Studies of Diarrheal Disease in Central America

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Abstract
Summary An antibiotic, paromomycin, and a sulfonamide, sulfamethoxypyridasine, were used as an added therapeutic measure to rehydration and nursing care in treatment of 535 patients with acute diarrheal disease, aged less than 5 years, under field conditions in a less developed region of the Guatemalan highlands. About 18% of 417 cases examined bacteriologically were associated with a recognized bacterial pathogen; about 82% were not. Shigella was found in 16% of cases. Under the conditions of the trial, treated cases of one village had a longer clinical course and duration than did untreated cases observed in a nearby community during the same time period. Patients there received no medical care other than family nursing and the usual folk remedies. Duration of disease in patients with shigellosis could not be distinguished from that of patients with undetermined diarrheal disease. No differences according to the three methods of treatment were discernible. The general death rate from all causes was lower in the village where general medical care was provided. Deaths from acute diarrheal disease were relatively few in both situations. The observed differences in annual mortality from diarrheal disease in the two villages, 7.7 per 1,000 children aged 0–4 years in the treated, and 17.3 in the untreated, community, represented 14% of all deaths in the treated village and 20% in the untreated. The more favorable rate for treated cases is believed to have been due mainly to general supportive measures during the illness, especially rehydration and nursing care. The effect of antibiotic and chemotherapy cannot be entirely discounted. The antibiotic paromomycin employed in the present trial proved highly effective in vitro against Shigella, but not in the clinical tests, as judged by duration of diarrhea in days after treatment. The sulfonamide was effective against only 61% of Shigella strains in vitro, and the somewhat lesser clinical result when that method of treatment was used is in accord. Escherichia coli strains were sensitive to both drugs, and as with Shigella, more so to the antibiotic than to the sulfonamide. The few treated patients precluded evaluation of clinical effect.

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