Treatment of Acute Diarrhoea: Past and Now

Context: Since ancient times diarrhoea has been a highly fatal disease and even today diarrhoea, the topic of this review, is a problem affecting millions of people around the world despite the efforts of governments and professionals from the medical area. Worldwide the most common cause of children’s death is diarrhoea. Evidence Acquisition: Diarrhoea disorders generally appear with watery stools, sometimes mixed with blood, accompanied by abdominal pain, vomiting and fever. The symptoms depend on the content and distribution of body fluid, daily water requirements and physiological water loss in connection with age through sweating, urination and breathing, the degree of fluid and electrolyte loss in the liquid stool. Results: Several effective interventions have been introduced as part of diarrhoea management in the last two decades such as oral rehydration solution, zinc supplementation, vitamin A supplementation and oral administration of antibiotics and vaccines. To reduce the mortality rate, control of safe drinking water, good sanitation and vaccination against typhoid and cholera are recommended, especially in high-risk populations. Probiotics have been proposed, after more than a half of century, as additional therapy in the treatment of acute diarrhoea. Several probiotic strains showed benefit in meta-analyses of randomised controlled trials. Conclusions: Due to the high level of evidence available, the term “oral bacteriotherapy”, used for decades in the prevention and therapy of gastroenteritis in the growing age and adults, has expanded, but probiotics are acquiring significant scientific value based on the results from human trials. The future of probiotics depends on further explanation/elucidation of basic mechanisms, allowing scientists and physicians to maximize their health benefits.