Guía de práctica clínica sobre el diagnóstico y tratamiento de la diarrea aguda infecciosa en pediatría Perú - 2011 / Clinical practice guidelines on the diagnosis and treatment of infectious acute diarrhea in children Peru - 2011

Guía de Práctica Clínica sobre el Diagnóstico y Tratamiento de la Diarrea Aguda Infecciosa en Pediatría del Perú es una información resumida sobre la definición criterios de inclusión y exclusión epidemiología y etiología de la diarrea infecciosa; considerando aspectos en el dignóstico y tratamiento (desidratación, tratamiento antibiótico, tratamientos de apoyo), soporte nutricional criterios de transferencias y alta y aspectos de prevención.

The Clinical Practice Guidelines cover the Diagnosis and Treatment of Acute Diarrhea in Pediatric Infectious is a consice information about definition, inclusion and exclusion criteria; epidemiology and etiology of infectious diarrhea. The guidelines cover aspects of diagnosis and treatment (dehydration, antibiotics, supportive therapy), nutritional support and other aspects of transferences and prevention.

Efficacy of Rifaximin Compared with Ciprofloxacin for the Treatment of Acute Infectious Diarrhea: A Randomized Controlled Multicenter Study

BACKGROUND/AIMS: Ciprofloxacin has been widely prescribed for acute infectious diarrhea. However, the resistance to this drug is increasing. Rifaximin is a novel but poorly absorbed rifamycin derivative. This study evaluated and compared the efficacies of rifaximin and ciprofloxacin for the treatment of acute infectious diarrhea. METHODS: We performed a randomized controlled multicenter study in Korea. Patients with acute diarrhea were enrolled and randomized to receive rifaximin or ciprofloxacin for 3 days. The primary efficacy endpoint was the time to last unformed stool (TLUS). Secondary endpoints were enteric wellness (reduction of at least 50% in the number of unformed stools during 24-hour postenrollment intervals), general wellness (subjective feeling of improvement), and proportion of patients with treatment failure. RESULTS: Intent-to-treat analysis (n=143) showed no significant difference between the rifaximin and ciprofloxacin groups in the mean TLUS (36.1 hours vs 43.6 hours, p=0.163), enteric wellness (49% vs 57%, p=0.428), general wellness (67% vs 78%, p=0.189), or treatment failure rate (9% vs 12%, p=0.841). The adverse events did not differ significantly between the two groups. CONCLUSIONS: These results suggest that rifaximin is as safe and effective as ciprofloxacin in the treatment of acute infectious diarrhea.

Management of Acute Infectious Diarrhea

Acute infectious diarrhea is a mostly self-limiting disease, but in some clinical situations such as infants, elderly, and immunocompromised patients, diarrheal illnesses might cause ominous results. Appropriate therapy could ameliorate symptoms and improve the prognosis. The mainstay of therapy consists of fluids and electrolytes, diet, symptomatic drugs, and antimicrobial agents. Rehydration is always the first goal of therapy by using oral rehydration solutions or intravenous fluids according to the patient's clinical condition. Antimicrobial therapy could be effective in the treatment of infectious diarrhea such as shigellosis, traveler's diarrhea, and C. difficile-associated colitis but also cause some adverse reactions such as worsening Shiga-toxin producing E. coli infection and increasing cost. So it is advisable to use antimicrobial agents properly and, first of all, preventive measures should be underscored.

Rifaximin versus Ciprofloxacin for Treatment of Acute Infectious Diarrhea / 中华医院感染学杂志

0.05).The incidence of adverse events was low and similar in each group. CONCLUSIONS Rifaximin is a safe and effective alternative to ciprofloxacin in the treatment of acute infectious diarrhea in adults.

Rifaximin in Treating Acute Infectious Diarrhea:A Clinical Study / 中华医院感染学杂志

OBJECTIVE To evaluate the clinical curative effect and safety of rifaximin in treating acute infectious(diarrhea).METHODS A multi-center randomized trial with double-blind double-analogue and parallel(-control) with positive drug was used.All the 240 chosen patients were classified into two groups.There were 120 cases in the trial group.On the first day,the patients received rifaximin 300mg tid.From the 2nd to 5th day,the patients(received) rifaximin 400 mg tid.There were 120 cases in the control group,on the first day,the patients received levofloxacin 100 mg tid;from 2nd to 5th day,they received levofloxacin 100 mg tid.The total therapeutic course was 3 to 5 days.RESULTS After 3-5 day treatment,symptoms such as ache in abdomen and diarrhea were(alleviated) or disappeared and stool examination was turned better or normally.To the trial group,the cure rate was 84.68%,the dominant effecive rate was 15.31%,and the total(effective) rate was 100.00%.The bacteria clearance rate was 100.00% in the trial group.There was no significant difference between two groups.There were no severe side effect in the two groups.CONCLUSIONS Rifaximin is an effective and safe drug for acute(infectious) diarrhea for adults.

Acute infectious Diarrhea in Pediatirc Patients / 소아과

Acute diarrhea is one of the most common diseases that are seen in pediatric patients. In the management of acute diarrhea, several differential diagnostic criteria should be considered based on clinical and/or laboratory findings. These criteria include:(1) normal variant stool versus diarrhea (2) infectious versus non-infectious condition and (3) bacterial versus non-bacterial etiology. The use of antibiotics should be considered to manage diarrhea caused by bacteria accompanying fever and bloody diarrhea in the following cases:(1) patients with serious clinical course, (2) under three months, (3) immunocompromised patients, (4) patients with nutritional deficiency and (5) patients presenting with moderate-to-severe dehydration. In patients presenting with the symptoms suspected to be bacterial origin, whose clinical course is not serious, antibiotic therapy is not necessary. These patients are easily manageable at OPD level. Moreover, except for some cases in which the use of antibiotics is inevitable, pediatric diarrhea can be managed by providing the suitable foods alone with no necessity of other specific drugs. Accordingly, it is crucial not so much to depend on the drugs as to provide appropriate foods including oral rehydration solution(ORS) with no further episodes of diarrhea. Special attention should be paid to the fact that younger pediatric patients will undergo nutritional deficiency unless acute diarrhea is properly managed.

Acute Infectious Diarrhea

Acute infectious diarrhea is the most common cause of diarrhea worldwide and is the leading cause of deaths in childhood. Despite improvements in public health and economic wealth, the incidence of intestinal infection remains high and continuous to be an important clinical problem in developed countries. Acute diarrhea, defined as an increased frequency of defecation (three or more times per day or at least 200 g of stool per day) lasting less than 14 days, may be accompanied by nausea, vomiting, abdominal cramping, clinically significant systemic symptoms, or malnutrition. Acute infectious diarrhea presents clinically as one of two major clinical syndromes, acute watery diarrhea, which usually resolves within 5~10 days, and diarrhea with blood (dysentery). The initial clinical evaluation of the patient with acute diarrhea should focus on the assessment of the severity of the illness, the need for rehydration, and the identification of likely causes on the basis of the history and clinical findings. In this article I focus on the causative agents, diagnosis, and management of acute infectious diarrhea in immunocompetent adults in Korea.