to the control sample. The total weight loss was significantly decreased by 10.59%; however, the residue amount was significantly increased by 63.29% in the treated ofloxacin compared with the control sample. The Trivedi Effect®-Consciousness Energy Healing Treatment generated a new polymorphic form of ofloxacin which may be more soluble, bioavail-able, and be thermally more stable compared to the untreated sample. The treated ofloxacin would be more efficacious against cellulitis, prosta-titis, chronic bronchitis, urinary tract infections, infections of the urethra and cervix, pneumonia, infectious diarrhoea, plague, etc. Source: https://www.trivedieffect.com/science/spectroscopic-and-calorimetric-evaluation-of-the-biofield-energy-healing-treated-ofloxacin/

Rotavirus is the major cause of infectious diarrhoea in infants and children throughout the world. Several studies have indicated that some milk fractions may protect against rotavirus infection. The present study evaluates the effect of some heat treatments on the antirotaviral activity of bovine and ovine whey by an immunofluorescence assay validated in this work. Neutralising activity of diverse proteins present in whey has also been verified individually. Bovine and ovine whey, at 1 mg mL−1 protein, inhibit MA104 cells infection with bovine rotavirus strain WC3, with values of 89.2 and 76.6% inhibition, respectively. Furthermore, the inhibitory activity was influenced by temperature and duration of heat treatment. The ability of bovine and ovine whey to inhibit rotavirus infection was not affected by treatment at 75 °C for 20 s; after 85 °C for 10 min bovine and ovine whey still maintained 16.1 and 32.5%, respectively, of neutralisation activity.

Background: Clostridium difficile ( C. difficile) is a leading cause of infectious diarrhoea in hospitals. Sending faecal samples for testing expedites diagnosis and appropriate treatment. Clinical suspicion of C. difficile based on patient history, signs and symptoms is the basis for sampling. Sending faecal samples from patients with diarrhoea ‘just in case’ the patient has C. difficile may be an indication of poor clinical management. Aim: To evaluate the effectiveness of an intervention by an Infection Prevention and Control Team (IPCT) in reducing inappropriate faecal samples sent for C. difficile testing. Method: An audit of numbers of faecal samples sent before and after a decision-making algorithm was introduced. The number of samples received in the laboratory was retrospectively counted for 12-week periods before and after an algorithm was introduced. Findings: There was a statistically significant reduction in the mean number of faecal samples sent post the algorithm. Results were compared to a similar intervention carried out in 2009 in which the same message was delivered by a memorandum. In 2009 the memorandum had no effect on the overall number of weekly samples being sent. Conclusion: An algorithm intervention had an effect on the number of faecal samples being sent for C. difficile testing and thus contributed to the effective use of the laboratory service.

Ofloxacin is a broad-spectrum antibiotic useful for the treatment of many Gram-positive and Gram-negative bacterial infections. The objective of this research work was to evaluate the impact of the Trivedi Effect® on the physicochemical and thermal properties of ofloxacin using modern analytical techniques. The sample was divided into two parts. One part of ofloxacin was considered as the control sample (no biofield energy treatment was provided), whereas the second part was received the Biofield Treatment remotely by a famous Biofield Energy Healer, Alice Branton and was termed as the treated sample. The PXRD peak intensities and crystallite sizes were significantly altered ranging from 7.45% to 73.06% and -44.1% to 77.95%, respectively in the treated sample compared to the control sample. The particle size values were significantly altered at d10 (-19.47%), d50 (1.14%), d90 (-8.70%), and D (4, 3) (-10.20%); whereas, the specific surface area was significantly increased by 15.66% in the treated sample compared to the control sample. The latent heat of fusion and latent heat of decomposition of the treated ofloxacin were significantly increased by 16.24% and 88.03%, respectively compared with the control sample. The total weight loss was significantly decreased by 6.21 %; additionally, the residue amount was significantly increased by 47.16% in the treated ofloxacin compared with the control sample. Thus, the Trivedi Effect® might generate a new polymorphic form of ofloxacin which would be more soluble, bioavailable, and be thermally more stable compared with the untreated sample. The Biofield Treated ofloxacin would be more efficacious against urinary tract infections, infections of the urethra and cervix, infectious diarrhoea, pneumonia, cellulitis, chronic bronchitis, prostatitis, plague, etc. Source: https://www.trivedieffect.com/science/evaluation-of-the-physicochemical-and-thermal-properties-of-the-biofield-energy-healing-treated-ofloxacin https://www.ommegaonline.org/article-details/Evaluation-of-the-Physicochemical-and-Thermal-Properties-of-the-Biofield-Energy-Healing-Treated-Ofloxacin/1965

Made available in DSpace on 2019-10-04T11:56:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01 Diarrhoeagenic Escherichia coli (DEC) is a leading cause of infectious diarrhoea worldwide. In recent years, Escherichia albertii has also been implicated as a cause of human enteric diseases. This study describes the occurrence of E. coli pathotypes and serotypes associated with enteric illness and haemolytic uremic syndrome (HUS) isolated in Brazil from 2011 to 2016. Pathotypes isolated included enteropathogenic E. coli (EPEC), enteroaggregative E. coli (EAEC), enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC) and Shiga toxin-producing E. coli (STEC). PCR of stool enrichments for DEC pathotypes was employed, and E. albertii was also sought. O:H serotyping was performed on all DEC isolates. A total of 683 DEC and 10 E. albertii strains were isolated from 5047 clinical samples. The frequencies of DEC pathotypes were 52.6% (359/683) for EPEC, 325% for EAEC, 6.3% for ETEC, 4.4% for ETEC and 4.2% for STEC. DEC strains occurred in patients from 3 months to 96 years old, but EPEC, EAEC and STEC were most prevalent among children. Both typical and atypical isolates of EPEC and EAEC were recovered and presented great serotype heterogeneity. HUS cases were only associated with STEC serotype O157:H7. Two E. albertii isolates belonged to serogroup O113 and one had the stx2f gene. The higher prevalence of atypical EPEC in relation to EAEC in community-acquired diarrhoea in Brazil suggests a shift in the trend of DEC pathotypes circulation as previously EAEC predominated. This is the first report of E. albertii isolation from active surveillance. These results highlight the need of continuing DEC and E. albertii surveillance, as a mean to detect changes in the pattern of pathotypes and serotypes circulation and provide useful information for intervention and control strategies. Adolfo Lutz Inst Ctr Bacteriol, Natl Reference Lab Escherichia Coil Enter Infect, Sao Paulo, Brazil Adolfo Lutz Inst Ctr Interdisciplinary Procedures, Culture Collect Microorganisms, Sao Paulo, Brazil Adolfo Lutz Inst Reg Lab Santo Andre, Sao Paulo, Brazil Univ Fed Sao Paulo, Sao Paulo, Brazil Univ Estadual Paulista, Botucatu, SP, Brazil Univ Estadual Paulista, Botucatu, SP, Brazil

Objectives The ‘3-day rule’ for stool culture ordering suggests that only selected inpatients with nosocomial diarrhoea should have stool cultures for enteropathogenic bacteria (EPBs). Patients with haematological malignancies are not included in this group. We have analysed the ordering of stool cultures at Laikon Hospital to investigate whether all patients with haematological malignancies should be excluded from the 3-day rule. Methods We have retrospectively analysed all inpatient stool specimens sent to the microbiology laboratory for enteropathogenic bacteria culture at Laikon Hospital, Athens, Greece, between January 1, 2014 and December 31, 2014. We classified stool cultures sent after the third day as ‘appropriate’, ‘excluded’ with standard rule, ‘excluded’ with haematological malignancies, and ‘inappropriate’. Results During the study period, 1101/1593 inpatient stool cultures (69.1%) had been ordered after the third day of hospitalization. The total yield for inpatient EPB stool cultures was 0.7% (11/1593). The yield for ‘appropriate’ cultures was significantly higher than the yield of all ‘excluded’ specimens (3.7% (3/81) versus 0.3% (2/585), p 0.018) and to ‘inappropriate’ orders (3.7% (3/81) versus 0.0% (0/485), p 0.0028). There was no difference in the yield between specimens ‘excluded’ with the standard rule and ‘excluded’ with haematological malignancies. Conclusions In our hospital, the yield of stool cultures from patients with haematological malignancies is similar to that of patients ‘excluded’ from the standard 3-day rule. If patients with haematological malignancies were not excluded from the rule, we would reduce the inpatient stool cultures by 13.6% (217/1593) at the cost of missing one positive stool culture.

Clostridium difficile associated diarrhoea (CDAD) is the most common cause of health-care-associated infectious diarrhoea. In the context of the German health-care system, direct and indirect costs of an initial episode of CDAD and of CDAD recurrence are currently unknown.We defined CDAD as presence of diarrhoea (≥3 unformed stools/day) in association with detection of Clostridium difficile toxin in an unformed faecal sample. Patients treated with metronidazole (PO or IV) and/or vancomycin (PO) were included. Comprehensive data of patients were retrospectively documented into a database using the technology of the Cologne Cohort of Neutropenic Patients (CoCoNut). Patients with CDAD were matched to control patients in a 1:1 ratio. Analysis was split in three groups: incidence group (CDAD patients without recurrence), recurrence group (CDAD patients with ≥1 recurrence) and control group (matched non-CDAD patients).Between 02/2010 and 12/2011, 150 patients with CDAD (114 patients in the incidence and 36 (24 %) in the recurrence group) and 150 controls were analysed. Mean length of stay was: 32 (95 %CI: 30-37), 94 (95 %CI: 76-112) and 24 days (95 %CI: 22-27; P =0.001), resulting in mean overall direct treatment costs per patient of €18,460 (95 %CI: €14,660-€22,270), €73,900 (95 %CI: €50,340-€97,460) and €14,530 (95 %CI: €11,730-€17,330; P =0.001). In the incidence and recurrence group, the mean cumulative number of antibiotic CDAD treatment days was 11 (95 %CI: 10-12) and 36 (95 %CI: 27-45; P =0.001).Especially CDAD recurrence was associated with excessive costs, which were mostly attributable to a significantly longer overall length of stay. Innovative treatment strategies are warranted to reduce treatment costs and prevent recurrence of CDAD.

Highlights • The diarrhoeal disease burden in a large, prospective infant cohort in Vietnam is defined. • Minimum incidence of clinic-based diarrhoea in infants: 271/1000 infant-years. • Rotavirus was most commonly identified, followed by norovirus and bacterial pathogens. • Frequent repeat infections with the same pathogen within 1 year. • Inclusion of rotavirus in the immunization schedule for Vietnam is warranted., Summary Objectives Previous studies indicate a high burden of diarrhoeal disease in Vietnamese children, however longitudinal community-based data on burden and aetiology are limited. The findings from a large, prospective cohort study of diarrhoeal disease in infants in southern Vietnam are presented herein. Methods Infants were enrolled at birth in urban Ho Chi Minh City and a semi-rural district in southern Vietnam, and followed for 12 months (n = 6706). Diarrhoeal illness episodes were identified through clinic-based passive surveillance, hospital admissions, and self-reports. Results The minimum incidence of diarrhoeal illness in the first year of life was 271/1000 infant-years of observation for the whole cohort. Rotavirus was the most commonly detected pathogen (50% of positive samples), followed by norovirus (24%), Campylobacter (20%), Salmonella (18%), and Shigella (16%). Repeat infections were identified in 9% of infants infected with rotavirus, norovirus, Shigella, or Campylobacter, and 13% of those with Salmonella infections. Conclusions The minimum incidence of diarrhoeal disease in infants in both urban and semi-rural settings in southern Vietnam was quantified prospectively. A large proportion of laboratory-diagnosed disease was caused by rotavirus and norovirus. These data highlight the unmet need for a rotavirus vaccine in Vietnam and provide evidence of the previously unrecognized burden of norovirus in infants.

While working on a busy child assessment unit you review an 11-month-old boy who has a 36-hour history of acute diarrhoea felt to be infectious in nature. He is the third patient you have seen that day with the same problem. You have overheard that probiotics may reduce the duration of diarrhoea so decide to explore whether their use can help your patients. In individuals younger than 18 years of age with suspected or confirmed acute infectious diarrhoea (patient), do oral probiotics (intervention) compared with placebo or no intervention (comparison) shorten the duration of diarrhoea (outcome)? An Ovid Medline and EMBASE (1947 to May 2017 week 1) search was conducted on 11 May 2017 using the search terms diarrhoea OR diarrhea AND probiotics OR Lactobacill* OR Lactococc* OR Bifidobact* AND paediatric OR pediatric. Results were limited to humans. A total of 383 results were identified and screened to ensure relevance. The Cochrane database was also searched and all references reviewed to find other papers. Four relevant papers were identified once irrelevant results and those which were duplicates included within reviews were excluded. These 4 papers were inclusive of 1 Cochrane review (inclusive of 63 randomised controlled trials (RCTs)), 1 meta-analysis (inclusive of 11 RCTs—all of which were also included in the 2010 Cochrane review) and 2 additional RCTs. The four relevant papers were critically appraised that can be …

In the West, rotavirus immunisation became routine several years ago, and we are now enjoying the benefits of fewer admissions for infectious diarrhoea. In low-income countries, rotavirus gastroenteritis is not just an inconvenience, but a common and frequently fatal illness. This is particularly true of sub-Saharan Africa. Uptake of mass immunisation has been slow, because of cost and difficulty in getting refrigerated vaccine to remote communities: the ‘cold-chain’ problem. Unlike bacterial …

BackgroundAcute intestinal infections are common conditions causing high morbidity and mortality especially in the young and elderly, resulting in a significant burden on health service resources and the economy. Current National Institute for Health and Care Excellence guidance are fluid and nutritional management; however, this does not reduce the duration of diarrhoea and the challenge of treating diarrhoea itself remains. We investigated the efficacy, tolerability and safety of intestinal adsorbent Enterosgel (polymethylsiloxane polyhydrate) compared with standard care in adults with acute diarrhoea.MethodsThis was a randomised controlled trial enrolling 105 subjects to receive the medical device Enterosgel up to six times daily for up to 8 days with standard care (oral rehydration solution), or standard care alone. The primary endpoint was the duration of diarrhoea (hours) from randomisation to first non-loose stool in the Enterosgel versus control group.ResultsA total of 51 subjects were randomised into the Enterosgel group and 54 into the control group, after excluding missing data, the data from 43 subjects in each group were analysed. Duration of diarrhoea was significantly shorter in the Enterosgel group at 27 hours versus 39 hours in the control group (HR was 1.74 [95% CI 1.06 to 2.87]) (p=0.03). This yielded a number needed to treat value of 5. Enterosgel was well tolerated and safe with no serious adverse events. One serious diarrhoea-related event resulting in hospitalisation was reported in the control group.ConclusionsEnterosgel treatment was associated with a significant reduction in the duration of diarrhoea in adults with patient-reported acute diarrhoea, compared with standard care. These findings support the role of Enterosgel in acute diarrhoea especially in vulnerable groups where rapid resolution of symptoms is required. Reduction in symptom duration could translate to less healthcare costs and socioeconomic burden.Trial registration numberISRCTN20758708