Treatment of gastrointestinal infections.
Studies aimed at improving treatment strategies for patients with acute diarrhea have included the clinical testing of modifications to the standard oral rehydration solution. A malabsorbed carbohydrate has been found to improve resuscitation, probably through the recruitment of colonic absorptive capacity. A reduced osmolarity solution is safe in adults and as effective as the standard solution. For non-nursing infants, increasing the frequency of feeding with reduced volume results in comparable total caloric intake and diminishes the risk of prolonged diarrhea. Increasing resistance of important enteric pathogens to inexpensive and newer antibiotics continues to be a concern. Reports from Asia of decreased Salmonella typhi resistance to chloramphenicol, attributed to restricted antibiotic usage, may indicate a reversal of the usual trend. A strategy to block the action of shiga toxins in the gut through the use of recombinant bacteria has shown promise in a mouse model. A small but well-designed study supported the use of either norfloxacin or amoxicillin-clavulanic acid in the treatment of small bowel overgrowth syndrome. Studies exploring passive immunity strategies for the treatment of Escherichia coli, Cryptosporidium, and Candida infections have reported variable levels of success.
Gorske
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A
Division of Gastroenterology, Department of Medicine, Walter Reed Army Medical Center, Washington, District of Columbia, USA.
McQueen
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C