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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