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Baby Having Diarrhoea. Stool Test Done. Prescribed With Probiotic, Norflox, Ofloxacin, Z&D. Is Ofloxacin Advisable For Kids?
Question: Hi,
We are based in Bangalore ( India) . Our daughter XXXXXXX (10 months old) was having Diarrhoea 10 days ago. We went to a doctor who suggested pro biotic (enterogermina) for 3 days and Norflox for 5 days. It got slightly better in 3 days after which we stopped the antibiotic ( Norflox). So we did not finish the antibiotic course. After we stopped giving the anti-biotic, we took stool test and found this - Color - Yellowish, Consistency - semi Solid, Mucus- Absent, Occult Blood - Positive, Ph - Alkaline, Reducing Substance - Nil, Undigested food particles - Present, Fat globules - Present, PUS cells - 1 to 2 / HPF, RBC's - 10-12/HPF, OVA - Not seen, CYST - Not seen. 3 days after the test and that is 3 days after stopping the antibiotic mid way, we spoke to a doctor today who asked to continue with the same probiotic (Enterogermina) for 3 days along with a new antibiotic Ofloxacin ( twice a day) for 5 days and Z&D for zinc. We just started this morning. Wanted to know whether this is right or is it not advisable to give oflox for kids? Lots of websites have not recommended oflox. Is it harmful? What should we do now?
We are based in Bangalore ( India) . Our daughter XXXXXXX (10 months old) was having Diarrhoea 10 days ago. We went to a doctor who suggested pro biotic (enterogermina) for 3 days and Norflox for 5 days. It got slightly better in 3 days after which we stopped the antibiotic ( Norflox). So we did not finish the antibiotic course. After we stopped giving the anti-biotic, we took stool test and found this - Color - Yellowish, Consistency - semi Solid, Mucus- Absent, Occult Blood - Positive, Ph - Alkaline, Reducing Substance - Nil, Undigested food particles - Present, Fat globules - Present, PUS cells - 1 to 2 / HPF, RBC's - 10-12/HPF, OVA - Not seen, CYST - Not seen. 3 days after the test and that is 3 days after stopping the antibiotic mid way, we spoke to a doctor today who asked to continue with the same probiotic (Enterogermina) for 3 days along with a new antibiotic Ofloxacin ( twice a day) for 5 days and Z&D for zinc. We just started this morning. Wanted to know whether this is right or is it not advisable to give oflox for kids? Lots of websites have not recommended oflox. Is it harmful? What should we do now?
Hello ,
Thanks for posting your query.
I understand your concern and would try my best to give you the facts so that you can take a better decision.
First of all your child's report does suggest gastroenteritis.
The common cause in infants could be a viral or bacterial infection more likely bacterial since the presence of blood in stools. The most preferred antibiotics in infants or less than 2 year olds are cephalosporin ( Cefixime ) , or colistin . The fluroquinolones ofloxacin or norfloxacin are best avoided in children due to their sideffects on growing musculoskeletal system of the infants.
But many a times doctors do prescribe it in cases of resistant diarrhoea .
The treatment for diarrhoea must include probiotic ( enterogermina ) and zinc supplement ( Z&D) which is appropriately prescribed . Along with this the antibiotic course should be completed even if diarrhoea stops in between and child has no symptoms otherwise this can lead to resistance and recurrent of infection.
Now considering the present scenario since the child is not having diarrhoea personally I would have advised a properly done stool culture test( the specimen should be collected carefully to avoid contamination.)
The stool culture test report comes after 72 hrs and it shows the exact causative organism( bacteria) and the antibiotic to which it will best respond . Meanwhile the probiotics and zinc can be continued.
If a patient refuses or the test is somehow not feasible only then I would in such situation advise a safer antibiotic like Cefixime or Colistin along with probiotics and zinc . So I would say the best option is to discuss with your doctor and get a stool culture test done which will give you the exact diagnosis and most preferred treatment.Alternatively you may ask the doctor for a change of antibiotic to be on the safer side if you cannot wait for 72 hrs.
Hope I have answered your query.
I'll be available for any follow up queries.
Regards
Thanks for posting your query.
I understand your concern and would try my best to give you the facts so that you can take a better decision.
First of all your child's report does suggest gastroenteritis.
The common cause in infants could be a viral or bacterial infection more likely bacterial since the presence of blood in stools. The most preferred antibiotics in infants or less than 2 year olds are cephalosporin ( Cefixime ) , or colistin . The fluroquinolones ofloxacin or norfloxacin are best avoided in children due to their sideffects on growing musculoskeletal system of the infants.
But many a times doctors do prescribe it in cases of resistant diarrhoea .
The treatment for diarrhoea must include probiotic ( enterogermina ) and zinc supplement ( Z&D) which is appropriately prescribed . Along with this the antibiotic course should be completed even if diarrhoea stops in between and child has no symptoms otherwise this can lead to resistance and recurrent of infection.
Now considering the present scenario since the child is not having diarrhoea personally I would have advised a properly done stool culture test( the specimen should be collected carefully to avoid contamination.)
The stool culture test report comes after 72 hrs and it shows the exact causative organism( bacteria) and the antibiotic to which it will best respond . Meanwhile the probiotics and zinc can be continued.
If a patient refuses or the test is somehow not feasible only then I would in such situation advise a safer antibiotic like Cefixime or Colistin along with probiotics and zinc . So I would say the best option is to discuss with your doctor and get a stool culture test done which will give you the exact diagnosis and most preferred treatment.Alternatively you may ask the doctor for a change of antibiotic to be on the safer side if you cannot wait for 72 hrs.
Hope I have answered your query.
I'll be available for any follow up queries.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi!
Thanks a lot for the detailed response.
We will take your suggestion and go in for stool culture test. We just have a couple of follow-up questions:
1. Can we stop Oflox (which we started yesterday and gave twice) till such time the stool culture report comes in? What are the implications for future resistance of this drug especially since we had also stopped Norflox midway. Actually, we were quite alarmed to read about the potential side-effects you have mentioned on the musculoskeletal system and are keen to stop Oflox right away, even if it means future resistance of this drug. Is this the right way? (Aditi seems completely normal in terms of activity, feeding and even the stools for the last 2-3 days). FYI the last stool report was taken 4 days back.
2. Does the anti-biotic effect the stool culture test? The last Oflox dose was given last evening at 8 pm. Can we give the stool sample for culture today itself or should we wait a few more days?
3. We started Z&D yesterday and would want to continue for 14 days and Enterogermina for 3 days. Is that fine?
Once the stool culture test report comes, we will mail you the same in another 3 days and take it forward with our local doctor as well.
Thanks a lot in advance.
Regards, XXXXXXX
Thanks a lot for the detailed response.
We will take your suggestion and go in for stool culture test. We just have a couple of follow-up questions:
1. Can we stop Oflox (which we started yesterday and gave twice) till such time the stool culture report comes in? What are the implications for future resistance of this drug especially since we had also stopped Norflox midway. Actually, we were quite alarmed to read about the potential side-effects you have mentioned on the musculoskeletal system and are keen to stop Oflox right away, even if it means future resistance of this drug. Is this the right way? (Aditi seems completely normal in terms of activity, feeding and even the stools for the last 2-3 days). FYI the last stool report was taken 4 days back.
2. Does the anti-biotic effect the stool culture test? The last Oflox dose was given last evening at 8 pm. Can we give the stool sample for culture today itself or should we wait a few more days?
3. We started Z&D yesterday and would want to continue for 14 days and Enterogermina for 3 days. Is that fine?
Once the stool culture test report comes, we will mail you the same in another 3 days and take it forward with our local doctor as well.
Thanks a lot in advance.
Regards, XXXXXXX
Hello,
Thanks for the follow up.
Answer 1. Yes , you can stop the antibiotic weighing the risk benefit ratio.
Though there are chances of development of resistance it's risk is less as compared to risk of sideffects . The fact that the child is a symptomatic further makes it unnecessary to give such a strong antibiotic.
Answer 2
The antibiotic may or may not affect the culture report depending on the load of infection and sensitivity of the bacteria however there is no point in waiting for the test as the results would be same if done now or after few days.
Answer 3. Yes zinc can be continued for 14 days and probiotics for 3 days as advised.
Hope I have answered your queries.
Wishing you and your family good health.
Regards
Thanks for the follow up.
Answer 1. Yes , you can stop the antibiotic weighing the risk benefit ratio.
Though there are chances of development of resistance it's risk is less as compared to risk of sideffects . The fact that the child is a symptomatic further makes it unnecessary to give such a strong antibiotic.
Answer 2
The antibiotic may or may not affect the culture report depending on the load of infection and sensitivity of the bacteria however there is no point in waiting for the test as the results would be same if done now or after few days.
Answer 3. Yes zinc can be continued for 14 days and probiotics for 3 days as advised.
Hope I have answered your queries.
Wishing you and your family good health.
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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