TREATMENT OF DIARRHEA

Treatment of diarrhea is based on rehydration therapy. Generally, oral rehydration, being inexpensive and accessible, is used in the prevention and treatment of dehydration. The use of oral rehydration significantly reduces hospital visits, complications, and mortality (5-12). Diarrhea caused by bacteria may require additional treatment with antibiotics.

The problem with oral hydration is that it only replenishes loss of water and electrolytes, but it does not reduce the volume or duration of diarrhea. Many children with diarrhea become too exhausted and are unable to sustain sufficient oral fluid intake. Consequently, they are unable to manage ongoing losses of water and electrolytes. Oral rehydration does not change the duration or severity of diarrhea; therefore, antidiarrheal drugs can be very useful.

Antidiarrheal drugs consist of two groups:

1. drugs that slow intestinal contractions (antiperistaltic drugs), and

2. drugs that reduce the amount of water produced by the intestine (antisecretory drugs).

Other preparations used in the treatment of treat diarrhea to facilitate recovery and lessen fluid losses may include:

1. probiotics (lactobacillus culture),

2. immune globulins administered orally, and

3. thickening compounds: kaolin (kaopectate®) and smectite.

Many antidiarrheal drugs [such as various preparations of tannins, bismuth subsalicylate (Pepto-Bismol®), cholestyramine, chlorpromazine, and diosmelith loperamide (13-17)] used in the reduction and severity of diarrhea have not proven to be consistently effective (18).

The most commonly used antidiarrheal drugs may cause serious side effects. For example, Pepto-Bismol®; can cause Reye's Syndrome (a form of fatal liver failure). Loperamide®;, one of the most commonly used antiperistaltic agents, is not recommended for use in young children and infants, because of the high incidence of ileus (abnormal reduction of intestinal contractions), and respiratory distress (19-21). Lomotil®, which contains an opium derivative diphenoxylate and atropine, can cause fever, elevation of heart rate, and respiratory depression.

Although antiperistaltic and antisecretory agents may diminish the volume of stool, shorten the duration of diarrhea, reduce the degree of dehydration, and eliminate the need for rehydration therapy, these currently available agents are not safe in the treatment of diarrhea and prevention of dehydration in children.

Thickening stool with kaopectate or smectite only enhances cosmetic changes of the stool, causing it to appear better formed. These agents do not actually reduce the volume of stool output and the amount of associated water and electrolyte losses (22-23).

Due to their astringent properties, plant-derived tannins are known to have an antidiarrheal effect. In infants, an oral administration of a plant-derived preparation containing tannins in a dose of 600 mg/kg/day can reduce duration of diarrhea (24).

An “ideal” antidiarrheal agent:

1. should be safe, even when used without a control by a medical professional;

2. must be compatible with oral rehydration solutions;

3. must effectively treat infectious diarrhea caused by any microbe; and

4. be inexpensive (25).

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