Treating diarrhoea

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7119.1377b (Published 22 November 1997) Cite this as: BMJ 1997;315:1377

Proposals are irresponsible and impractical

  1. Sandra J Taylor, General practitionera
  1. a Theatre Royal Surgery, East Dereham, Norfolk NR19 2EN
  2. b Health Centre, Crosshills, Keighley, West Yorkshire BD20 7LG
  3. c 22 Dovedale, Ware, Hertfordshire SG12 0XL
  4. d Lanes End Cottage, Trebarvah, Near Perranuthnoe, Cornwall TR20 9NG
  5. e University of Edinburgh, Department of Child Life and Health, Edinburgh EH9 1UW
  6. f University of Dundee, Medicines Monitoring Unit, Ninewells Hospital, Dundee DD1 9SY
  7. g 33 The Strand, Attenborough, Nottingham NG9 6AU
  8. h Department of Medicine and Elderly Care, New Cross Hospital, Wolverhampton WV10 0QP,
  9. i Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham B9 5ST
  10. j Tufts University School of Medicine, Boston, MA 02111, USA

    Editor—I vehemently disagree with Gorbach's editorial about treating diarrhoea.1 After my initial reaction of incredulity had died down I found myself asking, “Has this person ever practised medicine in a community?” “Which patients is he referring to?” “Has he ever even tried to contain costs and educate the public in British general practice?” Most importantly, “Has he ever been to the developing world?”

    His editorial was a slap in the face to general practitioners who have been trying to reduce demands for treatment of acute diarrhoeal illnesses (many of them made out of hours as emergencies) by encouraging people to understand that their illness is self limiting and can be managed with fluid replacement and simple analgesia. What would happen if patients now began demanding treatment with expensive drugs? Our surgeries would be under even more pressure and our drugs bill would escalate—just the things we (and the NHS) have been struggling against for years.

    Life is not perfect. We cannot expect freedom from colds and coughs—or the occasional bout of diarrhoea. And if I, a British general practitioner with only six months of experience in the developing world, feel enraged by this editorial, how much more do those continually working to improve the health of millions with minimal access to health care feel? Diarrhoeal illnesses are still treated inappropriately with a variety of unsuitable antibiotics, and resistance to these is becoming a worldwide problem. Fluid replacement is the mainstay of treatment and has been shown time and again to save lives. We now have an editorial in the (influential) BMJ suggesting that severe diarrhoea should be treated with expensive antimicrobial drugs.

    My message to Gorbach is “get real.” His suggestions may be suitable for rich northerners suffering the minor inconvenience of diarrhoea and for doctors who are willing …

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