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Four hundred adults presenting with acute watery diarrhoea were entered into a randomised, placebo controlled, double blind clinical trial of berberine, tetracycline, and tetracycline and berberine to study the antisecretory and vibriostatic effects of berberine. Of 185 patients with cholera, those given tetracycline or tetracycline and berberine had considerably reduced volume and frequency of diarrhoeal stools, duration of diarrhoea, and volumes of required intravenous and oral rehydration fluid. Berberine did not produce an antisecretory effect. Analysis by factorial design equations, however, showed a reduction in diarrhoeal stools by one litre and a reduction in cyclic adenosine monophosphate concentrations in stools by 77% in the groups given berberine. Considerably fewer patients given tetracycline or tetracycline and berberine excreted vibrios in stools after 24 hours than those given berberine alone. Neither tetracycline nor berberine had any benefit over placebo in 215 patients with noncholera diarrhoea. IntroductionTo reduce the need for treatment with oral and intravenous fluid in patients with severe diarrhoea due to cholera and similar bacterial enteric infections, agents that reverse the stimulation of secretion of water and electrolytes by cholera toxin and the related toxins of enterotoxigenic Escherichia coli are sought.' Berberine is an alkaloid derived from the roots and bark of the plant Berberis aristata: a spiny, deciduous, evergreen shrub with yellow flowers (berberry bush). Berberine has a broad spectrum antibiotic activity against selective bacteria,2 including Vibrio cholerae, shigella, pseudomonas, E coli, proteus, protozoa such as Entamoeba histolytica,3 trichomonas,4 giardia,5 leishmania,6 and fungi. Extracts of this plant have been used in antidiarrhoeal medication in Ayurvedic medicine in India and in the traditional medicine of China for the past 3000 years. More recently berberine has been shown to inhibit the action of V cholerae toxin when administered before or with the enterotoxin in animals,8 "to have an antisecretory effect in the ligated intestinal loop of the rabbit even when administered after the enterotoxin has been bound to intestinal mucosa,'2 and also to inhibit the secretory response of E coli ST (heat stable) toxin in the infant mouse. 12Few clinical trials of berberine to date have shown it to be effective in treating acute diarrhoea.'3"'9 No clinical trial studying the antisecretory effect of berberine in diarrhoea has been reported. This report concerns a randomised, double blind, placebo controlled clinical trial of berberine v tetracycline v berberine and tetracycline to study the antisecretory effect and clearance of vibrios from stools in patients with cholera. Patients and methodsAdults admitted to the Infectious Diseases Hospital with a history of watery diarrhoea less than 48 hours before admission and no history of antibiotic ingestion, coexisting illness such as pneumonia, systemic illness such as diabetes or hypertension, or diarrhoea within ...

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Breath-hydrogen tests were performed after a rice meal (3 g cooked rice/kg body wt, equivalent to 1 g carbohydrate/kg body wt) at monthly intervals for 6 mo on 75 village children aged 1-59 mo who were known hydrogen producers. The overall rate for rice-carbohydrate malabsorption was 46.7% (range 37.3-56.0%). Anthropometric measurements were made every 3 mo and growth rates were calculated. Forty-six percent to 59% of children were less than or equal to -3 SD of the National Center for Health Statistics (NCHS) median weight-for-age and length-for-age and less than -2 SD of the NCHS median weight-for-length. Rice malabsorbers (ie, those with hydrogen peaks greater than or equal to 10 ppm above baseline concentrations) in the age groups 36-47 mo and 48-59 mo had statistically significant diminished growth expressed as percent gain in length per annum per child (p less than 0.02). Thus, rice malabsorbers had a deficit in linear growth of 2.7 cm/y (range 2.5-2.9 cm/y) for children aged 36-47 mo old and 1.9 cm/y (range 1.7-2.1 cm/y) for children aged 48-59 mo.