Diarrheal diseases remain an important cause of childhood morbidity and death in developing countries, although diarrheal deaths have significantly declined in recent years, mostly due to successes in the implementation of
oral rehydration therapy (ORT), which is the principal treatment modality.
Diarrhea may occur for varied reasons; however, most episodes of
diarrhea in developing countries are infectious in origin. Three clinical forms of
diarrhea (acute watery
diarrhea, invasive
diarrhea, and persistent
diarrhea) have been identified to formulate a management plan. Acute
diarrhea may be watery (where features of
dehydration are prominent) or dysenteric (where stools contain blood and mucus).
Rehydration therapy is the key to management of acute watery
diarrhea, whereas
antimicrobial agents play a vital role in the management of acute invasive
diarrhea, particularly
shigellosis and
amebiasis. In persistent
diarrhea, nutritional
therapy, including dietary manipulations, is a very important aspect in its management, in addition to
rehydration therapy.
Rehydration may be carried out either by the oral or intravenous route, depending upon the degree of
dehydration.
Oral rehydration salts (
ORS)
solution (World Health Organization formula) is recommended for ORT. Intravenous fluid is recommended for initial management of severe
dehydration due to
diarrhea, followed by ORT with
ORS solution for correction of ongoing fluid losses. Antimicrobial
therapy is beneficial for
cholera and
shigellosis.
Antiparasitic agents are indicated only if
amebiasis and
giardiasis are present. Appropriate feeding during
diarrhea is recommended for nutritional recovery and to prevent bodyweight loss.
Antidiarrheal agents do not provide additional benefit in the management of infectious
diarrhea. Although some probiotics have been shown to be beneficial in the treatment of acute
diarrhea due to rotavirus, their use in the treatment of
diarrhea is yet to be recommended, even in developed countries. The children of developing countries might benefit from
zinc supplementation during the diarrheal illness, but its mode of delivery and cost effectiveness are yet to be decided.