Therapeutic targets
- Rehydration (fluid balance).
- Improvement of the symptomatology
- Elimination of pathogens
- Avoidance of complications
Therapy recommendations
- The most important therapeutic goal is to compensate for fluid and electrolyte losses: according to the WHO, this should be done with oral substitution of 3.5 g NaCl, 1.5 g KCl, 20 g NaHCO3 (sodium bicarbonate) and 20 g glucose.
- Symptomatic therapy (antiemetic/anti-nausea drug: loperamide (opioid), note contraindications/counter-indications).
- Antibiosis (antibiotic therapy: ciprofloxacin (quinolones), first-line agent; alternatively, single dose with azithromycin); may have a positive effect on duration and severity of infection – but of secondary importance!
- 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.
