Antibiotic and Antiparasitic Therapy in Chronic Diarrhea

Chronic and recurrent diarrheal illnesses are common in malnourished populations, particularly in young children, and contribute significantly to malabsorption and undernutrition. There is a vast array of infectious causes of these illnesses, parasitic, bacterial, fungal, and viral, which present major problems in prevention, control, and treatment of childhood diarrheal diseases in developing countries. It is risky to suggest rigid rules about antibiotic and antiparasitic therapy in chronic diarrheas. Regional variations in patterns of bacterial and parasitic gut infections can be vastly different depending on local environmental and geographic conditions. In most places where malnutrition and chronic diarrhea are endemic, the facilities available for adequate clinical diagnosis are usually lacking or too expensive to be able to be applied except to the elite. The subject is often complicated by multiple pathology on an individual or community basis, and multiple infections are the rule rather than the exception. There is a complex relationship between infecting organisms in the gastrointestinal tract. For example, invasive amebiasis is more common in children with Trichuris (whipworm) infection, and patients infected with whipworm who develop bloody diarrhea with mucus should be suspected of having coexisting amebiasis (1). Strongyloides stercoralis (roundworm) lives in the tissues of the small intestine, is often associated with eosinophilia, sometimes causes bloody diarrhea with mucus, can cause malabsorption, and may also predispose to amebiasis.