Prevention and Treatment

The factors contributing to the problem of acute diarrhea are well known. However, their modification will not be easy because of cost and required changes in behavior. The important variables that will require attention include the following: availability of plentiful potable water; adequate systems of sewage removal; improved personal and food hygiene; improved nutrition through food supplementation programs; discontinuance of the practice of using night soil as fertilizer; promotion of breast feeding; effective measles vaccine programs; availability of adequate health care to administer oral rehydration therapy and selected antimicrobial therapy; family planning; insect control; vaccine development and implementation for certain enteric infections such as cholera, enterotoxigenic E. coli diarrhea, rotavirus gastroenteritis, shigellosis, and typhoid fever. Because achieving all of these activities will initially be too costly in developing areas, research in developed countries will be essential to devising cost-effective prevention and treatment methods.

Currently there are three forms of therapy for acute diarrhea. The first and most fundamental form of treatment is fluid and electrolyte replacement. Nearly all forms of acute diarrhea can be successfully managed by administering oral rehydration solution. For dehydrating choleralike illnesses, the solution should have optimal electrolyte-glucose concentrations to facilitate intestinal absorption. The major problems with this solution are that it does not provide the caloric requirements of infants with diarrhea, and it may actually increase stool fluid losses. Newer "super solutions" are being evaluated that are better absorbed and furnish more calories at no osmotic expense. For nondehydrating forms of diarrhea, solutions with lower sodium concentrations are useful. The second form of therapy involves drugs that reduce the symptoms of diarrhea by inhibiting secretion or by binding to luminal water. The final form is antimicrobial therapy directed against a bacterial or parasitic agent, which is of value in the treatment of enterotoxigenic E. coli diarrhea, shigellosis, and travelers' diarrhea.

Herbert L. DuPont

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