PIP: Acute diarrhea is still responsible for about 40% of diarrhea-associated deaths, and oral rehydration therapy (ORT) does not actually reduce the duration of diarrhea. A species of lactobacilli specific for the human gut was first isolated in 1987, Lactobacillus casei strain GG, and several trials have used colonization of the gut by this organism as an adjunct to ORT. A placebo-controlled, triple-blind study in Pakistan showed a significant reduction in the number of children with persistent watery stools at 48 hours, as well as a reduction in stool output and vomiting. Dioctahedral smectite (DS) has been found to adsorb viruses, bacteria, and toxins resulting in the protection of gut mucosa. A randomized double-blind trial (placebo-controlled) studied outcome in 90 males, 3-24 months old, with acute diarrhea of or= 5 days duration. After rehydration, patients were given either 1.5 g of DS or placebo 4 times a day for 3 days. At 48 hours, 42% of the treatment group were free from diarrhea, as opposed to 13% of the placebo group, and at 3.5 days 20% of the placebo group still had diarrhea, as opposed to none in the treatment group. Mean duration of diarrhea in the treatment groups was 54.1 hours (placebo 72.9 hours, p 0.001). However, mean stool output was similar (97.9 g/kg vs. 110.9 g/kg). Bismuth subsalicylate (BSS) has been frequently used in adults with benefits in both prevention and treatment. 142 Chilean children 4-36 months old were randomized to receive either placebo or BSS (100 mg/kg/day) 5 times a day for 5 days. Stools were normal in the E. coli group by 72 hours as opposed 139 hours in the placebo group (p 0.01), while rotavirus-infected stools normalized in 57.5 hours, as opposed to 104.5 hours in the placebo group. Other effective approaches include micronutrient supplementation including zinc and folate.