A blind, randomized comparison of racecadotril and loperamide for stopping acute diarrhea in adults

AIM: Racecadotril is a specific enkephalinase inhibitor that exhibits intestinal antisecretory activity without affecting intestinal transit. Loperamide is an effective anti-diarrheal agent, but it usually induces constipation. This study is to compare the efficacy, safety, and tolerability of racecadotril versus loperamide in the outpatient treatment of acute diarrhea in adults. METHODS: A two-center, randomized, parallel-group, single-blind study was carried out to compare the efficacy, tolerability, and safety of racecadotril (100 mg thrics daily) and loperamide (2.0 mg 2 twics daily) in 62 adult patients suffering from acute diarrhea. The main efficacy criterion used was the duration of diarrhea after beginning the treatment (in hours). Other signs and symptoms were also evaluated. RESULTS: The clinical success rates for these anti-diarrheal treatments were 95.7% and 92.0% for racecadotril and loperamide respectively. Patients on racecadotril had a median duration of diarrhea of 19.5 h compared with a median of 13 h for patients on loperamide. Rapid improvement in anal burn and nausea was found for each drug. However, more patients on loperamide suffered from reactive constipation (29.0% vs 12.9%). Itching, another adverse event was notably higher in the racecadotril group (28.6% vs 0%). With regard to other adverse events, the two medications showed similar occurrence rates and similar concomitant medication usage rates. CONCLUSION: Racecadotril and loperamide are rapid, equally effective treatments for acute diarrhea in adults, but loperamide treatment is associated with a higher incidence of treatment-related constipation.

A scoring system for assessing the severity of acute diarrhea of adult patients

BACKGROUND: Diarrhea is frequently seen in developed and developing countries, and severe diarrhea is characterized by the high risk of death. Thus, it is very important to assess the severity of diarrhea early. We conducted a multi-center study to identify risk factors for the severity of diarrhea in adult patients and formulate an adult diarrhea state score(ADSS) for out-patient clinicians.METHODS: A total of 219 adult patients with acute diarrhea were divided into two groups: 132 patients with mild diarrhea and 87 with severe diarrhea. Logistic regression was used to determine risk factors for the severity of diarrhea. The risk factors were assessed and an ADSS was formulated. Receiver operating characteristic(ROC) analysis was made to evaluate the diagnostic accuracy of ADSS, and the Kappa test was used to confi rm the diagnostic reliability.RESULTS: Five risk factors for evaluating the severity of diarrhea in adults included age(P<0.05), axillary temperature(P<0.01), mean arterial pressure(P<0.01), white blood cell count(WBC; P<0.01), and WBC in stool(P<0.01). The area under the ROC curve for ADSS was 0.958 when the cut off value was 4(a sensitivity of 0.909; a specif icity of 0.874), and the Kappa value was 0.781(P<0.05).CONCLUSION: The risk factors associated with the pathogenic condition of diarrhea were identifi ed, quantifi ed and formulated into an ADSS, which has high diagnostic accuracy and reliability for the early identifi cation of patients with severe acute diarrhea.

Management of acute diarrhea in adults in hospitals in Beijing did not adhere well to Manatsathit working party guidelines

How hospital physicians adhere to guidelines on management of diarrhea in adults has not been adequately assessed. The purposes of this study were to evaluate the management of acute diarrhea in adults and to assess the adherence of hospital physicians to the Manatsathit working party recommended guidelines. A cross sectional survey was carried out during May to July 2011 among physicians in 10 hospitals in Beijing, China. Data were collected for 400 patients （208 females and 192 males） with the mean age of （35.54-14.8） years. Overall, 357 （89.3%） patients presented with watery diarrhea and 43 （10.7%） patients presented with bloody diarrhea. Of 357 patients who needed fluid and electrolyte therapy, however, up to 114 （31.9%） patients were not ordered any fluid and electrolyte replacement; although only 28 （7.8%） actually supposed to use the antibiotics due to an age of higher than 65 years or being immunologically compromised, however, 186 （52.1%） were prescribed antibiotics which significantly deviated from the guidelines recommended by the Manatsathit working party. Antimotility drugs were only used in seven patients with watery diarrhea, which was in line with the guidelines. Hospital physicians in Beijing did not adhere well to the guidelines for the management of acute diarrhea. Physicians might need to be refreshed on the guidelines in this specific field.

Viral and Bacterial Etiology of Acute Diarrhea among Children under 5 Years of Age in Wuhan, China

Background： Acute diarrhea remains the serious problem in developing countries, especially among children under 5 years of age. Currently, only two or three common diarrhea pathogens were screened at most hospitals in China. The aim of this study was to provide a wide variety of diarrhea pathogens and their antimicrobial resistance patterns in children under 5 years of age. Methods： Totally 381 stool samples collected from Tongji Hospital between July 1, 2014 and June 30, 2015 were tested by culture and/or polymerase chain reaction for eight kinds of bacteria and five kinds of viruses. An antimicrobial sensitivity test was performed using dilution method recommended by the Clinical and Laboratory Standards Institute. Results： Viral infections were mainly identified in infants （0-11 months）, whereas bacterial infections were more prevalent in the age of 24-59 months. About 69.8% of samples were positive for at least one pathogen, 51.7% of samples were virus positive, followed by bacteria positive cases （19.4%）, and 12.6% of cases displayed co-infections with two viruses or a virus and a bacterium. Rotavirus was the most prevalent pathogen, followed closely by norovirus, while Salmonella was the most commonly isolated bacteria, followed by diarrheagenic Escherichia coli （DEC） and Campylobacter. More than 40% of Salmonella spp. and DEC isolates were resistant to first-line antibiotics （ampicillin, trimethoprim-sulfamethoxazole, and tetracycline）. Around 10% of Salmonella spp. isolates were resistant to ceftriaxone and ciprofloxacin simultaneously. Campylobacter spp. displayed high resistance to ciprofloxacin but kept low resistance to azithromycin and doxycycline. Conclusions： The etiology of acute diarrhea varies in children of different age groups. The high frequency of infection with viruses suggests the urgent demand for new viral vaccine development. Proper use of antibiotics in the treatment of acute diarrhea is crucial due to the high level of antibiotic resistance.

Effect of Warming Moxibustion on Shenque Acupoint for the Treatment of Acute Diarrhea in Children with Infantile Cerebral Palsy

Objective:To observe the effect of warming moxibustion on Shenque acupoint(RN8) for the treatment of acute diarrhea in children with infantile cerebral palsy(ICP).Methods:Clinical observation was performed on 60 ICP children suffering from acute diarrhea,who were randomly assigned to two groups equally.The Mox group was treated with warming moxibustion on Shenque acupoint(RN8) and the control group treated with Smecta.The efficacy was evaluated by markedly effective rate and total effective rate after a 6-d...

Comparative study on epidemiological and etiological characteristics of patients with acute diarrhea with febrile or non-febrile symptoms in China

Background Acute diarrhea with fever can potentially represent a more severe form of the disease compared to non-febrile diarrhea. This study was to investigate the epidemiological characteristics and enteric pathogen composition of febrile-diarrheal patients, and to explore factors including pathogens associated with fever by age group.Methods A nationwide surveillance study of acute diarrheal patients of all ages was conducted in 217 sentinel hospitals from 31 provinces (autonomous regions or municipalities) in China between 2011 and 2020. Seventeen diarrhea-related pathogens, including seven viruses and ten bacteria, were investigated and their association with occurrence of fever symptoms was assessed using multivariate logistic analysis.Results A total of 146,296 patients with acute diarrhea (18.6% with fever) were tested. Th diarrheal children below 5 years had the highest frequency of fever (24.2%), and related to significantly higher prevalence of viral enteropathogens (40.2%) as compared with other age groups (P < 0.001). Within each age group, the febrile-diarrheal patients were associated with a significantly higher prevalence of bacterial pathogens than afebrile-diarrheal patients (allP < 0.01). There was discrepancy when each pathogen was compared, i.e., nontyphoidalSalmonella (NTS) was over-represented in febrile vs non-febrile patients of all age groups, while the febrile vs non-febrile difference for diarrheagenicEscherichia coli (DEC) was only significant for adult groups. The multivariate analysis revealed significant association between fever and infection with rotavirus A among children [odds ratio (OR) = 1.60], for DEC in adult groups (OR = 1.64), for NTS in both children (OR = 2.95) and adults (OR = 3.59).Conclusions There are significant discrepancy of the infected enteric pathogens in patients with acute diarrhea with fever between age groups, and it is valuable for priority detection of NTS and rotavirus A in patients with children < 5 years old and NTS and DEC in adult patients. The results may be useful in identifying dominant pathogen candidates for the application of diagnostic assays and prevention control.

Efficacy of stool multiplex polymerase chain reaction assay in adult patients with acute infectious diarrhea

BACKGROUND Recently,stool multiplex polymerase chain reaction(PCR)tests have been developed for identifying diarrhea-causing bacterial pathogens.Furthermore,fecal calprotectin is a well-known effective marker for intestinal mucosal inflammation.AIM To evaluate the efficacy of stool multiplex PCR and fecal calprotectin in acute infectious diarrhea.METHODS Overall,400 patients with acute infectious diarrhea were enrolled from Kangdong Sacred Heart Hospital(January 2016 to December 2018).Multiplex PCR detected 7 enteropathogenic bacteria including Salmonella,Campylobacter,Shigella,Escherichia coli O157:H7,Aeromonas,Vibrio,and Clostridium difficile.We reviewed clinical and laboratory findings using stool multiplex PCR.RESULTS Stool multiplex PCR test detected considerably more bacterial pathogens than stool culture(49.2%vs 5.2%),with Campylobacter as the most common pathogen(54%).Patients with positive stool PCR showed elevated fecal calprotectin expression compared to patients with negative stool PCR(1124.5±816.9 mg/kg vs 609±713.2 mg/kg,P=0.001).C-reactive protein(OR=1.01,95%CI:1.001-1.027,P=0.034)and sigmoidoscopy-detected colitis(OR=4.76,95%CI:1.101-20.551,P=0.037)were independent factors in stool PCR-based detection of bacterial pathogens.Sensitivity and specificity of calprotectin were evaluated to be 70.5%and 60.9%,respectively(adjusted cut-off value=388 mg/kg).CONCLUSION Stool multiplex PCR test has increased sensitivity in detecting pathogens than conventional culture,and it is correlated with calprotectin expression.Stool multiplex PCR and calprotectin may be effective in predicting clinical severity of infectious diarrhea.

Formulation of an Early Warning Infectivity Score System for Adult Patients with Acute Bacterial Diarrhea

The aim of our study was to develop a scoring system to predict whether diarrhea is of a bacterial origin and whether the diarrheal patients constitute a potential source of infection to others. Adults with acute diarrhea （n=424） were enrolled in the study. Logistic regression and standard regression coefficients were used to formulate the Early Warning Infectivity Score System for Adults with Acute Bacterial Diarrhea （EWIS-ABD）. Four risk factors were identified by logistic regression, including body temperature （P〈0.01）, abdominal pain （P〈0.01）, leukocyte count in stool （P〈0.01）, and unclean dietary history （P〈0.01）. EWIS-ABD was thus developed, in which the value 〉5 points was set as an indicator of bacterial diarrhea. The incidence of bacterial diarrhea increased along with the elevated score. EWIS-ABD was more specific for bacterial diarrhea than for viral diarrhea. The accuracy and reliability of EWIS-ABD was high by prospective validation in 478 patients with acute diarrhea.

Inappropriate use of empirical antibiotics in adults with acute infectious diarrhea in a large teaching hospital

Overuse of antibiotics for the treatment of acute diarrhea is very common. The aim of the current study was to investigate the inappropriate use of antibiotics in adults with acute infectious diarrhea and to evaluate the association between the use of antibiotics and clinical features. To achieve this aim, we reviewed 4891 patients＇ medical records from Apr. 2008 to Oct. 2009. Of the total 4891 cases, 30.5% had clinical features of invasive bacterial diarrhea, 48.1% were prescribed with antibiotics, and 20.3% received inappropriate antibiotic treatment. Of note, 19% involved unnecessary antibiotic prescriptions in non-indicated cases, which accounted for 39.4% of all antibiotics prescribed in the total 4891 patients. There was no significant differences between physicians and medical trainees in the inappropriate use of antibiotics （P = 1.0）. Logistic regression analysis demonstrated that except for body temperature, other clinical symptoms including abdominal pain, tenesmus, and faecal WBC count （〉10 cells/HPF） were associated with the use of antibiotics. In addition, other clinical indicators including vomiting, stool frequency of 5-10 times/d, mucous stool, and fecal WBC count of 1-10 cells/HPF, which are not normally indicators for prescribing antibiotics, were also associated with the use of antibiotics. This might suggest that these symptoms were mistaken as features of invasive bacterial diarrhea, thus leading to the overuse of antibiotics.

Pathogens and possible opinion for antibiotic treatment in adult patients with 1–14 fecal WBC/HPF of acute non-bloody diarrhea

The pathogens and opinion for antibiotic treatment in adult patients with 1-14 fecal white blood cells per high power field （WBC/HPF） of acute non-bloody diarrhea remain obscure. The study attempts to clarify it. Stool specimens of adult patients with acute non-bloody diarrhea and stool examination showing 1-14 fecal WBC/HPF were collected for bacterial culture and viral detection. Patients included in this study were 196 cases with mean age of （37.9±17.4） years and 42.3% was women. The bacterial and viral detection rates were 63 （32.1%） and 21 （10.7%）, respectively. Of the isolated pathogens, campylobacteria was present in 14 （22.0%） samples and was the most common bacteria and calicivirus was found in 10 （47.6%） samples and was the most common virus. Based on single pathogens, 46 cases were caused by invasive pathogens, 26 cases were caused by non-invasive pathogens. The body temperature was significantly higher in feverish patients caused by invasive pathogens than those caused by non-invasive pathogens （（38.44-0.7） ℃ vs （37.74-0.4） ℃, P = 0.002）. The probability of diarrhea caused by invasive pathogens was higher in patients with T〉38.4℃ than those with T_〈38.4℃ （RR = 1.5）. When T〉38.4℃ is used as the threshold for antibiotic treatment, the misuse rate of antibiotics would decrease from 26.9% to 3.8% （P = 0.021）. So T〉38.4 ℃ may be used as a possible reference value for antibiotic treatment in adult patients with 1-14 fecal WBC/HPF of acute non-bloody diarrhea.

Inevitability of an Enhanced Monitoring Strategy to Reduce Water Borne Illness Combining Indicators of Sanitary Protection and Measuring Water Quality

Background: Diarrhoea is the second leading cause of childhood mortality in children under five years old. Water is a major contributing risk factor for this disease that is a common illness and a global killer. Material and Methods: Water samples from different areas of Karachi were collected and were processed by MPN technique to evaluate the presence of microbiological substances. Results: Out of the processed samples, 64% were positive for the presence of mix enteric pathogen from different areas of Karachi;from Bhens colony, 74% were positive for the presence of fecal coli forms, among which 4% were positive for EHEC isolated from storage tank and water tank. Conclusion: The abovementioned results reflect the presence of organisms of public health importance in different sources of drinking water. According to WHO guidelines, there should be zero tolerance of these organisms in water.