January 2006

Some Selected Abstracts:


1.                      Cohen SA Use of nitazoxanide as a new therapeutic option for persistent diarrhea: a pediatric perspective. Curr Med Res Opin. 2005 Jul;21(7):999-1004.

         Children's Center for Digestive Health Care, Atlanta, GA 30342, USA.

Despite advances in the management of diarrheal disorders, diarrhea is the second most frequent illness in the world. Persistent diarrhea, common in community pediatrics, is often caused by organisms such as Giardia lamblia, Cryptosporidium parvum and, less frequently, Cyclospora, Isospora belli, and Clostridium difficile. Identifying the causative organism is often challenging, and diagnostic tests may be inaccurate and expensive and, thus, of limited benefit. Consequently, carefully chosen empiric therapy guided by a physician's clinical impressions may be a useful and cost-effective option in children with persistent diarrhea, particularly those whose signs and symptoms suggest a protozoal etiology. This article discusses the empiric use of anti-infective nitazoxanide, a thiazolide compound, in three case reports of children with persistent diarrhea, and presents an overview of the diagnostic and therapeutic issues associated with this disorder and the pharmacodynamics and pharmacokinetics of the drug.


Wang X, Wang Y, Kang C.Feeding practices in 105 counties of rural China. Child Care Health Dev. 2005 Jul;31(4):417-23.

         Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, PR China.

BACKGROUND: China has the largest population in the world with more than 70% of the people living in rural areas. Over 34% of children under the age of 5 years are responded to show moderate or severe growth stunting, so United Nations International Children's Emergency Fund and Chinese Ministry of Health conducted this large-scale survey in China. This study aimed to learn the feeding practice, to find the problems in child-feeding practice and to provide evidence for the government to develop an approach to child malnutrition in rural China. METHODS: A structured questionnaire was used to survey 21,036 mothers of children with age of 0-24 months. RESULTS: Of the 20,915 children, 98.22% were breastfeeding and 24.36% were exclusively breastfeeding. The proportion of children with weekly protein intake was 78.47%. Among the infants under 4 months, the risk of pneumonia in the group of exclusive breastfeeding was 1.69%, while in the group of non-exclusive breastfeeding was 3.63%, showing a statistically significant difference between the two groups. The risk of diarrhoea in the group of exclusive breastfeeding and in the group of non-exclusive breastfeeding among the infants under 4 months was 24.37% and 40.86%, respectively, also showing a statistically significant difference between the two groups. For children with age 4-6 months, the complementary feeding contributed to a higher prevalence of diarrhoea, but not pneumonia. CONCLUSIONS: The breastfeeding was very common, but the exclusive breastfeeding was quite low and the exclusive breastfeeding for children under the age of 4 months decreased the risks of pneumonia and diarrhoea. For children with age 4-6 months, the exclusive breastfeeding could decrease the risk of diarrhoea, too. Protein intake was insufficient for children in rural China. The rural people lacked health knowledge and were greatly influenced by traditional feeding practices.


Patole S, Rao S, Doherty D. Erythromycin as a prokinetic agent in preterm neonates: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2005 Jul;90(4):F301-6

Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, University of Western Australia, Perth, Western Australia 6008.

         BACKGROUND: It often takes several days or even weeks to establish full enteral feeds (FEFs) in preterm, especially extremely low birthweight neonates because of feed intolerance related to gastrointestinal hypomotility. Clinical trials of erythromycin as a prokinetic agent in preterm neonates have reported conflicting results. AIM: To systematically review the efficacy and safety of erythromycin as a prokinetic agent in preterm neonates. METHODS: Only randomised controlled trials in preterm neonates (gestation < or = 37 weeks) were considered eligible for inclusion. The primary outcome was the time to reach FEFs of 150 ml/kg/day. The secondary outcomes included the incidence of erythromycin related adverse effects such as diarrhoea, cardiac arrhythmias, and hypertrophic pyloric stenosis. No restrictions were applied on the dose (low: 3-12 mg/kg/day; antimicrobial: > or = 12 mg/kg/6-8 hours) and route (oral or intravenous) and mode (prophylactic or rescue) of administration. The standard methodology for systematic reviews was followed. A subgroup analysis was pre-planned based on the dose and mode of drug administration. RESULTS: Seven trials (three prophylaxis, four rescue) with various doses, routes and modes of administration, and durations of erythromycin treatment and different results were found to be eligible for inclusion in the analysis. Meta-analysis could not be performed, as specific data were either inadequate or not available. CONCLUSION: The conflicting trial results may be explained by differences in dose and route and mode of administration of erythromycin and in gastrointestinal motor responses in the presence of different feeding conditions-for example, fasting v fed state, intermittent v continuous feeds. Gestational and postnatal ages during erythromycin treatment are also important.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics: 

13215    Bisseling TM, Op den Akker JW, Janssen M, Strijk SP. A patient with prolonged vague pain in the lower abdomen following a three-day period with diarrhoea and vomiting. Neth J Med. 2005 Jul-Aug;63(7):278, 285.

13216.  Chen PJ, Shyu RY, Chao YC. Image of the Month: Behcet' disease. Gastroenterology. 2005 Aug;129(2):407, 775.

13217.  Cohen SA. Use of nitazoxanide as a new therapeutic option for persistent diarrhea: a pediatric perspective. Curr Med Res Opin. 2005 Jul;21(7):999-1004. Review. 

13218.  Gurney D. A 38-year-old woman with numb fingertips, shortness of breath, vomiting, watery diarrhea, and red swollen painful buttock: Are they all related? J Emerg Nurs. 2005 Aug;31(4):411-2.

13219.  Hamoda H, Ashok PW, Flett GM, Templeton A. A randomised controlled trial of mifepristone in combination with misoprostol administered sublingually or vaginally for medical abortion up to 13 weeks of gestation. BJOG. 2005 Aug;112(8):1102-8.

13220.  Kim HJ, Newman B, Keljo DJ. Clinical challenges: 18 year old male with bloody diarrhea. J Pediatr. 2005 Aug;147(2):267-70.


13221.   Price EH, Hunt GH, Oliver A. Etiology of diarrhea in pediatric outpatient settings. Pediatr Infect Dis J. 2005 Jul;24(7):661-2.

13222.   Qadri F, Khan AI, Faruque AS, Begum YA, Chowdhury F, Nair GB, Salam MA, Sack DA, Svennerholm AM. Enterotoxigenic Escherichia coli and Vibrio cholerae diarrhea, Bangladesh, 2004. Emerg Infect Dis. 2005 Jul;11(7):1104-7.

13223.  Wang X, Wang Y, Kang C. Feeding practices in 105 counties of rural China. Child Care Health Dev. 2005 Jul;31(4):417-23.


13224.   Grigoleit HG, Grigoleit P. Peppermint oil in irritable bowel syndrome. Phytomedicine. 2005 Aug;12(8):601-6. Review.

13225.   Patole S, Rao S, Doherty D. Erythromycin as a prokinetic agent in preterm neonates: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2005 Jul;90(4):F301-6.

13226.   Pittet D. Clean hands reduce the burden of disease. Lancet. 2005 Jul 16-22;366(9481):185-7.

13227.  Yang G, Wu XT, Zhou Y, Wang YL. Application of dietary fiber in clinical enteral nutrition: a meta-analysis of randomized controlled trials. World J Gastroenterol. 2005 Jul 7;11(25):3935-8.


April 2006

Some Selected Abstracts:


1                     Carlo JT, DeMarco D, Smith BA, Livingston S, Wiser K, Kuhn JA, Lamont JP. The utility of capsule endoscopy and its role for diagnosing pathology in the gastrointestinal tract.  Am J Surg. 2005 Dec;190(6):886-90.

Department of Surgery and Gastroenterology, University Medical Center, 3409 Worth Street, Suite 420, Dallas, TX 75246, USA.

BACKGROUND: Capsule endoscopy (CE) is a new device that enables visualization of areas of the small bowel that were previously inaccessible through other noninvasive procedures. The purpose of this study is to evaluate this new diagnostic tool and its efficacy in finding occult GI tract pathology. METHODS: A single-institution retrospective review was completed on patients undergoing CE from January 2002 to September 2004. Data evaluated included indications for CE, results of previous studies, CE findings, and complications of the CE study. RESULTS: A total of 702 CE studies in 652 patients were performed during the study period. Suspicious GI bleeding presenting as anemia, guaiac positive stools, or history of gross bleeding were the most common reasons to perform CE (75.8%). Other indications included abdominal pain (11.5%), diarrhea (3.1%), or others (9.5%). In studies performed for GI bleeding (N = 532), a source was found in 49.3% of CE studies. Arteriovenous malformation (AVM) was the most common reported finding (43.9%), followed by ulcer (24.1%), colon or gastric pathology (14.1%), mass/tumor (9.1%), and stricture (6.9%). Patients with abdominal pain (n = 81) had findings 46.9% of the time including edema/ulcer (47.4%), stricture (10.5%), mass/tumor (26.3%), gastric pathology (10.5%), AVM (2.6%), or sprue (2.6%). Patients with diarrhea (n = 22) had findings 45.5% of the time including edema/ulcer (75%), mass/tumor (12.5%), or sprue (12.5%). A total of 66 patients underwent operative exploration after a CE study at this institution either because of the observed findings or for other reasons. There were 12 (1.7%) CE studies in which the capsule was retained and required surgical removal. Pathology at the retention site included benign strictures or adhesions (n = 9, 75%), Crohn's stricture (n = 1, 8.3%) carcinoid tumor (n = 1, 8.3%), and villous adenoma (n = 1, 8.3%). CONCLUSIONS: CE is an accurate study to locate abnormalities in the GI tract that may have either been missed by previous diagnostic studies or cannot be observed through other non-invasive means. When used for diagnostic challenges such as GI bleeding with no apparent source, CE can be helpful in guiding surgical decisions in patients and thus should be integrated as part of the diagnostic workup.


1                     Gadewar S, Fasano A. Current concepts in the evaluation, diagnosis and management of acute infectious diarrhea. Curr Opin Pharmacol. 2005 Dec;5(6):559-65.

Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University of Maryland School of Medicine, 22 S. Greene St. N5W70, Baltimore, Maryland 21201-1595, USA.

Despite recent advances in our understanding of the pathogenesis of enteric diseases, acute infectious diarrhea remains a major cause of morbidity and mortality worldwide. Infection is the most common cause of acute diarrhea. Some causes of infectious diarrhea also result in serious long-term sequelae such as hemolytic uremic syndrome, Guillain-Barre syndrome and malnutrition. A better understanding of bacterial pathogenesis has grown increasingly important because of the emergence of new pathogens and the growing problems of resistance among enteric pathogens and other enteric flora. Non-antimicrobial approaches to therapy have become increasingly important with the emergence of serious antimicrobial resistance, such as vancomycin-resistant enterococcal colonization of the gastrointestinal tract. Finally, new understanding of how intestinal bacteria cause disease is revealing that enteric infections might trigger damage to epithelial cells or the intestinal barrier, or disrupt intestinal barrier and absorptive function (without necessarily causing overt diarrhea); thus, enteric infections might be far more important as emerging causes of malnutrition than has been previously appreciated. Therefore, diarrhea is both a cause and an effect of malnutrition. Treatment in most cases of bacterial and viral diseases consists of correcting fluid loss and electrolyte imbalance by oral or parenteral rehydration. Prevention of enteric illness by virtue of improved hygiene and provision of sanitation and water treatment is impractical in most developing countries, where morbidity and mortality rates are highest. For this reason, development of vaccines against the most important gastrointestinal infections remains a high priority.


3.                   Juca CA, Rey LC, Martins CV. Comparison between normal saline and a polyelectrolyte solution for fluid resuscitation in severely dehydrated infants with acute diarrhoea. Ann Trop Paediatr. 2005 Dec;25(4):253-60.

Emergency Unit, Hospital Infantil Albert Sabin, Fortaleza, Brazil.

The optimal intravenous solution for rehydration of infants and children with severe dehydration is debated. AIM: The aim was to compare the efficacy of a polyelectrolyte solution (group PS) with sodium chloride 0.9% solution (group NS) in rapid parenteral rehydration of severely dehydrated infants with acute diarrhoea. METHODS: Primary outcomes were volume and time to hydration. Secondary outcomes were urea, creatinine, electrolytes, glucose, arterial pH and bicarbonate levels. Patients were assigned randomly and openly to one of the two treatment groups. Severe dehydration was defined as one or more of the following associated with any other sign of dehydration: depressed consciousness, a weak or absent pulse or capillary refill time > 10 sec. Peripheral blood samples for chemical pathology were collected before and after rapid fluid therapy. The mean age of the 36 enrolled infants was 9.1 mths. All had depressed consciousness or severe hypotension/shock. The fluid infusion rate was 50 ml/kg/hr until haemodynamic stability was restored (absence of severe hypotension and two urine emissions). Fluid volume, time to rehydration and weight before and after rehydration were recorded. RESULTS: All infants recovered full pulse within 1 hr; most had a better level of consciousness or capillary refill <3 sec. Group NS (15 infants) showed (before and after treatment, respectively) a decrease of plasma potassium (3.4 to 3.1 mmol/L, p=0.07), bicarbonate (13.3 to 12.2 mmol/L, p=0.01) and glucose (8.2 to 5.8 mmol/L, p<0.01). Group PS (21 infants) showed a decrease of potassium (4.4 to 3.2 mmol/L, p<0.01) but an increase in bicarbonate (11.6 to 13.3 mmol/L, p<0.01) and glucose (11.4 to 14.8 mmol/L, p=0.08). CONCLUSION: Polyelectrolyte solution was as effective as normal saline on volume expansion and better for correcting acidosis.


3.                   Shamir R, Makhoul IR, Etzioni A, Shehadeh N. Evaluation of a diet containing probiotics and zinc for the treatment of mild diarrheal illness in children younger than one year of age. J Am Coll Nutr. 2005 Oct;24(5):370-5.

Division of Pediatric Gastroenterology and Nutrition, Meyer Children's Hospital of Haifa, Israel. shamirr@netvision.net.il

OBJECTIVES: Supplementation of probiotics and supplementation of zinc during acute gastroenteritis in children have been shown to exert positive effects on diarrhea duration and severity. Our aim was to evaluate a new diet enriched with zinc and probiotic bacteria in the treatment of acute gastroenteritis in young children. METHODS: In a double blind prospective study, 65 children aged 6-12 months were randomized to receive 6 x 10(9) colony forming units of Streptococcus thermophilus, Bifidobacterium lactis, Lactobacillus acidophilus (2 x 10(9) of each strain), 10 mg of zinc/day, and 0.3 grams of fructo-oligosaccharides in the supplemented group (n = 33) or placebo (n = 32), given in a soy protein based rice cereal. For each child, age, sex, weight, degree of dehydration, the presence of fever or vomiting, stool frequency and consistency were recorded daily until diarrhea resolution. RESULTS: Diarrhea resolution occurred after 1.43 +/- 0.71 days in the supplemented group vs. 1.96 +/- 1.24 in the control group (p = 0.017). In the subset of children who presented with vomiting, time to vomiting resolution was 0.27 +/- 0.59 vs. 0.81 +/- 0.91 days in the supplemented and control groups, respectively (p = 0.06). On day 3, there was only 1 child with watery stools in the supplemented group versus 10 children in the control group (p = 0.02). CONCLUSIONS: In our series, the feeding of a cereal containing Streptococcus thermophilus, Bifidobacterium lactis, Lactobacillus acidophilus and zinc, reduced the severity and duration of acute gastroenteritis in young children. However, whether this combination is better than either the addition of probiotics or zinc alone is yet to be determined.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

13755.  Audi J, Belson M, Patel M, Schier J, Osterloh J. Ricin poisoning:a comprehensive review. JAMA. 2005 Nov 9;294(18):2342-51. Review. 

13756.  Barthold CL, Schier JG. Organic phosphorus compounds--nerveagents. Crit Care Clin. 2005 Oct;21(4):673-89, v-vi. Review. 

13757.  Beyer PL, Caviar EM, McCallum RW. Fructose intake at currentlevels in the United States may cause gastrointestinal distress innormal adults. J Am Diet Assoc. 2005 Oct;105(10):1559-66.

13758.  Garcia-Careaga M Jr, Kerner JA Jr. Gastrointestinalmanifestations of food allergies in pediatric patients. Nutr Clin Pract.2005 Oct;20(5):526-35. Review.

13759.  Hadley SK, Gaarder SM. Treatment of irritable bowel syndrome.Am Fam Physician. 2005 Dec 15;72(12):2501-6. Review.

13760.  Izumi T, Hyodo T, Kikuchi Y, Imakiire T, Ikenoue T, SuzukiS, Yoshizawa N, Miura S. An adult with acute poststreptococcalglomerulonephritis complicated by hemolytic uremic syndrome andnephrotic syndrome. Am J Kidney Dis. 2005 Oct;46(4):e59-63.

13761.  Karch H, Tarr PI, Bielaszewska M. EnterohaemorrhagicEscherichia coli in human medicine. Int J Med Microbiol. 2005Oct;295(6-7):405-18. Review.

13762.  Nirmaljit Kaur, Diwan N, Patwari A K. Role of non-lactosefermenting Escherichia coliin diarrhoea. Indian med Gaz 2005; 139(3):83-8.

13763.  Sequeira A, Atray NK, Vachharajani TJ. A large splenic cyst:"incindentalocyst". South Med J. 2005 Oct;98(10):1054-5.



13764.    Brooks JT, Sowers EG, Wells JG, Greene KD, Griffin PM, HoekstraRM, Strockbine NA. Non-O157 Shiga toxin-producing Escherichia coliinfections in the United States, 1983-2002. J Infect Dis. 2005 Oct15;192(8):1422-9.

13765.    DuPont HL. What's new in enteric infectious diseases at home andabroad. Curr Opin Infect Dis. 2005 Oct;18(5):407-12. Review.

13766.    Okhuysen PC. Current concepts in travelers' diarrhea:epidemiology, antimicrobial resistance and treatment. Curr Opin InfectDis. 2005 Dec;18(6):522-6. Review.

 13767.    Snelling AM. Effects of probiotics on the gastrointestinal tract.Curr Opin Infect Dis. 2005 Oct;18(5):420-6. Review.



July 2006

Some Selected Abstracts:


Szymanski H, Pejcz J, Jawien M, Chmielarczyk A, Strus M, Heczko PB. Treatment of acute infectious diarrhoea in infants and children with a mixture of three Lactobacillus rhamnosus strains--a randomized, double-blind, placebo-controlled trial. Aliment Pharmacol Ther. 2006 Jan 15;23(2):247-53.

Department of Pediatrics, St Hedwig of Silesia Hospital, Trzebnica, Poland.

BACKGROUND: Multiple studies document that probiotics are effective in treating in fectious diarrhoea in children. Lactobacillus rhamnosus GG is the most extensively studied but effectiveness of other strains has been poorly examined. AIM: To determine whether L. rhamnnsus strains (573L/1; 573L/2; 573L/3) (Lakcid L, Biomed, Lublin, Poland) would be effective in shortening infectious diarrhoea. METHODS: In a randomized, double-blind, placebo-controlled trial, 87 children (age range: 2 months to 6 years) with infectious diarrhoea were administered Lakcid L at a dose 1.2 x 10(10) CFU or placebo, twice daily, for 5 days. Primary outcome measure was the duration of diarrhoea. Secondary measures were duration of parenteral rehydration, adverse events, and gastrointestinal tract colonization by administered strains. RESULTS: In an intention to treat analysis of 87 children, the mean duration of diarrhoea in the treated group: 84 +/- 56 h; placebo: 96 +/- 72 h (P = 0.36). In rotavirus infection: 76 +/- 35 h vs. 115 +/- 67 h (P = 0.03), respectively. Duration of parenteral rehydration: 15 +/- 14 h vs. 38 +/- 33 h (P = 0.006). Gut colonization by administered strains was 80% and 41% at five and 14 days, respectively. No adverse events were noted. CONCLUSIONS: Administration of L. rhamnosus strains shortens the duration of rotaviral diarrhoea in children but not of diarrhoea of any aetiology. Intervention shortens the time of intravenous rehydration.


14314. Birks J. Cholinesterase inhibitors forAlzheimer's disease. Cochrane Database Syst Rev. 2006 Jan25;(1):CD005593. Review.

14315. Cezard JP, Salazar-Lindo E. Racecadotril inacutediarrhoea. Indian Pediat.2005; 42(5):502-3.

14316. Murphy C, Vernon M, Cullen M. Intravenousimmunoglobulin for resistant Clostridium difficile infection. AgeAgeing. 2006 Jan;35(1):85-6.

14317. Pingle A, Hadaye R, Pandit D. Aninterventional study toassess the impact of knowledge on hygiene anddiarrhoea amongmunicipal school children. J Commun Hlth. 2005;

14318. Szajewska H, Dziechciarz P, Mrukowicz J.Meta-analysis: Smectite in the treatment of acute infectious diarrhoeain children. Aliment Pharmacol Ther. 2006 Jan 15;23(2): 217-27.



October 2006


Some selected abstract:


Barennes H, Balima-Koussoube T, Nagot N, Charpentier JC, Pussard E. Safety and efficacy of rectal compared with intramuscular quinine for the early treatment of moderately severe malaria in children: randomised clinical trial. BMJ. 2006 May 6;332(7549):1055-9.


Centre MURAZ, 01BP390 Bobo-Dioulasso, Burkina Faso. hubert.barennes@auf.org


OBJECTIVE: To compare the safety and efficacy of quinine given by the rectal route with quinine given by the intramuscular route in children with moderately severe Plasmodium falciparum malaria. DESIGN: Randomised, open, clinical trial. SETTING: Health centre in Burkina Faso. PARTICIPANTS: 898 children with moderately severe P falciparum malaria who were unable to take oral treatment. INTERVENTION: Rectal quinine (20 mg/kg diluted to 30 mg/ml in water solution) or intramuscular quinine (12.5 mg/kg) every 12 hours until oral quinine could be taken. MAIN OUTCOME MEASURES: Primary safety outcome was the presence of blood in stools and secondary safety outcome was diarrhoea. Primary efficacy outcome was early treatment failure and secondary efficacy outcomes were late clinical and parasitological failures, fever clearance time, and time to oral intake. RESULTS: Blood in stools and diarrhoea were more common in children given quinine by the rectal route than by the intramuscular route (blood in stools: 5% v 1%, absolute difference 3.9%, 95% confidence interval 1.8% to 6.1%; diarrhoea: 5% v 1%, 3.5%, 1.3% to 5.7%). On anoscopy, inflammatory lesions (9/248, 3%) were associated with bloody striations in stools. Side effects of rectal quinine were rare and transitory. Local pain (90%), inflammation (79%), and transient impairment of mobility (15%) were observed with intramuscular quinine. Early treatment failure was higher in the rectal group (6% v 3%, absolute difference 3.0%, 95% confidence interval 0.2% to 5.9%). All except two children in each group had negative blood slide results at day 5. Fever recurrence at day 7 was higher in the intramuscular group (37/375 v 18/395, absolute difference 5.3%, 1.6% to 8.9%). Other efficacy outcomes (late clinical failure, late parasitological failure, fever clearance time, time to starting oral intake and rate of deterioration to severe malaria) did not differ. CONCLUSION: Quinine given by the rectal route has an acceptable safety profile and could be used in the early management of moderately severe malaria in children in sub-Saharan Africa, halting progression to severe disease.



Hill DR, Ford L, Lalloo DG. Oral cholera vaccines: use in clinical practice. Lancet Infect Dis. 2006 Jun;6(6):361-73. Review.


National Travel Health Network and Centre, London, UK. david.hill@uclh.org


Cholera continues to occur globally, particularly in sub-Saharan Africa and Asia. Oral cholera vaccines have been developed and have now been used for several years, primarily in traveller populations. The licensure in the European Union of a killed whole cell cholera vaccine combined with the recombinant B subunit of cholera toxin (rCTB-WC) has stimulated interest in protection against cholera. Because of the similarity between cholera toxin and the heat-labile toxin of Escherichia coli, a cause of travellers' diarrhoea, it has been proposed that the rCTB-WC vaccine may be used against travellers' diarrhoea. An analysis of trials of this vaccine against cholera (serotype O1) shows that for 4-6 months it will protect 61-86% of people living in cholera-endemic regions; lower levels of protection continue for 3 years. Protection wanes rapidly in young children. Because the risk of cholera for most travellers is extremely low, vaccination should be considered only for those working in relief or refugee settings or for those who will be travelling in cholera-epidemic areas and who will be unable to obtain prompt medical care. The vaccine can be expected to prevent 7% or less of cases of travellers' diarrhoea and should not be used for this purpose.


14703.  Boran P, Tokuc G, Vagas E, Oktem S, Gokduman MK. Impact of zinc supplementation in children with acute diarrhoea in Turkey. Arch Dis Child. 2006 Apr;91(4):296-9.