Oral rehydration of infants with diarrhoea is an effective therapy that is becoming increasingly available in developing countries. To formulate judicious recommendations for preparation and storage of such solutions, we assessed the capability of recognized bacterial enteropathogens to survive and proliferate in solutions made either with sterile distilled or river water collected in two developing countries. Shigella flexneri, an enteropathogen typically transmitted by faecal/oral contact rather than by water or food, survived very poorly. In contrast, Vibrio cholerae and enterotoxigenic Escherichia coli, pathogens classically associated with transmission by food and water, reached concentrations of 103-104 per ml by 12 h and 104-106 by 24 h after inoculation of solutions made with river water and somewhat lower concentrations in distilled water. This potential exposure to bacteria must be considered in the context of the field situation where children are already ingesting high levels of bacteria in drinking water and food and where the oral rehydration solution would probably add little to their exposure. Although it is probably wise to prepare solutions fresh each day with water as free from faecal pollution as possible, in situations where lack of fuel to boil water or scarce supply of glucose/electrolyte packets preclude compliance with these recommendations prompt administration of oral rehydration solutions to infants with diarrhoea should nevertheless proceed.
PIP: Oral rehydration of infants with diarrhea is an effective therapy that is becoming increasingly available in developing nations. To formulate judicious recommendations for preparation and storage of such solutions, the capability of recognized bacterial enteropathogens to survive and proliferate in solutions made either with sterile, distilled, or river water collected in 2 developing countries was assessed. The samples of water (approximately 250 ml) were collected from the Paramaribo River in Surinam and from the Jutigalpa River in Honduras. These waters were used by the local people in both areas for drinking and preparing food. Shigella flexneri, an enteropathogen typically transmitted by fecal/oral contact rather than by water or food, survived very poorly. In contrast, Vibrio cholera and enterotoxigenic Escherichia coli, pathogens classically associated with transmission by food and water, reached concentrations of 1000-10,000 per ml by 12 hours and 10,000-1,000,000 per ml by 24 hours after inoculation of solutions made with river water and somewhat lower concentrations in distilled water. Oral rehydration solutions made with sterile river water or even distilled water are capable of supporting the growth of bacterial enteric pathogens. The more rapid growth of V. cholera and E. coli in solutions made with river water than in those with distilled water may indicate that the dead organic matter present in such water may further enhance growth by supplying a source of nitrogen or other nutrients in addition to the glucose carbon source. Thus, oral rehydration solutions made with contaminated water (or if contaminated after preparation) and if stored for more than 18-24 hours, could expose children with diarrhea to high levels of bacteria. The significance of this observation must be considered in the context of the field situation.