Proliferation of enteropathogens in oral rehydration solutions prepared with river water from Honduras and Surinam.

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.