Supportive treatment is the mainstay therapy in most cases of acute diarrhoea and not antibiotics, according to V. Ramasubramanian, consultant, infectious diseases, Apollo Hospitals.
He was speaking on the role of antibiotics in common syndromes in outpatient settings at a two-day Apollo Infectious Diseases Conference – 2018 conducted by the Institute of Infectious Diseases, Apollo Hospitals, on Saturday.
“Almost 80% of diarrhoea cases in the country are bacterial,” Dr. Ramasubramanian said, adding that most cases do not require investigation to determine the cause and can be treated empirically. The first thing to ensure is rehydration. Feeding a patient is beneficial. Probiotics have been beneficial in minimising the duration of diarrhoea in children,” he said.
Moderate to severe diarrhoea, more than four stools per day, blood or mucus in stool and colitis are the factors to be considered for empiric antibiotics, Dr. Ramasubramanian said. “Supportive treatment, including antimotility agents to slow down gut movement and rehydration, are essential. One should think of antibiotics only in the case of more than five stools per day, bloody diarrhoea or high fever,” he added.
Most upper respiratory infections do not require antibiotics because they are caused by virus. Dr. Ramasubramanian also insisted that patients should let the doctors decide and not resort to self-medication.
In another session on tropical infections (dengue and malaria), D. Suresh Kumar, consultant, infectious diseases, Apollo Hospitals, said any fever lasting for more than seven days is unlikely to be dengue. “Ask the patients for sharp onset of fever, headache, and fever for three to five days and abdominal discomfort,” he said. Patients with presence of shock, dangerously low platelet count and high-risk patients, especially children, need admission.