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Watery Stools, Reducing Sugar And Pus Cells Found, Prescribed Norfloxacin. Shall We Give Immodium Drops To The Baby?
Question: Our baby boy is 4.5 months. On 15th May, 2012 we took a flight from Pune to Delhi. In Pune his routine was one stool a day or once in two days. Now the day we reached Delhi 15th may, he passed stool once. But from 16th May to till today (20th May 2012), we are observing that he is passing watery stools 5-6 times a day. We consulted a Paediatrician in Delhi, the doctor advised us to get the stool test. In stool test the reducing sugar is found present and PUS is 5-6, the consistency is loose.
From last 4 days we are observing that his motions are loose (some times less quantity), some times seedy and today we found it a bit light greenish in colour. The Paediatrician prescribed us Bacigyl Suspension ( Norfloxacin Suspension) brand Aristo Pharmacutical Ltd 3 ml twiceX3 days and Enterogermina (Bacillus Clausii spores suspension) one 5 ml bottle, twice daily. We have started giving the Enterogermina from 18th May 2012 but not giving Bacigyl Suspension as of now. We were told by another MD medicine ( Our family friend) that not to give Bacigyl Suspension to baby, instead try giving immodium drops. We have yet not given any out of the two. We are a bit confused in the selection of one from the above two. Kindly help us by telling what are the disadvantages of the bacigyl suspension & shall we start giving it or not. Shall we give immodium drops or any other medicine you prescribe for our baby. Also, would like to inform you that otherwise the activities of the baby are normal, he is taking breast feed as usual and no signs of any fever or abnormal behaviour. We are already giving him Bonnisan drops 10 drops 3-4 times a day & Visyneral zinc drops 0.5 ml once daily from past four months. From past two months we are also giving Osiocalcium syrup 2.5 ml once daily from the second week of March 2012. The baby is mostly on breast feed, only some times in a day we give small quantity of coconut water or few drops of some fresh juice. Kindly guide us what medicine should we give to baby ( dosage & timings) or shall we wait for few more days to get it stabilize. What can be the reason for this problem, is it some problem ( Stomach infection) or it's common. is it something serious, what cure/ medicine is required, What precautions should we take in this case.
Additional Information:
date of birth of baby is 9.1.2012. The weight & height at time of birth was 3.3 Kg & 49 cms.
On 24th April the height of the baby was 65 cms & weight was 6.5 kg.
On 18th may 2012,the weight of the baby is 6.8 Kg.
From last 4 days we are observing that his motions are loose (some times less quantity), some times seedy and today we found it a bit light greenish in colour. The Paediatrician prescribed us Bacigyl Suspension ( Norfloxacin Suspension) brand Aristo Pharmacutical Ltd 3 ml twiceX3 days and Enterogermina (Bacillus Clausii spores suspension) one 5 ml bottle, twice daily. We have started giving the Enterogermina from 18th May 2012 but not giving Bacigyl Suspension as of now. We were told by another MD medicine ( Our family friend) that not to give Bacigyl Suspension to baby, instead try giving immodium drops. We have yet not given any out of the two. We are a bit confused in the selection of one from the above two. Kindly help us by telling what are the disadvantages of the bacigyl suspension & shall we start giving it or not. Shall we give immodium drops or any other medicine you prescribe for our baby. Also, would like to inform you that otherwise the activities of the baby are normal, he is taking breast feed as usual and no signs of any fever or abnormal behaviour. We are already giving him Bonnisan drops 10 drops 3-4 times a day & Visyneral zinc drops 0.5 ml once daily from past four months. From past two months we are also giving Osiocalcium syrup 2.5 ml once daily from the second week of March 2012. The baby is mostly on breast feed, only some times in a day we give small quantity of coconut water or few drops of some fresh juice. Kindly guide us what medicine should we give to baby ( dosage & timings) or shall we wait for few more days to get it stabilize. What can be the reason for this problem, is it some problem ( Stomach infection) or it's common. is it something serious, what cure/ medicine is required, What precautions should we take in this case.
Additional Information:
date of birth of baby is 9.1.2012. The weight & height at time of birth was 3.3 Kg & 49 cms.
On 24th April the height of the baby was 65 cms & weight was 6.5 kg.
On 18th may 2012,the weight of the baby is 6.8 Kg.
Hello,
Thanks for posting your query.
I understand your concern and appreciate your efforts as a vigilant parent.
Considering the details provided by you it seems most probably that your child is suffering from an infection ie gastroenteritis either viral or bacterial.
Both norfloxacin and Imodium are contraindicated in small infants hence not advisable.Probiotics like enterogermina , zinc and multivitamins , and oral rehydration solution are the most appropriate treatment and infact most viral diarrhoeas respond to the same within a week or two.However bacterial infections show no response and might require antibiotics in addition.
The curative treatment for such a condition is best done only after knowing the exact causative organism . This is done by a test called stool culture and antibiotic sensitivity test. This ensures that the antibiotic prescribed to the infant is effective for the particular infective bacteria .
However many pediatricians might start antibiotics empirically without doing such testing . The usual antibiotics advisable are colistin or Cefixime or less preferably ofloxacin ( less safe ).
I would advise you that since the child is well hydrated and active you may just get a stool culture done without starting any antibiotic . In three days (72hrs)the results will show wether or not the child is having a bacterial infection and to what it's most responsive . The treatment can then be done accordingly.
Meanwhile you can continue the enterogermina , zinc and rehydration with home available fluids and breast feeding .
If its viral then the symptoms might gradually resolve on its own with such supportive treatment only.
Please do not worry , as the situation at present is not worrisome but does warrant a thorough investigation and further management .
Hope I have answered your query .
Wishing your child a speedy recovery.
Regards
Thanks for posting your query.
I understand your concern and appreciate your efforts as a vigilant parent.
Considering the details provided by you it seems most probably that your child is suffering from an infection ie gastroenteritis either viral or bacterial.
Both norfloxacin and Imodium are contraindicated in small infants hence not advisable.Probiotics like enterogermina , zinc and multivitamins , and oral rehydration solution are the most appropriate treatment and infact most viral diarrhoeas respond to the same within a week or two.However bacterial infections show no response and might require antibiotics in addition.
The curative treatment for such a condition is best done only after knowing the exact causative organism . This is done by a test called stool culture and antibiotic sensitivity test. This ensures that the antibiotic prescribed to the infant is effective for the particular infective bacteria .
However many pediatricians might start antibiotics empirically without doing such testing . The usual antibiotics advisable are colistin or Cefixime or less preferably ofloxacin ( less safe ).
I would advise you that since the child is well hydrated and active you may just get a stool culture done without starting any antibiotic . In three days (72hrs)the results will show wether or not the child is having a bacterial infection and to what it's most responsive . The treatment can then be done accordingly.
Meanwhile you can continue the enterogermina , zinc and rehydration with home available fluids and breast feeding .
If its viral then the symptoms might gradually resolve on its own with such supportive treatment only.
Please do not worry , as the situation at present is not worrisome but does warrant a thorough investigation and further management .
Hope I have answered your query .
Wishing your child a speedy recovery.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Good Morning Dr.
Thanks for your valuable reply.
1. For stool culture test, do we need to collect stool sample directly in a container or can be collected from his diaper/nappies. As we never come to know when he has passed the stool.
2. What can be the cause of such infection, is it due to baby touching various things and putting his hands in mouth or any other, so that we can avoid in future.
3. Can we use a alcoholic hand sanitizer to clean his hands or kindly advise some better option which we should follow.
4. If it takes 72 hours for stool culture and antibiotic sensitivity test, Shall we start colistin or cefixime from today. What is the dosage we need to give it to baby and how long.
Regards
XXXXXXX
Thanks for your valuable reply.
1. For stool culture test, do we need to collect stool sample directly in a container or can be collected from his diaper/nappies. As we never come to know when he has passed the stool.
2. What can be the cause of such infection, is it due to baby touching various things and putting his hands in mouth or any other, so that we can avoid in future.
3. Can we use a alcoholic hand sanitizer to clean his hands or kindly advise some better option which we should follow.
4. If it takes 72 hours for stool culture and antibiotic sensitivity test, Shall we start colistin or cefixime from today. What is the dosage we need to give it to baby and how long.
Regards
XXXXXXX
Hello ,
Thanks for the follow up.
Ans 1. Use a sterile container and collect a thumb size or 10 ml of stool carefully without touching the container to any surface . You can collect from diaper but preferably freshly passed stool .
And 2. Yes it happens because infants put contaminated fingersand objects in their mouth. You can be careful but you can't absolutely prevent it.
And 3. Yes you can use a alcohol based sanitizer or use wipes to frequently clean his hands. Though sometimes its impractical especially in crawling infants . Use minimal sanitizer and it's better to avoid him mouthing his fingers for best results.
And 4. It's better to wait till the report comes since if the bacteria are resistant to colistin or Cefixime then you will have to repeat the course with new antibiotic . The dose of colistin is 15mg/kg/ day in three divided doses and of Cefixime is 8mg/ kg/day in two divided doses.
But it's advisable to consult a pediatrician with the reports before starting any antibiotic .
Hope this answers your query.
Regards
Thanks for the follow up.
Ans 1. Use a sterile container and collect a thumb size or 10 ml of stool carefully without touching the container to any surface . You can collect from diaper but preferably freshly passed stool .
And 2. Yes it happens because infants put contaminated fingersand objects in their mouth. You can be careful but you can't absolutely prevent it.
And 3. Yes you can use a alcohol based sanitizer or use wipes to frequently clean his hands. Though sometimes its impractical especially in crawling infants . Use minimal sanitizer and it's better to avoid him mouthing his fingers for best results.
And 4. It's better to wait till the report comes since if the bacteria are resistant to colistin or Cefixime then you will have to repeat the course with new antibiotic . The dose of colistin is 15mg/kg/ day in three divided doses and of Cefixime is 8mg/ kg/day in two divided doses.
But it's advisable to consult a pediatrician with the reports before starting any antibiotic .
Hope this answers your query.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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