Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0740441 (acute diarrhea)
 2,275 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty-four children with acute diarrhoea were treated orally with 50 mg/kg/day of either ampicillin in 4 divided doses, or with cefaclor in 3 divided doses for 5 days. Shigella was isolated from the stool of 28 patients, 6 of whom were hospitalized. All isolates, including ampicillin-resistant strains, were susceptible in vitro to cefaclor. For ampicillin-sensitive infections, the clinical response and clearing of Shigella from stools appeared to occur more rapidly in patients treated with ampicillin than in those treated with cefaclor. In areas where ampicillin resistance is a problem, cefaclor appears not to be a drug of choice for the treatment of Shigella.
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PMID:Comparison of cefaclor and ampicillin in the treatment of shigellosis. 39 85

One-hundred seventy-four infants and children with acute diarrhea were treated as ambulatory patients with either ampicillin (100 mg/kg/day orally in four divided doses) or trimethoprim sulfamethoxazole (10 mg TMP and 50 mg SMX/KG/day orally in two divided doses). There were 65 patients with shigellosis. Responses of those treated with TMP/SMX and of those with susceptible Shigella treated with ampicillin were comparable. Patients with resistant organisms failed to respond to ampicillin. All Shigella, including ampicillin-resistant strains, were suseptible in vitro to TMP/SMX, and patients with ampicillin-resistant strains responded favorably to treatment with TMP/SMX. TMP/SMX appears to be the best, currently available drug for the treatment of shigellosis.
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PMID:Comparison of trimethoprim-sulfamethoxazole and ampicillin theraphy for shigellosis in ambulatory. 104 83

Most ampicillin-resistant Shigella are susceptible to cephalexin. Randomized treatment with cephalexin or ampicillin was given to 154 infants and children with acute diarrhea. Rectal swab cultures revealed Shigella in 42%, Salmonella in 6%, enteropathogenic Escherichia coli in 2%, and no pathogen in 50%. Cephalexin failed to eradicate Shigella after 5 days of treatment in 76% of patients as contrasted with 28% of ampicillin-treated patients with susceptible organisms. Shigella persisted in 78% of ampicillin-treated patients with resistant organisms. Diarrhea lasted more than 5 days in 43% of cephalexin-treated patients, in 56% of the ampicillin group with resistant organisms, but in only 9% of ampicillin-treated patients with susceptible organisms. The failure of cephalexin was due to the relatively high minimal inhibitory concentrations and minimal bacterial concentrations of 5 or 10 mug/ml and, although serum concentrations were twice the minimal bacterial concentration, they were not sufficient to demonstrate killing by the serum dilution method. In vitro susceptibility or resistance of Shigella to ampicillin correlated with clinical success or failure. Cephalexin is not a suitable drug for treatment of shigellosis in patients with ampicillin-resistant organisms.
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PMID:Comparative efficacy of cephalexin and ampicillin for shigellosis and other types of acute diarrhea in infants and children. 109

Antibiotic-associated pseudomembranous colitis is an uncommon but potentially serious adverse reaction, resulting in acute diarrhoea and characterised by colonic pseudomembranes. A direct relationship between the disease, recent antibiotic therapy and proliferation of Clostridium difficile in the colonic lumen was established in the late 1970s. It is thought that antibiotic therapy may alter the enteric flora, enabling C. difficile to proliferate and produce toxins with cytopathic (toxin B or cytotoxin) and hypersecretory (toxin A or enterotoxin) effects on the mucosa. Apart from clindamycin, the first antibiotic recognised to be clearly associated with pseudomembranous colitis, the antimicrobial agents most commonly responsible are cephalosporins and ampicillin (or amoxicillin). However, virtually all antibiotics except parenterally administered aminoglycosides can cause the disease. Vancomycin and metronidazole, 2 drugs used to treat antibiotic-associated pseudomembranous colitis, have also been reported to be responsible for the complication when used parenterally. Pseudomembranous colitis may develop after perioperative prophylactic antibiotic therapy with cephalosporins. Antibiotic-associated pseudomembranous colitis is most frequent in elderly and debilitated patients and in intensive care units. Nosocomial acquisition of C. difficile has been documented. Therefore it has been recommended that enteric isolation precautions should be taken with patients with this disease. The clinical symptoms include watery diarrhoea, abdominal cramping, and frequently fever, leucocytosis and hypoalbuminaemia. Toxic megacolon and acute peritonitis secondary to perforation of the colon are the most serious complications. The pseudomembranes are usually seen during endoscopic procedures, sigmoidoscopy or, if possible, colonoscopy; the most useful microbiological tests for confirmation of the diagnosis include cycloserine cefoxitin fructose agar (CCFA) stool cultures and stool toxin assays on tissues or by immunological techniques. However, cultures and toxin tests may be positive in patients without pseudomembranous colitis or C. difficile-associated diarrhoea. Mild cases may respond to discontinuation of the drug responsible, but therapy with an anticlostridial antibiotic is often necessary: a 10-day course of oral vancomycin, metronidazole or bacitracin should be given. Relapses are seen in 5 to 50% of patients treated. Antibiotic treatment should avoid sporulation leading to other relapses. 'Biotherapy' (lactobacilli, Saccharomyces) has also been proposed.
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PMID:The clinical significance of antibiotic-associated pseudomembranous colitis in the 1990s. 193 Jul 40

Shigella species have been one of the most common causes of acute diarrhea in Bangkok, Thailand. The incidence of shigellosis increased steadily from 1984 to 1988. The majority of Shigella species isolated from specimens from patients with acute diarrhea in Bangkok in 1988 were resistant to both ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ). Shigella flexneri was the most commonly isolated organism and had the highest rate of resistance to ampicillin, chloramphenicol, TMP-SMZ, and tetracycline. The antimicrobial agents of choice for the treatment of shigellosis have been changed from ampicillin to TMP-SMZ and recently to the fluoroquinolones. We conducted a controlled study of norfloxacin that revealed its efficacy for eradication of Shigella species from the stool of both adults and children. The fluoroquinolones shorten the course of diarrhea, reduce the shedding of the organism, and prevent the spread of infection. No short-term adverse effects of the quinolones were observed in this study; however, its use among children should be restricted to treatment of severe shigellosis and the duration of treatment should be as short as possible.
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PMID:Response to antimicrobial therapy for shigellosis in Thailand. 204 60

The effect of antibiotic therapy on intake of food and absorption of nutrients for 19 male children aged 1-5 years with suspected shigella infection was studied. The children were admitted to the hospital with acute diarrhea, high fever, abdominal pain, and greater than or equal to 25 red blood cells and white blood cells per high-power field in the stool. Microbiologic diagnosis was made within 48 hours of admission. On the basis of clinical and microbiologic criteria, children were classified as having mild or severe infection. Ten children with mild infection did not receive antibiotics, whereas nine children with severe infection were treated with ampicillin. After the children were rehydrated, a 72-hour balance study was carried out during the acute stage of infection with Shigella and was repeated 2 weeks after recovery. The levels of consumption of food and absorption of nutrients were estimated. During the acute stage of infection, such levels were higher for the children treated with antibiotics than for the untreated group. During the recovery phase, the levels of intake of food and absorption of nutrients were equal for both groups. Thus, children who are treated with appropriate antibiotics not only may recover from infection with Shigella more rapidly, but they also may be able to absorb nutrients more efficiently.
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PMID:Effect of antibiotics on food intake and absorption of nutrients for children with diarrhea due to Shigella. 204 61

Before 1970, laboratory staff could not only identify the causative organism of acute diarrhea in 20% of cases, but in 1990, they could identify it in 80% of cases. These organisms are either bacteria, virus, or parasites. The bacteria include enterotoxigenic bacteria (Vibrio cholerae, enterotoxigenic Escherichia coli, Clostridium perfringens, and Staphylococcus aureus) and enteroinvasive bacteria (Campylobacter jejuni, C. coli, and Salmonella and Shigella species). The leading cause of death in diarrhea patients is dehydration. Oral rehydration solutions (ORS) can alleviate mild and moderate dehydration regardless of the etiology of the diarrhea or the age of the patient. WHO recommends an ORS containing glucose and various electrolytes which permit salt and water absorption in many cases of acute diarrhea. Due to the possibility of excess salt entering the bloodstream (hypernatremia), some pediatricians do not use the WHO recommended ORS in newborns and young infants. Instead they use 2 parts ORS followed by 1 part water. This treatment is not easy for illiterate mothers to follow, however. Continued breast feeding during diarrheal episodes along with administration of ORS protects not only against dehydration, but also hypernatremia. ORS should not be administered in severe case of dehydration, however. Medical personnel need to administer replacement fluid such as Ringer's Lactate solution intravenously regardless of the age group. Once the initial deficit has been controlled, ORS administration and reintroduction of foods can follow. Antibiotics should only be administered if the medical personnel suspect severe cholera in an endemic area (tetracycline and furazolidone); shigellosis, but 1st the bacteria must be tested to see if the strain is multiple drug resistant (ampicillin, trimethoprim-sulphamethoxazole, furazolidone, nalidixic acid), and acute amebiasis or giardiasis (metronidazole and tinidazole). Antidiarrheals should not be used.
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PMID:Management of acute diarrhoea. 210 85

A conjugative R-plasmid PE004, Inc F11, conferring resistance to ampicillin, tetracycline, streptomycin, kanamycin and trimethoprim was obtained from an E. coli serotype 026 isolate from the stool of a child with acute diarrhoea. The R-plasmid PE004 also co-transfers an enteropathogenicity antigen without the production of enterotoxins or manifestation of invasiveness. It is not yet known whether this transferable antigen mediates enterocyte damage with consequent diarrhoea. The R-plasmid was of molecular weight 2.4 megadaltons (3.7 kilobase) with a transfer frequency of 6 x 10(-4) cfu/ml E. coli J53-1. The uncontrolled mediation with antibiotics in cases of acute diarrhoea could select gut bacteria not only possessing R-plasmids conferring resistance to several antibiotics but with associated undesirable extrachromosomal genes.
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PMID:Faecal Escherichia coli mediating transferable multi-antibiotic resistance and undesirable extra-chromosomal genes. 243 37

To study the cost-effectiveness of fecal culture in the detection of enteropathogenic or enteroinvasive bacteria, a review and analysis was done of fecal cultures from ambulatory or hospitalized patients treated for acute diarrhea at a Buenos Aires sanatorium during 1985. Of 1,295 fecal cultures performed, pathogens were isolated in 369 cases (28.5%), of which 79 corresponded to Shigella sp. (S. flexnerii, 49; S. sonnei, 29; S. dysenteriae, 2), 25 to Salmonella sp., and 270 to enteropathogenic Escherichia coli (EPEC) of the infant. There was no statistically significant difference between the ambulatory patients and the hospitalized patients in the proportion of positive fecal cultures. The cost of each positive fecal culture was US$ 60.36, while the cost of diagnosing invasion of the mucous membrane (isolation of Shigella sp. or detection of leukocytes in feces) was US$ 109.74. These costs are excessive and could be greatly reduced if the test were applied in only selected cases. Many of the strains of Shigella sp., Salmonella sp., and EPEC that were found were resistant to ampicillin, chloramphenicol, and cotrimoxazole. These cases of resistance suggest that fosfomycin may be one of the antibiotics of choice for the treatment of diarrhea caused by invasive organisms.
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PMID:[Cost and effectiveness of fecal culture in the etiologic diagnosis of acute diarrhea]. 253 67

Thirty eight enterotoxigenic Escherichia coli (ETEC) isolated from children with acute diarrhea were analyzed in order to assess the possible associations among enterotoxigenicity, antibiotic resistance and other plasmid-mediated virulence properties such as CoIV, Hly and CFA/I. Eighty four percent of ETEC strains were multiresistant. Twenty strains (52.63%) were able to transfer one or more properties studied and 92.68% of the transconjugants were multiresistant. The simultaneous transfer of genes encoding ST enterotoxin and CoIV, Hly or CFA/I was very low (1.82%). The plasmid analysis revealed the presence of a heterogeneous enterotoxigenic (Ent) plasmid population. Additionally, the existence of a conjugative plasmid of approximately 31 megadaltons (Md) of molecular weight encoding for ST and resistance to ampicillin, kanamycin and streptomycin was found. However, this plasmid was not present in all isolates. These results show a diversity of Ent plasmid population which is probably a consequence of the indiscriminate use of antibiotics and the molecular mechanism of transposition of ST and drug-resistance in the evolution of bacterial strains.
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PMID:Heterogeneous plasmid population from enterotoxigenic Escherichia coli strains isolated in Venezuelan children with acute diarrhea. 253 60


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