Treatment of Diarrhoea

Antidiarrhoeal agents are used as adjuncts in the symptomatic treatment of diarrhea, although the main aim in the management of acute diarrhoea is the correction of fluid and electrolyte depletion with rehydration therapy; this is especially important in infants and young children and antidiarrhoeal agents are not generally recommended for this age group. Their use is also limited in chronic diarrhea for treatment aimed at the underlying disorder will often alleviate the diarrhea. The main groups of antidiarrhoeal agents are the drugs, which reduce Intestinal motility such as Loperamide, and the adsorbents (kaolin which may absorb bacterial toxins and act as mucosal protectants).

Oral Rehydration salt

Powder -each sachet for 1 liter contains

Sodium chloride ……………….  3.5gm

Trisodium citrate Dihydrate ……  2.9gm

Potassium chloride ……………  1.5gm

Glucose …………………….. 20.0gm

Indications: -replacement of fluid and electrolyte loss in diarrhoea.

Contraindications: – anuria, oliguria, severe dehydration with symptoms of shock, severe diarrhoea, glucose malabsorption, inability to drink, severe and sustained vomiting, intestinal obstruction, paralytic ileus, perforated bowl which may be irritated by ORS.

Dose and Administration: – reconstitute one sachet by adding sufficient water to make 1 liter Oral Rehydration Solution. Dose – according to fluid loss, usually 200-400ml solutions after every loose motion، child – 200ml after every loose motion, infant 1 – 11/2 times usual feed volume.

• Adsorbent Mixtures

Kaolin/Pectin Suspension:

Indications: fast relief of diarrhea.

Contraindications: not recommended for acute diarrhea. Do not use for more

than 2 days or in the presence of high fever.

Dose and Administration: 10-20ml every 4 hours.

• Antimotility Drugs:

LOPERAMIDE:

Indications: symptomatic treatment of acute diarrhoea; adjunct to rehydration in acute diarrhoea in adults and children over 4 years; chronic diarrhoea in adults only.

Contraindications: conditions where inhibition of peristalsis should be avoided, where abdominal distension develops, or in conditions such as active ulcerative colitis or antibiotic-associated colitis

Dose and Administration: Acute diarrhoea, 4 mg initially followed by 2 mg after each loose stool for up to 5 days; usual dose 6–8 mg daily; max. 16 mg daily; child under 4 years not recommended; 4–8 years, 1 mg 3–4 times daily for up to 3 days only; 8–12 years, 2 mg 4 times daily for up to 5 days. Chronic diarrhoea in adults, initially, 4–8 mg daily in divided doses, subsequently adjusted according to response and given in 2 divided doses for maintenance; max. 16 mg daily.