Hello,
Thank you for your query at DoctorSpring.com

I can understand your concerns. But I need to know the following details:
1. Exact age of the baby/ weight
2. How many stools per day over the last 20 days? What is her pre-illness stool frequency and consistency? I need detailed description of the stools- colour/ odour/ volume/ consistency/ presence of blood/mucus/ any other gross stool observation findings.
3. Where are you residing? From where are you getting the above treatment? Please attach scanned versions of hospital visit consultations as well as laboratory reports (if possible; If it is not feasible, it is okay) I would appreciate if you can scan, in particular the stool culture report and attach it. That may be of help.
Feel free to discuss further,
Regards
Dr. Saptharishi L G

Dear Parent,

Thank you for providing the above details.
It appears to me that the whole situation is a little complex. What started of as a primary illness has got modified because of the treatment administered. At this point, I would like to present my analysis of your child's problem.
1. Your child started off with loose stools and cough/cold. It could be viral/ bacterial. Most viral illnesses present with a prodrome like cough/cold/ nasal stuffiness. Plus viral cause is much commoner. In such a situation, only presence of either high-grade fever, a very sick child or the presence of blood/mucus in stools is a justification for using ANTIBIOTICS. In your child's case, multiple antibiotics have been used unnecessarily in my opinion.
2. Stool culture growing Escherichia coli means absolutely nothing unless the isolate is of a particular strain (O157:H7 or ETEC or EHEC). I do not think that the laboratories that you have mentioned have tested for the E.coli strain. Escherichia coli bacteria is a normal inhabitant bacteria in the intestines (food tubes) and would grow in all our stool cultures. It may not be the causative organism in your child's case.
3. A child's diarrhoea could start with a viral infection-based trigger but can continue because of multiple reasons. Viral diarrheas are self limited (resolve by themselves) except when there is a secondary/super-added bacterial infection or when there is a secondary lactose intolerance. Secondary lactose intolerance is a condition where the initial virus destroys the lining of the intestines [disaccharidase enzyme at the tip of villi- to be specific]. Even after the infection subsides, the body is unable to absorb sugar and continues to have osmotic diarrhoea.
Theoretical explanations apart, let me suggest the following for your child:
1. STOP all ANTIBIOTICS unless your child is running a fever/ has any other evidence of sepsis - I am assuming that blood culture/ urine cultures were sent and were sterile. I am also assuming that your child is otherwise well, active, without fever and does not have rapid breathing/ other organ involvement
2. Start using curd/ probiotic
3. Stop using ORS/oral rehydration solution unless the stools are large volume and watery
4. Start your child on 2.5 ml per day of Syrup ZN-20 for 2 weeks
5. Continue only breastfeeds for the next two weeks.
6. Keep a record of stool pattern, consistency and frequency over the next week - It ll gradually come down over the next 5-10 days. Please do not start treating every increase in stool frequency with antibiotics.

Regards,
Dr. Saptharishi L. G.

Dear Parent,

It is good that you stopped all antibiotics. There seems to be some miscommunication regarding this LACTOGEN test. There is no test by that name. I am assuming that they tested for lactose intolerance. 1+ again does not mean much. I would advise you not to use ZEROLAC. Please continue with mother's milk. Add curd to the child's diet. It is a natural probiotic and will help in digestion of the mother's milk. ZEROLAC is a lactose-free formula and is not required at this stage. If your child continues to have SIGNIFICANT loose stools despite this protocol, then as a next step we can consider using ZEROLAC. At this point, it is not to be used.
There is no role for DUOLIN nebulisation for cold, unless there is evidence of WHEEZING (Viral URI/LRI triggered bronchospasm). Kindly use steam inhalation and Nasoclear drops if there is significant nasal congestion. Rest of the treatment is in-line with my suggestions.
Hope this was helpful,
Regards.

Dear Parent,
Glad to know that my medical advice was useful in helping your child recover from her illness. It has been my pleasure to be of some help.
Regarding her appetite, it is normal for babies to have a change in feeding practice after any acute illness. But, that change can be utilized positively for the benefit of the baby. You can introduce solid feeds to your daughter now. The complementary feed that can be introduced at this age are:
1. Rice water
2. Mashed banana
3. Suji/Ragi kheer or porridge
4. Home-made health mix - made into a pasty consistency by addition of milk
5. Mashed rice with milk
6. Curd
7. Finely mashed chichi
The important thing to remember is that you need to introduce one new food item at a time. Give it daily for a week so that she can adjust to the new food and start liking it. Only then introduce a second food. You can start her on multivitamins: Syrup ZEVA 2.5 ml twice daily and Syrup Calcimax 2.5 ml twice daily. Please do not give any medicines to improve her appetite. The ones that I have suggested above are multi-vitamins and calcium supplements.
Regards.