salicylates and Gastroenteritis

ORS has led to improved outcome of acute gastroenteritis in both industrialised and developing countries. In both settings there is an increasing demand for active therapy to reduce the duration of diarrhoea and its complications. Persistent diarrhoea is a major consequence of intestinal infections and is responsible for a high number of deaths in poor countries. Bismuth subsalicylate has been used for treatment of acute diarrhoea, with preliminary promising results. In this issue of Acta Paediatrica, a trial with BSS is essential. However the results were marginal and did not justify a mass scale use of BSS, also because of poor cost efficacy rate.

Topics: Acute Disease; Bismuth; Child, Preschool; Diarrhea; Gastroenteritis; Humans; Infant; Organometallic Compounds; Rehydration Solutions; Salicylates

The therapeutic efficacy of bismuth subsalicylate was examined in a randomized double-blind fashion in 59 volunteers who were inoculated with Norwalk agent. Sixty-eight percent of the volunteers demonstrated seroconversion; 57% became ill. The severity and duration of the illness in 32 volunteers in the treatment and placebo groups were compared. Significant reduction in the severity and duration of abdominal cramps (P less than 0.01) and in the median duration of GI symptoms (P less than 0.05) was noted in the treatment group. There was no difference in the number, weight, or water content of stools, or in the rate of viral excretion between the two groups. The median duration of illness was 20 hr in the treatment group and 27 hr in the placebo group (0.1 greater than P greater than 0.05).

Topics: Adolescent; Adult; Antibodies, Viral; Bismuth; Double-Blind Method; Female; Gastroenteritis; Gastrointestinal Agents; Humans; Male; Organometallic Compounds; Parvoviridae; Random Allocation; Salicylates; Virus Diseases

Metabolic acidosis is associated with most severe malaria deaths in African children, and most deaths occur before maximum antimalarial action is achieved. Thus, specific acidosis treatment may reduce mortality. However, the underlying mechanisms remain poorly understood and no specific interventions have been developed. A detailed characterisation of this acidosis is critical in treatment development. We used the traditional and Stewart's approach to characterise acidosis in consecutive paediatric admissions for malaria and other acute non-surgical conditions to Kilifi District Hospital in Kenya. The overall acidosis prevalence was 21%. Gastroenteritis had the highest prevalence (61%). Both the mean albumin-corrected anion gap and the strong ion gap were high (>13 mmol/l and >0 mmol/l, respectively) in malaria, gastroenteritis, lower respiratory tract infection and malnutrition. Presence of salicylate in plasma was not associated with acidosis but was associated with signs of severe illness (odds ratio 2.11, 95% CI 1.1-4.2). In malaria, mean (95% CI) strong ion gap was 15 (14-7) mmol/l, and lactate, creatinine and inorganic phosphorous explained only approximately 40% of the variability in base excess (adjusted R2 = 0.397). Acidosis may be more common than previously recognised amongst paediatric admissions in Africa and is characterised by the presence of currently unidentified strong anions. In malaria, lactate and ketones, but not salicylate, are associated with acidosis. However, unidentified anions may be more important.

Topics: 3-Hydroxybutyric Acid; Acidosis; Acute Disease; Biomarkers; Child, Preschool; Creatinine; Female; Gastroenteritis; Hospitalization; Humans; Infant; Kenya; Ketones; Lactates; Lung Diseases; Malaria; Male; Malnutrition; Regression Analysis; Salicylates

Topics: Acute Disease; Bismuth; Child; Child, Preschool; Evidence-Based Medicine; Gastroenteritis; Humans; Infant; Organometallic Compounds; Safety; Salicylates; Treatment Outcome

Topics: Anti-Bacterial Agents; Bismuth; Drug Therapy, Combination; Eczema; Gastroenteritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Recurrence; Salicylates; Tetracycline

Topics: Adenosine Triphosphate; Child, Preschool; Creatine Kinase; Gastroenteritis; Humans; L-Lactate Dehydrogenase; Male; NAD; Poisoning; Salicylates; Transaminases