Diarrhoea is a common global health problem affecting people all ages and genders. According to World Health Organisation (WHO), diarrhoea is one of identified causes of death among children below five years old. Most of the cases are secondary to severe dehydration from prolonged and poorly managed diarrhoea.
Definition of Diarrhoea
WHO defines diarrhoea as defecation of soft and watery stools, three or more times in a day (or more frequent defecation when compared with the normal condition). Frequent passing of formed or hard stool is not classified as diarrhoea. Stool from breastfeeding babies are also not classified as diarrhoea even though the stool is watery.
Infection of the digestive tract caused by bacteria, virus or parasite might lead to diarrhoea. Patients suffering from the infection will experience nausea, vomiting and spasm of stomach muscle.
Classification of Diarrhoea
Generally, diarrhoea can be classified into three main types. The first type of diarrhoea is acute watery diarrhoea (can last for hours and up to few days, but less than 14 days). Cholera is a subtype of acute watery diarrhoea.
The second type of diarrhoea is acute bloody diarrhoea or dysentery. The third type of diarrhoea is prolonged diarrhoea which can last up to 14 days or more. Some experts categorize prolonged diarrhoea for more than 30 days as chronic diarrhoea.
Causes of Diarrhoea
Diarrhoea is always associated with hygienic factors. Drinking contaminated water remains the most common cause of diarrhoea cases in developing countries. Besides that, poor sanitisation also exposes people to the risk of having diarrhoea.
Untreated domestic water supply can be infected by diarrhoea-causing microorganisms like Escherichia coli, Vibrio cholera, Shigella spp, Salmonella spp and Campylobacter spp. These microorganisms will infect digestive tract of susceptible person and subsequently the person will get diarrhoea.
Diarrhoea is always associated with hygienic factors. Drinking contaminated water remains the most common cause of diarrhoea cases in developing countries. Besides that, poor sanitisation also exposes people to the risk of having diarrhoea. Untreated domestic water supply can be infected by diarrhoea-causing microorganisms like Escherichia coli, Vibrio cholera, Shigella spp, Salmonella spp and Campylobacter spp. These microorganisms will infect digestive tract of susceptible person and subsequently the person will get diarrhoea.
Diarrhoea is always associated with hygienic factors. Drinking contaminated water remains the most common cause of diarrhoea cases in developing countries. Besides that, poor sanitisation also exposes people to the risk of having diarrhoea.
Untreated domestic water supply can be infected by diarrhoea-causing microorganisms like Escherichia coli, Vibrio cholera, Shigella spp, Salmonella spp and Campylobacter spp. These microorganisms will infect digestive tract of susceptible person and subsequently the person will get diarrhoea.
The use of Antibiotics to Treat Diarrhoea
The use of antibiotics in treatment of diarrhoea is still being debated and discussed among health professionals and scientists. Most of the experts believe that antibiotics are not necessary for the treatment of diarrhoea. Several factors must be considered prior to antibiotic therapy in patients with diarrhoea.
The necessity of antibiotics use is the utmost important. Increasing pattern in bacterial resistance towards antibiotics and the emergence of suprainfection indicate the need of a thorough assessment by a doctor before using antibiotics to treat diarrhoea.
As a rule of thumb, patients with mild diarrhoea and those who begin to show progress in recovering should not be given antibiotic. Doctor will usually prescribe antibiotics for patients who have a more severe and prolonged diarrhoea.
Apart from that, the strain of microorganism infecting the digestive tract determines whether or not antibiotics are needed. For example, antibiotics are necessary for dysentery and cholera cases caused by shigellosis spp. In contrast, use of antibiotics in diarrhoea cases caused by Escherichia coli and Campylobacter spp has yet to be justified. However, in certain serious cases, antibiotics use is allowed.
Antibiotics use in diarrhoea treatment is beneficial as it helps minimizing the severity and promotes prompt recovery from diarrhoea, if only it is being used appropriately. On top of that, the use must be justified by a thorough clinical and physical assessment by doctors.
Importance of Body Rehydration
Diarrhoea might lead to dehydration if it is not managed correctly. In fact, dehydration is the most serious complication of diarrhoea. Diarrhoea causes a significant loss of body fluid and electrolytes from the body. If this episode continues and replenishment does not take place, the patient will start to experience dehydration.
In addition to antibiotics use, WHO has also ruled out a guideline for diarrhoea treatment. The main corrective action is to rehydrate the patient. Oral rehydration salt (ORS) is used for this purpose.
ORS contains few main electrolytes and low concentration sugar. Electrolyte aids in maintaining body fluid while the sucrose helps to produce energy. Most of ORS commercial products in Malaysian market comes in 55g pack size and need to be diluted in 250 millilitres water.
WHO recommends a quarter to half of cup of ORS is given to children less than two years old. Older children need half to a full cup of ORS. It is recommended that ORS is given after each defecation or vomiting.
WHO also emphasizes that ORS should be given as soon as diarrhoea symptoms occur. However, in severe cases, ORS is probably insufficient to correct dehydration. Therefore, these patients should be warded and intravenous drip should be administered .
Other Medications for Diarrhoea Treatment
Some patients might also need other medications such as anti-diarrhoeal agents like diphenoxylate-atropine and loperamide. These drugs act by slowing the movement of intestines (peristalsis) and subsequently allowing much water to be absorbed back from the stools. Such medications can be purchased from retail pharmacies such as over the counter products. Self medication to treat diarrhoea should be done appropriately.
Zinc-containing supplement is good for children with diarrhoea. Zinc deficiency in children increases the risk of getting digestive tract infection as compared to those who are healthy. Additionally, zinc is required for protein synthesis and an enhanced body immune system. Doses of 20 milligrams zinc supplement per day are recommended by WHO for children aged six months old and above while 10 milligrams are for younger kids. The course of treatment 10 to 14 days.
Moreover, recent studies demonstrate the benefit of probiotics, at certain doses in children having diarrhoea. Probiotics that contain bacteria strain such as Lactobacillus GG and Saccharomyces boulardi are good to treat acute watery diarrhoea in infants and babies. However, the effectiveness of probiotics has to be further studied and should not be the first treatment option, says the expert.
Importance of High Nutritional Food
Diarrhoea patients are encouraged to consume nutritious and well balanced meal during the episodes. Food provides enough energy and nourishment thus, promoting speedy recovery in patients. Nursing mothers are advised to breastfeed their babies adequately throughout the diarrhoea episode.
Treatment of Diarrhoea is an All Around Approach
Antibiotics use is not the first line therapy for diarrhoea treatment. It should be started only when it is deemed necessary upon a thorough assessment by doctors. Doctors shall decide the necessity of the antibiotics use. Diarrhoea should be tackled and treated from different approaches and the scope of treatment should not be confined only at treating infection.
Patients must have a well hydration status. At the same time, loss of water and nutrients has to be minimised. Patients should consume a well balanced diet for fast recovery. Supplement like probiotic and zinc could also be helpful to synergize the effects from other agents.
In summary,diarrhoea must be managed accordingly in order to help patients recover and prevent possible complications.
References
- Guidelines on The Management of Acute Diarrhoea in Children; Academy of Medicine Malaysia; 2011
- Diarrhoea: Why Children Are Still Dying and What Can We Done; UNICEF, World Health Organisation; 2009
- Management of Infectious Diarrhoea; A. C. Casburn-Jones et. al; 2004; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774945/
- Diarrhoea; World Health Organisation; http://www.who.int/topics/diarrhoea/en/; 2016
- Diarrhoeal disease; World Health Organisation; http://www.who.int/mediacentre/factsheets/fs330/en/; 2016
- Diarrhoea-Treatment; NHS; http://www.nhs.uk/Conditions/Diarrhoea/Pages/Treatment.aspx Diarrhoea Meciation; Medscape; http://emedicine.medscape.com/article/928598-medication
| Last Reviewed | : | 19 October 2017 |
| Writer/Translator | : | Mohd Shahiri bin Abd. Ghapar |
| Accreditor | : | Munira bt. Muhammad |
