Effects of pectin on diarrhea in critically ill tube-fed patients receiving antibiotics.

BACKGROUND: Anaerobic colonic flora are necessary for the fermentation of fiber into short-chain fatty acids and constitute the bulk of fecal mass. Lack of dietary fiber in most enteral feedings, compounded by antibiotic therapy, suppresses normal colonic metabolism, resulting in diarrhea. Pectin, a water-soluble fiber, stimulates epithelial growth in the colon and thus reduces diarrhea. METHODS: Forty-four critically ill patients receiving enteral nutrition and antibiotic therapy were randomized to receive fiber-containing or fiber-free tube feedings and pectin or placebo. Data on frequency, consistency, and volume of fecal output; energy (caloric) intake; and administration of specific medications were collected for 9 days. Diarrhea was defined as 2 or more days with scores of 12 or higher on the Hart and Dobb diarrhea scale. RESULTS: Subjects in the 4 groups did not differ significantly in age, sex, severity of illness, or energy intake. Twelve subjects (27.3%) experienced diarrhea. Significantly fewer subjects in the fiber-free/placebo and fiber/pectin groups experienced diarrhea than did subjects in the fiber/placebo group (P = .02). On the basis of repeated-measures analysis of variance of daily mean scores, the severity of diarrhea did not differ significantly among the study groups over time (P = .16). CONCLUSIONS: The reduced rate of diarrhea found in this study may be related to the stringent definition of diarrhea used. The therapeutic dose of pectin for reducing diarrhea needs further exploration. The trend was toward less diarrhea in the fiber/pectin group, but the study needs to be replicated with a larger sample.

Provider endorsement: the strongest cue in prompting high-risk adults to receive influenza and pneumococcal immunizations.

Vaccination against influenza and pneumococcal disease could decrease the sickness, suffering, and death from flu and pneumonia, yet immunization rates for adults at highest risk remain less than Healthy People 2000's goal of 60%. This study examined the effect of an educational cue on vaccination acceptance, ascertained the most influential reasons for receiving vaccination, and determined to what extent prior influenza immunization affected repeat vaccination. Two brochures, one each for influenza and pneumonia, were disseminated to 52% of 463 participants residing in two rural Maine counties. Information was sought from all participants via an anonymous written questionnaire. An educational cue did not increase vaccination coverage in this high-risk sample. Provider recommendation was the most important reason adults received immunization. Prior vaccination was a strong predictor of present immunization status. This study suggests that practitioner endorsement can significantly decrease the morbidity and mortality associated with flu and pneumonia by improving immunization rates.