Therapeutic targets
- Rehydration (fluid balance).
- Elimination of pathogens
- Avoidance of complications
Therapy recommendations
- Symptomatic therapy including fluid replacement – oral rehydration for signs of dehydration (fluid deficiency; >3% weight loss): administration of oral rehydration solutions (ORL), which should be hypotonic, between meals (“tea breaks”) for mild to moderate dehydration.
- Compensation of electrolyte losses
- If necessary, symptomatic therapy of diarrhea (loperamide (opioid); note contraindications / contraindications).
- Antibiotics should be avoided. As a rule, the course is self-limiting, ie, without external influences ending. Only in the following indications, antibiosis (antibiotic therapy: erythromycin (macrolide), agent of first choice) is recommended:
- High fever
- Severe course
- Suspicion of septic spread
- See also under “Further therapy“.
Contraindications for loperamide:
- Ileus (intestinal obstruction)
- Diarrhea with fever
- Diarrhea with blood
- Acute ulcerative colitis (inflammatory bowel disease).
- Pseudomembranous colitis (Clostridium difficile infection).
- Young children (< 2. LJ)
Further notes
- AkdÄ Drug Safety Mail | 19-2016: The United States Food and Drug Administration (FDA) currently warns of serious cardiac events / cardiac arrhythmias when taking loperamide in higher doses than recommended: FDA Safety Announcement, 07/06/2016In cases of cardiac events not otherwise explained, such as QT prolongation, torsades de pointes, other ventricular arrhythmias, syncope (brief loss of consciousness), or cardiac arrest, loperamide use should be considered as a possible cause. Patients should be advised of proper dosing.
