EVALUATION OF AN ALGORITHM FOR THE TREATMENT OF PERSISTENT DIARRHEA -A MULTICENTER STUDY

Described are the findings of a multicentre cohort study to test an al gorithm for the treatment of persistent diarrhoea relying on the use o f locally available, inexpensive foods, vitamin and mineral supplement ation, and the selective use of antibiotics to treat associated infect ions. The initial diet (A) contained cereals, vegetable oil, and anima l milk or yoghurt. The diet (B) offered when the patient did not impro ve with the initial regimen was lactose free, and the energy from cere als was partially replaced by simple sugars. A total of 460 children w ith persistent diarrhoea, aged 4-36 months, were enrolled at study cen tres in Bangladesh, India, Mexico, Pakistan, Peru, and Viet Nam. The s tudy population was young (11.5 +/- 5.7 months) and malnourished (mean weight-for-age Z-score, -3.03 +/- 0.86), and severe associated condit ions were common (45% required rehydration or treatment of severe infe ctions on admission). The overall success rate of the treatment algori thm was 80% (95% CI, 76-84%). The recovery rate among all children wit h only diet A was 65% (95% CI, 61-70%), and was 71% (95% CI, 62-81%) f or those evaluated after receiving diet B. The children at the greates t risk for treatment failure were those who had acute associated illne sses (including cholera, septicaemia, and urinary tract infections), r equired intravenous antibiotics, and had the highest initial purging r ates. Our results indicate that the short-term treatment of persistent diarrhoea can be accomplished safely and effectively, in the majority of patients, using an algorithm relying primarily on locally availabl e foods and simple clinical guidelines. This study should help establi sh rational and effective treatment for persistent diarrhoea.