Chronic suppurative otitis media

When the eardrum has been perforated in an acute attack of otitis media and remains patent infection with the original pathogens may persist or repeated infections may be caused by secondary invaders such as S. aureus coliform bacilli, Pseudomonads and bacteroides. Swabs of the discharge in the external meatus should be cultured to guide the choice of antibiotics for systemic and topical therapy, but it must be borne in mind that such swabs are liable to be contaminated with commensal bacteria from the skin lining the meatus. These contaminants are mainly albus Staphylococci diplitheroid bacilli and saprophytic mycobacteria which should be ignored but may include s. aureus and coliform bacilli.
Otitis externa. Chronic inflammation of the skin of the external meatus, with irritation and discharge, may be caused by bacteria, particularly Pseudomonas aerugjnosa colifoon bacilli and S. aureus, or fungi, most commonly Candida or Aspergillus. A swab should be taken from the meatus and cultured aerobically on blood agar and MacConkey plates for the bacteria on a Sabouraud agar plate with a nystatin 50 Unit disk for 48h at 35-37°C for Candida and on a Sabouraud agar for 10 days at 28°C for Aspergillus . The results will guide the choice of drug for topical antibacterial or antifungal treatment.

Management of Childhood Diarrhea

Diarrhea is one of the most common causes of morbidity and mortality in children all over the world especially in developing countries. The median global incidence of diarrhea was 5 and 2.6 episodes per child per year in infants (6-11months) and for all children between 0-4 years respectively 1 . Much higher rates are seen in children from low socioeconomic status. The causes of childhood diarrhea vary with location, season and population. With the advent of AIDS, various enteric pathogens are now being associated with diarrheal diseases.
Standard management of acute childhood diarrhea as stated by WHO include ORS, feeding and zinc supplementation. Recently probiotics has been proposed as adjuvant for therapy.
Probiotics are live microbial feeding supplements that beneficially affect the host animal by improving its microbial balance. They are commonly used in the treatment and prevention of acute diarrhea. Several randomized controlled trials and meta-analyses suggested that probiotics are effective in primary and secondary prevention of gastroenteritis and its treatment. Selected Lactobacillus strains had a modest, although significant effect in primary prevention. Saccharomyces boulardii was effective in antibiotic-associated and in Clostridium difficile diarrhea. There is evidence that it might prevent diarrhea in day-care centers.