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• Apr–Jun 2014 • Vol LIII • No 4
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Dear reader,
According to the World Health
Organization, the prevalence of
chronic diarrhea in children ranges
from 3% to 20%, worldwide.
Chronic diarrhea lasting for more
than 14 days could lead to weight
loss, dehydration, and severe
nutritional impairment. Accurate
diagnosis and appropriate
treatment are crucial since
diarrhea impairs physical and
psychological development
in children. Improvements in
nutritional status of infants and
children as well as prevention and
rational management of diarrhea
are keys to prevent chronic
diarrhea and its complications.
The treatment of chronic diarrhea
often includes nutritional diet,
general supportive care, and
medications.
The “Clinical Studies”section
of this issue features a clinical
trial that highlights the safety
and efficacy of
Diarex
syrup, a
phytopharmaceutical formulation
of The Himalaya Drug Company,
in the management of diarrhea
in children. The section also
features articles that discuss
about the clinical efficacy of
Pilex
in the treatment of piles and
fissures,
Lukol
in the treatment
of leukorrhea and its associated
symptoms, and
Septilin
in the
management of respiratory tract
infections.
In addition to these, this issue
includes interesting articles in our
regular features like Health News,
Health Tips, Fitness, and Fact File.
Hope you find this issue
informative and interesting. For
any suggestions/feedbacks,
write to us at
publications@
himalayahealthcare.com
.
Happy reading!
— Editor
E D I T O R I A L
elimination diet, general
supportive care, and drugs.
Several nutrients and
microelements affect the
regulation of intestinal
epithelial proliferation,
differentiation, apoptosis, and
migration. Enteric infection,
a common cause of chronic
diarrhea induces secondary
lactase deficiency. Thus,
according to WHO, a lactose-
free diet preferentially should
be started in all children with
chronic diarrhea. An easily
available yogurt-based diet can
be used to treat mild chronic
diarrhea of uncomplicated
nature and without
enteropathy. Elimination diet
is considered when allergic
enteropathy is induced by
a cow’s milk protein or soy
protein. It refers to exclusion
of these allergic foods from the
diet, one at a time.
Parents and caretakers of
children suffering from
diarrhea should be cautious
and avoid contracting the
infection themselves and
spreading to family, friends,
and others. Employing
extensive care with
handwashing, diapering, and
keeping sick children out of
school or daycare are a few
ways to limit the number of
persons exposed to infectious
microorganisms.
References
1. Lee KS, et al.
Pediatr Gastroenterol
Hepatol Nutr.
2012;15(4):229–236.
2. Das JK, et al.
BMC Public Health.
2013;13(Suppl 3):S9.
Highly-resistant
Escherichia coli
, a Common Cause
of Diarrhea in Children
UNICEF and WHO have noted that India
has more number of deaths (estimated
386,600 annually) due to diarrhea than any
other country in the world. It is common to
prescribe antimicrobial agents to children with
severe diarrhea and those who do not respond
adequately to rehydration therapy. However,
rapidly growing antimicrobial resistance is a
global concern, leaving the physicians with
very few choices for antimicrobials.
A study was undertaken with the aim of
determining the role of
Escherichia coli
in
acute diarrhea among children aged < 5 years.
It was also aimed at determining the degree
of antimicrobial resistance and production
of extended-spectrum
β
-lactamase (ESBL)
by the diarrheagenic
E coli
(DEC). The study
was conducted over a period of 1.5 years in
347 children aged < 5 years presenting with
acute diarrhea (with or without visible blood/
mucus) of duration < 14 days. Stool samples of
these patients were analyzed. Microorganisms
were identified on the basis of colony
characteristics and biochemical reactions.
Bacterial enteropathogens were subjected to
antimicrobial susceptibility testing, using
disc diffusion method against a wide range
of antimicrobial agents and phenotypic
confirmatory test for ESBL production.
Of the stool specimens from 347 children,
pathogenic organisms were isolated from
156 (44.9%) patients. DEC was the most
common bacterial agent, responsible for 87
(25.1%) cases. By serotyping, enteropathogenic
E coli
was found to be the most frequent type
among
E coli
specimens (48 cases; 55.1%),
followed by enterotoxigenic
E coli
(29 cases;
33.3%), enteroaggregative
E coli
(9 cases;
10.3%), and enterohemorrhagic
E coli
(1
case; 1.1%).
Shigella
spp. and
Vibrio cholerae
were isolated in 36 (10.4%) and 13 (3.7%)
cases, respectively.
A large number of these strains were found
to show multidrug resistance to 3 or more
classes of antimicrobials (72.4%). All DEC
strains were resistant to nalidixic acid (100%)
while more than two-thirds were resistant
to ampicillin (90.8%), doxycyline (80.5%),
cotrimoxazole (95.8%), ofloxacin (73.3%), and
ciprofloxacin (72.4%).
These results suggest that DEC is the most
common bacterial cause of pediatric diarrhea
with majority of the strains being resistant to
several antimicrobials.
Source
:
Aggarwal P, et al.
J Health Popul Nutr
.
2013;31(3):409–412.
