Clinical evaluation of the addition of lyophilized, heat-killed Lactobacillus acidophilus LB to oral rehydration therapy in the treatment of acute diarrhea in children.

BACKGROUND: Addition of a medication to the World Health Organization protocol for treatment of acute diarrhea in children is controversial. In this trial, the clinical efficacy of a medication (Lactéol Fort sachets; Laboratoire du Lactéol du Docteur Boucard, Houdan France) containing lyophilized heat-killed Lactobacillus acidophilus LB was assessed as an adjunct to oral rehydration therapy. METHODS: Children aged 3 to 24 months with acute diarrhea and mild or moderate dehydration were enrolled in the study. Children received oral rehydration therapy for the first 4 hours. After this first rehydration phase, undiluted milk formula or breast milk was fed alternately with oral rehydration solution. Children were fed rice gruel as tolerated. They received either one sachet containing 10 billion of lyophilized heat-killed L. acidophilus LB or placebo at admission and at 12-hour intervals for five doses. RESULTS: Seventy-three children (37 L. acidophilus LB, 36 placebo) were enrolled, of whom 40 (17 L. acidophilus LB, 23 placebo) received an antibiotic before inclusion. Rotavirus was identified in approximately 50% of the children in each group. After 24 hours of treatment, the number of rotavirus-positive children with watery stools was significantly lower (p = 0.012) in the L. acidophilus LB group. Mean duration of diarrhea was decreased (p = 0.034) with L. acidophilus LB (43.4 hours) versus placebo (57.0 hours). This decreased duration was particularly marked in children with no antibiotic therapy before inclusion (31.1 hours): 42.9 hours for the L. acidophilus LB group versus 74.0 hours for the placebo group (p = 0.016). CONCLUSIONS: Addition of L. acidophilus LB to oral rehydration therapy was effective in the treatment of children with acute diarrhea by decreasing the duration of diarrhea.

The protective effect of inhaled terbutaline, sodium cromoglycate and budesonide on exercise-induced asthma in children.

The effect of single-dose inhaled terbutaline, sodium cromo-glycate and budesonide were compared with control in 11 exercise-induced asthma (EIA) patients, aged 9-14 years. Patients exercise for 6 minutes, 15 minutes after inhaling drugs. The FVC, FEV1, PEFR and MMEF were recorded before exercise and after exercise at 5 minutes interval up to 25 minutes. After exercise, the mean (SEM) maximal percentage fall in FEV1 after placebo, 200 micrograms of terbutaline, 10 mg of sodium cromoglycate, and 100 micrograms of budesonide were 22.81 (3.45), 4.05 (2.11), 11.29 (1.18), and 20.36 (2.33) respectively. It was concluded that single-dose inhaled terbutaline and sodium cromoglycate resulted in a significant protective effect on exerxide-induced asthma whereas budesonide did not.

Comparison of efficacy of peptilose-base ORS (ORALNU) and WHO-ORS.

We examined whether replacing glucose with Peptilose into standard ORS would be advantageous over WHO-ORS. A study was carried out on 134 diarrheal children with mild to moderate dehydration. They received either WHO-ORS or Peptilose-ORS by randomized selection. In only two cases in each group, diarrhea was caused by Vibrio cholerae non 0-1. Significant per cent weight gain was observed in patients with Peptilose-ORS compared to those treated with WHO-ORS (P = 0.046). The patients could voluntarily take a higher amount of Peptilose-ORS and had significantly less stool output in the combined mildly and moderately dehydrated patients. It is concluded that Peptilose-ORS is more advantageous and acceptable than the standard WHO glucose-ORS for treatment of non cholera and 2 cases of cholera dehydrating diarrhea in children.

An intervention model for breast feeding in Maharat Nakhon Ratchasima Hospital.

To promote breast feeding and/or prevent further decline of adverse infant feeding practices, we developed an integrated comprehensive breast feeding promotion program, and implemented it in Maharat Nakhon Ratchasima Hospital in 1987. The program provided sound knowledge and attitudes toward breast feeding to all mothers at the Antenatal Care Unit, delivery room, the Postnatal Care Unit, and the Outpatient Department. The program activities included early bonding, assistance with initiation of breast feeding, rooming-in, provision of a breast feeding corner in the special care unit, collecting breast milk for sick babies, a lactation clinic and home visits. The impact of the program was evaluated in 1992. Altogether 1,428 mothers were interviewed using structured questionnaires. The results were highly encouraging. A majority of the mothers were of low socioeconomic status, 60 percent of them worked outside the home, and 40 percent were housewives. Compared with baseline data reported in 1986, breast feeding in infants aged 0 to one month increased from 85 to 90 percent, and the practice in the nine- to 12-month old group increased from 39 to 47 percent. However, the acute drop of the practice from 90 percent at birth to 50 percent at the one- to two-month old stage observed was similar in the two studies. The main reasons given by mothers for prematurely stopping breast feeding were the mothers' working outside the home (46%), and insufficient milk (23%). Provision of breast feeding education, along with improved maternal nutrition, extension of maternity leave, and availability of nurseries at the work place, may sustain a longer period of breast feeding.

Aluminium hydroxide and cholestyramine in the treatment of acute diarrhea.

A randomized, double blind control study of the treatment of acute diarrhea with aluminium hydroxide and cholestyramine in comparison with a control group demonstrated the effectiveness of cholestyramine in shortening the hospital stay, and the diarrhea course was better than that of aluminium hydroxide. However, aluminium hydroxide was superior to intravenous fluid plus early feeding.

Early home oral rehydration therapy (ORT) in primary health care.

PIP: This is a detailed account and comparison of use of 3 types of home-prepared oral rehydration solution versus no early treatment in 4 Thai villages from March 1983 to February 1984. The solutions, prepared with boiling water in a standard 750 ml fish sauce bottle contained: 2 spoons sugar and 2 spoon handle tips salt; 2 spoons sugar and 2 spoon tips tea; or 2 spoon tips salt in rice water as opposed to boiling water. Amounts dispensed were specified by number of watery stools and age of sufferer. All treatment was followed by breast feeding or soft diet within 2-4 hours. There were 0.05 episodes of diarrhea per person yearly, 0.10 per child, 9.5% in infants under 1 year, and 20.1% per child aged 1-4. Recovery rates ranged from 91-99% with home treatment, the highest with the tea mixture. Acceptability was good except for the rice water mixture: rice water is used for pig and dog food in this culture. In the test villages, 6.6% of diarrhea episodes required rehydration at the health center, while the control village needed treatment for 25.9% of episodes at the local health center, provincial hospital or private clinics. The estimated cost of therapy for each diarrheal episode was over $2.00 US for purchased medication, or 30 times the expense of home mixed solution. Medicines used were oral rehydration solutions, sulfa, tetracycline, chloramphenicol, kaolin, loperamide, or herbs. Analysis of some home mixed solutions is reported. The tea mixture contained virtually no electrolytes, but was effective because it was used earlier than solution requiring mealtime rice water, for example. In this trial, where treatment was under control of villagers and fully integrated into the primary health care system, early home treatment was more effective than later care in the center.^ieng

The role of parents and medical auxiliaries in oral rehydration in Thailand.

Parents and medical auxiliaries should participate in the oral rehydration programme to reduce diarrhoeal diseases mortality. Integration of this programme into the national health programme will require a system of education and training that can reach everyone involved in the delivery of health care. A pilot study carried out at a province in northeast of Thailand showed that only 0.6% of diarrhoeal cases had to be referred for treatment to the provincial hospital. The benefit of oral rehydration at periphery by local health officers could be appreciated by the reduction in admission of diarrhoeal cases to the provincial hospital and significant reduction of mortality rate. The role of parents and medical auxiliaries in practice and promotion of oral rehydration is the key to the success of control of diarrhoeal diseases in the context of primary health care.