pectins and Diarrhea--Infantile

Acute diarrhea is amongst the most common childhood illnesses. Of paramount importance is an oral rehydration with glucose-electrolyte solutions. A number of herbal therapies are available to shorten the duration of the diarrhea and to alleviate the unpleasant symptoms. Although herbal preparations are generally well tolerated, only a few have been tested on children and adjusted to their needs. Various therapies for diarrhea in childhood are highlighted with regard to the clinical trials with children, and their user-friendliness.

Topics: Age Factors; Antidiarrheals; Chamomile; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Diarrhea, Infantile; Food Additives; Humans; Infant; Pectins; Phytotherapy; Time Factors

Various available forms of therapy can decrease morbidity and mortality associated with acute diarrhea. Oral fluids represent the cornerstone of therapy of all cases. A variety of agents acting nonspecifically can decrease diarrhea and improve other worrisome symptoms associated with enteric infection. Kaopectate makes the stool more formed but has little additional effects. Bismuth subsalicylate, an antisecretory agent, reduces the number of stools passed by about 50 percent and improves other associated symptomatology. The drugs that affect motility such as loperamide and diphenoxylate are the most active of the nonspecifically acting drugs. They must be avoided in patients with significant fever and dysentery. Trimethoprim/sulfamethoxazole is now considered the drug of choice for shigellosis due to the presence of ampicillin-resistant Shigella strains in most regions of the world. Trimethoprim/sulfamethoxazole is also an effective form of therapy for enterotoxigenic Escherichia coli infection and for traveler's diarrhea without definable cause. Erythromycin, although not proved to be effective against Campylobacter, probably shortens the disease. Furazolidone, although not dramatically effective, has a spectrum of activity that includes Shigella, enterotoxigenic E. coli, Campylobacter, and Giardia lamblia. It may not be effective in severely ill (hospitalized) patients with diarrhea. The various forms of available therapy can be administered empirically, depending on symptomatology. Mildly ill patients (one to three unformed stools in 24 hours with minimal additional symptoms) probably are best treated with fluids only. Mild to moderately ill persons (three to six unformed stools in 24 hours) can be treated with a drug that acts nonspecifically, such as bismuth subsalicylate or loperamide. Those with severe diseases (six or more unformed stools with moderate to severe associated symptoms), particularly when associated with fever and the passage of bloody mucoid stools, may be given an antimicrobial agent. The antimicrobial drug given will be determined by ancillary laboratory tests (dark-field examination or examination of a wet-mount preparation for motile Campylobacter or stool culture for Shigella, Campylobacter, or Salmonella) or may be administered on an empiric basis. Traveler's diarrhea can be eliminated in selected persons by the administration of a pharmacologic agent. Liquid bismuth subsalicylate is effective in large doses, which may be impr

Topics: Acute Disease; Adult; Anti-Infective Agents; Bismuth; Campylobacter Infections; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Diarrhea, Infantile; Drug Combinations; Dysentery, Amebic; Dysentery, Bacillary; Escherichia coli Infections; Giardiasis; Humans; Infant; Kaolin; Loperamide; Narcotics; Organometallic Compounds; Parasympatholytics; Pectins; Salicylates; Salmonella Infections; Travel

Topics: Cellulose; Diarrhea; Diarrhea, Infantile; Diet; Diet Therapy; Dietetics; Fruit; Galactans; Humans; Mannans; Pectins; Plant Gums; Vegetables

To evaluate the effects of green banana and pectin (nondigestible, dietary sources of colonic shortchain fatty acids [SCFA]) on intestinal permeability, 57 boys (5-12 months) with persistent diarrhea (> or = 14 days) were given a week's treatment with a rice-based diet containing either cooked green banana (n = 19), pectin (n = 17), or rice diet alone (n = 21). Intestinal permeability was assessed before and after treatment by giving a lactulose-mannitol (LM) drink and measuring urinary recovery after 5 hr. Treatment with banana significantly (P < 0.05) reduced lactulose recovery, increased mannitol recovery, and decreased the LM ratio, indicating improvement of permeability. Pectin produced similar results. Permeability changes were associated with a 50% reduction in stool weights which correlated strongly (green banana, r2 = 0.84, pectin, r2 = 0.86) with the LM ratio. Green banana-derived and SCFA-mediated stimulation of colonic as well as small bowel absorption is responsible for their antidiarrheal effects. The antidiarrheal effects of green banana and pectin are mediated by improvement of small intestinal permeability in addition to their known colonotrophic effects.

Topics: Antidiarrheals; Bangladesh; Diarrhea, Infantile; Humans; Infant; Intestinal Absorption; Intestinal Mucosa; Lactulose; Male; Mannitol; Musa; Oryza; Pectins; Permeability

Because of the beneficial intestinal effects of dietary fibers, we have evaluated the therapeutic effects of green banana or pectin in children with persistent diarrhea.. In a double-blind trial, 62 boys, age 5-12 months, were randomly given a rice-based diet containing either 250 g/L of cooked green banana (n = 22) or 4 g/kg pectin (n = 19) or the rice-diet alone (control, n = 21), providing 54 kcal/dL daily for 7 days. Stool weight and consistency, frequency of vomiting and purging, and duration of illness were measured.. Most children (60%) had no pathogens isolated from stools, 17% had rotavirus, 5% Vibrio cholerae, 4% Salmonella group B, and 11% had enterotoxigenic Escherichia coli infections. By day 3 posttreatment, significantly (P < 0.001) more children recovered from diarrhea receiving pectin or banana than controls (59%, 55%, and 15%, respectively). By day 4, these proportions correspondingly increased to 82%, 78%, and 23%, respectively, the study diet groups being significantly (P < 0.001) different than controls. Green banana and pectin significantly (P < 0.05) reduced amounts of stool, oral rehydration solution, intravenous fluid, and numbers of vomiting, and diarrheal duration.. Green banana and pectin are useful in the dietary management of persistent diarrhea in hospitalized children and may also be useful to treat children at home.

Topics: Antidiarrheals; Bangladesh; Diarrhea, Infantile; Disease-Free Survival; Double-Blind Method; Feces; Fluid Therapy; Humans; Infant; Infusions, Intravenous; Male; Oryza; Pectins; Treatment Outcome; Vomiting; Zingiberales

Various available forms of therapy can decrease morbidity and mortality associated with acute diarrhea. Oral fluids represent the cornerstone of therapy of all cases. A variety of agents acting nonspecifically can decrease diarrhea and improve other worrisome symptoms associated with enteric infection. Kaopectate makes the stool more formed but has little additional effects. Bismuth subsalicylate, an antisecretory agent, reduces the number of stools passed by about 50 percent and improves other associated symptomatology. The drugs that affect motility such as loperamide and diphenoxylate are the most active of the nonspecifically acting drugs. They must be avoided in patients with significant fever and dysentery. Trimethoprim/sulfamethoxazole is now considered the drug of choice for shigellosis due to the presence of ampicillin-resistant Shigella strains in most regions of the world. Trimethoprim/sulfamethoxazole is also an effective form of therapy for enterotoxigenic Escherichia coli infection and for traveler's diarrhea without definable cause. Erythromycin, although not proved to be effective against Campylobacter, probably shortens the disease. Furazolidone, although not dramatically effective, has a spectrum of activity that includes Shigella, enterotoxigenic E. coli, Campylobacter, and Giardia lamblia. It may not be effective in severely ill (hospitalized) patients with diarrhea. The various forms of available therapy can be administered empirically, depending on symptomatology. Mildly ill patients (one to three unformed stools in 24 hours with minimal additional symptoms) probably are best treated with fluids only. Mild to moderately ill persons (three to six unformed stools in 24 hours) can be treated with a drug that acts nonspecifically, such as bismuth subsalicylate or loperamide. Those with severe diseases (six or more unformed stools with moderate to severe associated symptoms), particularly when associated with fever and the passage of bloody mucoid stools, may be given an antimicrobial agent. The antimicrobial drug given will be determined by ancillary laboratory tests (dark-field examination or examination of a wet-mount preparation for motile Campylobacter or stool culture for Shigella, Campylobacter, or Salmonella) or may be administered on an empiric basis. Traveler's diarrhea can be eliminated in selected persons by the administration of a pharmacologic agent. Liquid bismuth subsalicylate is effective in large doses, which may be impr

Topics: Acute Disease; Adult; Anti-Infective Agents; Bismuth; Campylobacter Infections; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Diarrhea, Infantile; Drug Combinations; Dysentery, Amebic; Dysentery, Bacillary; Escherichia coli Infections; Giardiasis; Humans; Infant; Kaolin; Loperamide; Narcotics; Organometallic Compounds; Parasympatholytics; Pectins; Salicylates; Salmonella Infections; Travel

To evaluate the efficacy of antidiarrheal agents in the treatment of diarrheal illnesses, a study was conducted with children in Guatemala who had an acute diarrheal illness. Eighty patients, aged 3 to 11 years, were hospitalized and treated for two days with one of five agents: kaolin-pectin suspension concentrate (Kao-Con), kaolin suspension, pectin suspension, diphenoxylate-atropine liquid (Lomotil), or placebo. Although the patients receiving kaolin-pectin produced stools that tended to be more formed than those of the placebo-treated group patients, the study did not demonstrate any effect by any of the agents tested in influencing the frequency of bowel movement, the water content of the stools, or the weight of stools. Kaolin-pectin suspension and diphenoxylate-atropine liquid do not appear to be useful in the relief of acute nonspecific diarrhea in children.

Topics: Acute Disease; Antidiarrheals; Atropine; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea, Infantile; Diphenoxylate; Drug Evaluation; Feces; Female; Humans; Kaolin; Male; Pectins; Placebos

The management of acute diarrhea in infants with drugs is justified only where these drugs have specific interactions with the pathophysiologic mechanisms involved. Most of the infectious diarrheas are self-limited, many patients recover spontaneously. Antimicrobial drugs are only indicated if mucosal destruction takes place and symptoms of dysentery respectively inflammation are observed. Some authors propose to treat newborn and young infants in case of doubt. If antimicrobial drugs are given uncritically a selection of not obligatory microorganisms can occur, or the number of asymptomatic carriers increases. There is no confirmation that drugs like adsorbents (kaolin, pectin, charcoal) or lyophilized microorganisms have a therapeutic effect. In contrast morphine derivatives like loperamide act not only by slowing the intestinal motility but also by inhibiting the secretion mechanisms of the enterocyts. Nevertheless these drugs can not be recommended for infants since ileus symptoms have been observed.

Topics: Anti-Bacterial Agents; Charcoal; Diarrhea, Infantile; Gastrointestinal Motility; Humans; Infant; Intestinal Secretions; Kaolin; Loperamide; Pectins

Drugs that have been used or investigated in the treatment of diarrhoea in infancy were presented, such as stool thickening agent kaolin-pectin, anti-motility agent loperamide, anti-secretory agents such as chlorpromazine, aspirin, indomethacin, and antibiotics. Also treatment with oral rehydration solution was discussed from studies carried out. The present clinical studies demonstrate that most of anti-diarrhoeal drugs are not superior than the usual mode of fluid therapy in the treatment of infantile diarrhoea. The use of these anti-diarrhoeal drugs in the community, therefore, should be considered carefully since they may distract from the essential treatment--oral rehydration.

Topics: Anti-Bacterial Agents; Antidiarrheals; Aspirin; Chlorpromazine; Cholestyramine Resin; Diarrhea, Infantile; Humans; Infant; Kaolin; Loperamide; Pectins

Topics: Antacids; Diarrhea, Infantile; Female; Humans; Infant; Male; Pectins; Sorbitol

Topics: Atropa belladonna; Child, Preschool; Diarrhea, Infantile; Female; Humans; Infant; Kaolin; Male; Neomycin; Pectins; Phytotherapy; Plants, Medicinal; Plants, Toxic; Sulfaguanidine

Topics: Child; Diarrhea; Diarrhea, Infantile; Humans; Infant; Intestines; Kaolin; Neomycin; Opium; Pathology; Pectins; Toxicology