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Watery stools of different colours in baby. TAXIM.

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Hello,

My 5 months 9 days old boy is suffering from Diarrhea since 25 days.

On Second day of Diarrhea One doctor Prescribed O-XOL (Ofloxacin & Ornidazole suspension).We continued this for 6/7 days 4 drops Thrice a day with Enterogermina and Motonorm (Frequency of passing stool reduced).

On 10th Day he got pain in stomach at night and started passing watery stools of different colors (green/dark green/yellow) with an average frequency of 15/16 times.

Another doctor suggested to apply Nutrolin-B and Echonorm sache for 3 days (It again reduced to 6/7 times but returned on 4th day with 15/16 times of frequency).

When Stools routine Tested, it was reported that There are RBC/hpf (1-2) & Puss (1-2) and my third doctor advised (This doctor looking after my boy from his birth time) stools Culture sensitivity test with applying Taxim-o for 5 days.

My Boy is on Taxim - o now but he still passes 7/8 times of loose stool with varied amount( mostly very small amount every time).

Today Culture report has come which shows baby is infected by E Coli and it has only sensitivity to Tygecycline, nitrofurantoin & colistin.

My Third Doctor (who is a regular doctor of my boy from his birth time) has suggested to continue Taxim- O only.

Request your expert opinion.

Category: Pediatrician

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Category: ICU/ Critical Care Specialist
 32 Doctors Online

Hello.
Thank you for posting your query at DoctorSpring.com
I understand your concerns. I can also imagine the agony you must be facing while shuttling between three different practitioners. Let me put forth my opinion very frankly:
No infection would usually last for 25 days. Giving antibiotics to a 5 month-old baby with diarrhoea was probably inappropriate, unless your baby had high-grade fever or bloody stools or mucoid diarrhoea. Giving a two antibiotic combination was unwarranted.
Stools turning greenish could mean many things: 1. Whenever stool frequency increases significantly, bile content increases in stools and that could have cause the green colour. Or 2. Unnecessary antibiotics can alter the normal gut microflora and cause colonisation with other microbes (Clostridium difficult) causing what is known as 'Antibiotic associated colitis/ diarrhoea'. In your child, it is difficult to determine which of the two things happened.
Presence of 1-2 RBC/HPF as well as 1-2 PC/HPF has no meaning as they can be seen in any child with diarrhoea. They do not mean anything. Moreover, Escherichia coli is a normal gut flora present in everybody's intestines (food pipe). Growth of E.coli does not mean your child has diarrhoea due to E.coli, UNLESS the strain of E.coli grown is either toxigenic/entero-invasive/etc.. (special strains Eg: O157, etc)
Kindly let me know if the baby has any fever. How is the general activity of the baby? How s the feeding? What feeds is he getting? What is the overall weight loss during these 25 days? Are there any other clinical symptoms?
I ll be able to guide you further after you answer these queries.
Regards
Dr. Saptharishi L G


Patient replied :

Thanks Dr. Saptharishi for your attention.
Here is the answer of some questions that you've asked:
Baby does not have any fever. Baby is active. Feeding is regular. He is exclusively breast fed (recently my doctor has suggested to give him Ragi & Banana since it hardens the stool but we've stopped providing him after giving two days since he's passing un processed ragi as is)
Regarding his weight, when weighted him a month back he was of 6.2 kg, after a month/45 days when we weighted him recently he was of 6.96 (so he has lost 500/800 gm of weight).
He passes stool just after the feed (which was not earlier).
Due to the frequency of passing stool he got rashes around his anus.He create extra pressure while passing stool (constipation like pressure).
Other than above points, baby does not have any clinical symptom, baby is active, playful (no sign on this appearance of such situation he is passing through).
Hope that clarifies your query.
Regards
Utpal


Dear Parent,

Thank you for patiently answering my queries. I now get the complete picture. Many of the things that you have described would be considered normal in a young infant (Eg: creating extra pressure during passing stools, passing stools 7-8 times per day, passing stools just after the feed, etc)

Now, let me guide you:

Once diarrhoea sets in, the virus (which is the most common etiological agent of loose stools in children) damages the lining of the intestine (intestinal villi). This causes some degree of malabsorption i.e our gut is unable to effectively absorb all the nutrients in the milk (Medical term - secondary lactose intolerance). So, in many children, despite resolution of the infection, the baby may continue to have loose stools due to poor absorption of lactose from the intestines. This is usually benign and obviously, only worsen further with antibiotics (as they will damage the lining of the intestine further).
Rest assured, this secondary lactose intolerance heals spontaneously without need for any intervention. The gut needs time to heal itself.

1. STOP all antibiotics.
2. Give only breastfeeds. DO NOT add any new food now. Because of the damage caused by the virus to your baby's gut, the baby would not be able to absorb newer foods (ragi in your case). Stick to EXCLUSIVE breastfeeds for another three-four weeks.
3. Consider introducing small amounts of CURD. Curd is a natural probiotic and contains beneficial bacteria (the commercial probiotics are a mimic of this natural product)
4. For the rashes around his anus, you can use a gentle emollient like SILODERM ointment. DO NOT apply any antibiotic creams. These rashes would automatically heal once his lactose intolerant stools subside.

I hope your child recovers soon. God bless.

Regards,
Dr. Saptharishi L G.


Patient replied :

Many Thanks Doctor, Your explanation clarifies things well.
But, I'm worried if :
1. Dragging infection for such duration spreads in other organs
2. Applying Probiotics or Antibiotics reduces but it returns back and passing stool for such higher frequency (16/18 time, very small amount though) on a regular basis causes any other issues (not sure)
Rest i fine to follow your advise.
Thanks and Regards
Utpal


Dear parent,

It is impossible to be 100% sure about anything in medicine; especially, when a doctor does not see the child in-person. However, in your case, it appears that antibiotics would do more harm than good to your baby.
There is tendency among Indian private practitioners to overprescribe antibiotics. You would be surprised to know that in most of the European countries, prescribing antibiotics unnecessarily is looked down upon.
Having said that, the choice is entirely yours and please free feel to take opinion from a pediatric gastro-enterologist.

Wishing your child a speedy recovery.


Patient replied :

Thanks Doctor,
Certainly i appreciate your approach.
I personally wont prefer to apply antibiotic to my little champ as long as it has mild alternative but feel sad experiencing such approach (instead of choosing advanced specialized hospital/doctor).
Would like to mention here that
1. My First doctor is a MD -Medicine
2. Second Doctor is MBBS,DCH
3. Third Doctor is MD (Neonatalogist and senior paediatrician in a popular speciality hospital bangalore).
Thanks for your wish and opinion.
Regards
Utpal


Hello.
Thank you for your appreciation.
Hopefully you will get a consult from a pediatric gastro-enterologist. He will certainly be able to guide you in the right direction.
Regards.


Dr. Saptharishi L G
Category: ICU/ Critical Care Specialist
Experience: 
Senior Residency: DM,  Pediatric Critical Care, PGIMER

Residency: MD, Pediatrics, Postgraduate Medical Education & Research (PGIMER), Chandigarh, 2013

Internship: JIPMER, 2009

Medical School: MBBS, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, 2008
Dr. Saptharishi L G and 4 other Medical Specialists are ready to help you

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