Senior consultant Apollo Hospitals Delhi, Delhi, India
Abstract: Antibiotic induced diarrhoea: new therapy Reetesh gupta ,Tenzin sangay Introduction - Antibiotic induced diarrhoea is not an uncommon entity in PCICU . It mainly affects infants and young kids on broad spectrum antibiotics causing loose stools , electrolyte imbalance and fluid losses. Antibiotics are the main cause altering heathy gut flora and causing secondary lactose intolerance. Management is primarily lactose free feeding, probiotics sometimes and fluid and electrolyte management, but at times it is troublesome specially in infants causing severe dehydration and electrolyte imbalance. We tried a new therapy with positive outcome in such cases. Case report - Baby A underwent arterial switch surgery at 6months of age for dTGA VSD. His postoperative course was stable but on 5th pod he developed loose stools causing hypernatremia ( sr Na-165) , dehydration and perianal redness. He was managed by lactose free feeds and fluid replacement and stopping diuretics but he had persisting loose stools with electrolyte imbalance .Because of massive ongoing diarrhea he was started on racecodotril sachet (1.5mg/kg) thrice daily and the child improved dramatically in next 24 hrs. His fluid looses reduced and he was stable in next 48hrs . Discussion -Racecadotril is the first truly intestinal antisecretory drug to gain approval for treatment of acute diarrhea. Racecodotril (acetorphan) is an enkephalinase inhibitor that decreases intestinal hypersecretion but not motility in animals and humans. The efficacy of racecadotril in acute diarrhoea is not associated with adverse gastro intestinal effects. Though many studies have shown benefits in acute diarrhoea till now no studies have done on antibiotics induced diarrhea in ICU patients, but it’s antisecretory effects can be beneficial in AID. Conclusion - AID though not common in icu settings but can be really troublesome in patients on prolong antibiotics and long PCICU stay. The goal is to reduce fluid and electrolyte imbalance. Racecodotril role as anti secretory drug is helpful in this setting. Further studies are warranted for its use in ICU patients with AID
