Can I Give Metronidazole For My Child Suffering From Mushy Stools ?

Posted on Mon, 27 Jan 2014

Question: My daughters has Loose Bowel Movement which started 7 days ago (5-6 episodes per day). Her fecalysis exam ( 7 days ago) was watery and showed WBC: 4-5/hpf, RBC: 1-3 with no ova or parasite seen and She was given cotrimoxazole then. Four days ago her fecalysis results was mushy with WBC: 0-2 and RBC 0-1 and she is still on cotrimoxazole. Until now, on here last day of cotrimoxazole, repeat fecalysis showed many fat globules with WBC: 10-15/hpf and RBC: 3-5/hpf. She has still 2-3 mushy stools per day.. Can she take metronidazole although no actual amoeba cyst was seen or what can we do? What about the fat globules? her weight is 10 kg thank you XXXXXXX Do we need to change her milf formula to lactose free? thanks

Answered by Dr. Sudha Shree Venkataraman (53 minutes later)

Brief Answer: No Metronidazole. Lactose free milk can be given. Detailed Answer: Hi Mr. XXXXXXX Thanks for writing to Health Care magic. There is no need for Metronidazole I would like to know the Stool pH and how ill is the child now? Was there fever at any point of time? If she is active and oral intake is good, you may just continue with same cotrimoxazole for a total of 7 days along with the following Dietary advice. - To include Rice based items, curd, Banana, bread, Boiled mashed potato in her diet. These items will act as stool binders. - To give fluids like soups, coconut water, Lemonade to prevent dehydration. Since lactose intolerance is seen along with infections, its advisable - To stop cow's milk or formula milk. You may continue with breast milk. - If she is only on formula, you may change the normal formula to ISOMIL/ Lactose free milk for the next 2 to 3 weeks. But if she persists to have fever or is sick even now, its advisable to do a stool culture and change the antibiotic with your Pediatrician's advice. Do not be bothered about fat globules. You may give Enzyme preparations like Syrup Neopeptine or Neogandin 2.5 ml twice a day for a week to help in digestion. There is no need to repeat stool R/E often during a single episode. If needed, please repeat the test after 2 weeks when child is fine. Hope I have answered your query. Please get back if you need any further help. Best wishes.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Sudha Shree Venkataraman (36 minutes later)

Thank you. WE will change the milk formula to ISOMIL and follow your dietary advice. There is no result for the stool pH. My daughter presently has 3-4 episodes of mushy stools. She is active and looks fine except for the diarrhea. Oral intake is good but more on milk formula. She is eating little solid food but even before she is sick. She had no fever at any point. We are also giving her Oral Rehydration Salt (pedialyte) from time to time. Her cotrimoxazole is already consumed today (she had already taken it for 7 days). Is the stool exam result (WBC: 10-15/hpf and RBC: 3-5/hpf) which was examined today after consuming 7days of cotrimoxazole fine? We dont have available neopetine syrup here. Is probiotic like Erceflora (Bacillus clausi) and zinc supplement good for my daughter at this point. thank you very much XXXXXXX

Answered by Dr. Sudha Shree Venkataraman (29 minutes later)

Brief Answer: Probiotic and zinc supplement can be taken. Detailed Answer: Hi Mr. XXXXXXX Now things are more clear. Absence of fever rules out major bacterial infections. After treatment with cotrimoxazole for 7 days, stool R/E should have been fine if it was an isolated bacterial infection. Mushy stools, presence of fat globules and absence of fever, goes in favor of protozoal infections and mostly Giardiasis. With giardiasis, stool examination can be normal without any cysts seen. In such cases, its better to start treatment with Metronidazole for 7 days. If Metronidazole is not available separately, you may give her combinations of Norfloxacin and Metronidazole (Bacigyl- N) for 7 days. Probiotics and Zinc are more useful in viral diarrhea. How ever they will not cause any harm when given in these cases. And please follow the dietary advice given before. Sorry for the contradictory statement about Metronidazole. Since I can make out the history better now, my opinion differs. Hope my answer helps. Please do get back if you need further assistance.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Sudha Shree Venkataraman (29 minutes later)

Thank you Dr. XXXXXXX For my last concern, after 2-3 weeks of ISomil or lactose free milk can we resume her previous milk? and is there no need to stop multivitamins and ascorbic acid supplements while my child has still diarrhea. Again thank you very much. XXXXXXX

Answered by Dr. Sudha Shree Venkataraman (6 minutes later)

Brief Answer: Yes Detailed Answer: Hi Thanks for getting back. Yes after 2 to 3 weeks, she can be brought back to normal milk. When reintroducing, you may make it slow, say once a day for 3 days and see. If she has no problems with that, then you may give her normal milk as before. And there is no need to stop multivitamins and ascorbic acid supplements now. Best wishes.

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Above answer was peer-reviewed by : Dr. Shanthi.E