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Suggest Treatment For Severe Diarrhoea In A Child
Question: My 12 year old son has been experiencing on and off soft stools and diarrhea for about 5 weeks. He has been back and forth to his pediatrician and he was diagnosed with Possible IBD because his lab work was all coming back normal. Come to find out they made a mistake with the stool sample and with a retake it was diagnosed that he actually has c-diff. His symptoms are not as severe as what I have read online he has had soft stools and some with a little blood on two occasions Over 5 weeks. There are some days where he does not have a bowel movement at all. He was on a course of clindamycin about 2 months ago and the pediatrician feels that is probably what caused it. She wants to put him on a course of Flagyl 250 milligrams 4 times a day for 14 days. My concern is that he will have worse side effects. I have been reading online that recurrence of cdiff is very common and can lead to other complications. I am very worried can you ease my mind about the cure for C diff is this something he is going to battle for ever?
Brief Answer:
Give him curd or yogurt on regular basis.
Detailed Answer:
Thanks for asking on HealthcareMagic.
I have gone very carefully through your query and understand your concerns. Our gastrointestinal tract contains a number of types of bacteria, most of which are beneficial. Clindamycin should have killed off most of them, leaving behind the more resistant C.difficile. Your doctor has done the right thing in prescribing Flagyl. It is a very safe and widely used medicine and you need not worry about side effects other than a metallic taste in mouth. The primary solution however would be to replenish the bacterial flora of the intestines. Curd or yogurt contains plenty of beneficial bacteria and hence should be given on regular basis. This would prevent the recurrence of C. difficile infections which are likely cause of the problems that you have reported.
Relax. Unless there is blood in stool, you need not worry and need not do anything other than giving ORS (oral rehydration solution) to replenish the lost fluids and salts.
Regards
Give him curd or yogurt on regular basis.
Detailed Answer:
Thanks for asking on HealthcareMagic.
I have gone very carefully through your query and understand your concerns. Our gastrointestinal tract contains a number of types of bacteria, most of which are beneficial. Clindamycin should have killed off most of them, leaving behind the more resistant C.difficile. Your doctor has done the right thing in prescribing Flagyl. It is a very safe and widely used medicine and you need not worry about side effects other than a metallic taste in mouth. The primary solution however would be to replenish the bacterial flora of the intestines. Curd or yogurt contains plenty of beneficial bacteria and hence should be given on regular basis. This would prevent the recurrence of C. difficile infections which are likely cause of the problems that you have reported.
Relax. Unless there is blood in stool, you need not worry and need not do anything other than giving ORS (oral rehydration solution) to replenish the lost fluids and salts.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
He has had some blood in stool 3 times over the 5 weeks. No fever or pain. Just percolating intestines (his words). So you are saying to take the flagyl with probiotics to prevent recurrence? What strain is best? How much?
Brief Answer:
Get his stool tested while he has blood in stool.
Detailed Answer:
Thanks for writing back. During episodes when he has blood in stool, get the stool microscopy done and share the report using the facility on the upper right of this page. I am interested in the pus cell count. You can give probiotics but I would prefer simple yogurt. If you choose prebiotics and probiotics, I would not be choosy about the strain as the intestine contains a composite of different strains. Complete the course of flagyl in the meantime (not non-specifically long term).
Regards
Get his stool tested while he has blood in stool.
Detailed Answer:
Thanks for writing back. During episodes when he has blood in stool, get the stool microscopy done and share the report using the facility on the upper right of this page. I am interested in the pus cell count. You can give probiotics but I would prefer simple yogurt. If you choose prebiotics and probiotics, I would not be choosy about the strain as the intestine contains a composite of different strains. Complete the course of flagyl in the meantime (not non-specifically long term).
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The dr. Prescribed 250mg 4 times a day for 14 days. Is this normal? Seems like a high dose for mild symptoms. What is the norm?
Brief Answer:
Dosage proper
Detailed Answer:
Thanks again for writing back. The dose for oral metronidazole (the ingredient contained in Flagyl) is 7.5 mg/kg/dose orally every 6 hours with a maximum dose of 4 g per day. Usual duration of therapy is 7 to 10 days. For a 12 year child, the dose of 250 mg for 10-14 days can be considered as standard and acceptable.
You may find the following article helpful:
http://www.medscape.com/viewarticle/410904_5
Regards
Dosage proper
Detailed Answer:
Thanks again for writing back. The dose for oral metronidazole (the ingredient contained in Flagyl) is 7.5 mg/kg/dose orally every 6 hours with a maximum dose of 4 g per day. Usual duration of therapy is 7 to 10 days. For a 12 year child, the dose of 250 mg for 10-14 days can be considered as standard and acceptable.
You may find the following article helpful:
http://www.medscape.com/viewarticle/410904_5
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. One last question. How about contagiousness? We don't share the same bathroom and I make sure he washes very thoroughly after using the bathroom. Is it only contagious through the stool? Not through saliva, etc? Also, how long will it be until he is no longer contagious? How long does he need to be on antibiotic to be not contagious? Can he continue going to school, etc?
Brief Answer:
Everyone's stool contains loads of microbes
Detailed Answer:
Thanks for asking back again. Let me mention that our fecal matter is laden with a large number of bacteria. These bacteria can spread through feco-oral route. Hence proper hand washing and hygiene is required to stop their spread. C.difficile is just one among the numerous bacteria in stool.
Rather than terming it as contagious, I would use the term infectious. Separation of toilet is not the main concern here. Rather proper hand washing is more important. Otherwise you yourself are at risk from your own germs. I hope that you understand the concept.
He can go to school normally. Not a cause for concern.
Regards
Everyone's stool contains loads of microbes
Detailed Answer:
Thanks for asking back again. Let me mention that our fecal matter is laden with a large number of bacteria. These bacteria can spread through feco-oral route. Hence proper hand washing and hygiene is required to stop their spread. C.difficile is just one among the numerous bacteria in stool.
Rather than terming it as contagious, I would use the term infectious. Separation of toilet is not the main concern here. Rather proper hand washing is more important. Otherwise you yourself are at risk from your own germs. I hope that you understand the concept.
He can go to school normally. Not a cause for concern.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the information. I am in the process of filling the prescription but my concern is treating him with antibiotics even though he has mild symptoms. By mild I mean for example he had loose stools 1-2x on one day then could skip a whole day and not have a bowel movement at all. Small amounts of blood have appeared only twice over the last month. No fever either. He has been on probiotic for a week as well. I just want to make sure that antibiotics is still the best course of treatment for a mild case. My fear is causing more issues. Want to be sure that giving him such a strong course of antibiotic is the best choice. Also what is the reoccurrence rate after treatment in children and what can I so to prevent reoccurrence?
Brief Answer:
You need not worry that much.
Detailed Answer:
Thanks for writing back.
Mild symptoms do not need 'mild' treatment. Its either 'treat' or 'do not treat' - its your call to decide. I understand that you are sceptical but I would not prefer not treating. The recurrence would actually be reinfection (an independent infection) - there would be no association between the present one and the next.
The following links should be helpful:
http://yyyyy/yyyyyy/diagnosis-and-yyyyyyy-of-c-difficile-associated-yyyyyy-and-yyyyyyyy/
http://www.ncbi.yyy.yyy.yyyy/pmc/yyyyyyyyyyyy/PMC0000/
http://www.medscape.com/yyyyyyyyy/410904_5
Regards
You need not worry that much.
Detailed Answer:
Thanks for writing back.
Mild symptoms do not need 'mild' treatment. Its either 'treat' or 'do not treat' - its your call to decide. I understand that you are sceptical but I would not prefer not treating. The recurrence would actually be reinfection (an independent infection) - there would be no association between the present one and the next.
The following links should be helpful:
http://yyyyy/yyyyyy/diagnosis-and-yyyyyyy-of-c-difficile-associated-yyyyyy-and-yyyyyyyy/
http://www.ncbi.yyy.yyy.yyyy/pmc/yyyyyyyyyyyy/PMC0000/
http://www.medscape.com/yyyyyyyyy/410904_5
Regards
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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