Therapeutic targets
- Rehydration (fluid balance).
- Elimination of pathogens, if necessary
- Stool regulation
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. In children, intravenous rehydration is required if loss exceeds 7.5% of body weight.
- If necessary, symptomatic therapy of diarrhea/anti-diarrheal drugs (opioid: loperamide; note contraindications/counter-indications, see below).
- In chologenic diarrhea (bile acid-induced diarrhea), typically in condition after ileum resection (surgical removal of parts of the small intestine): colestyramine (bile acid adsorbent).
- Antibiotics may need to be given depending on the underlying disorder. Their use should be thoroughly considered, as antibiotics are often themselves the cause of diarrhea.
- Administration of antibiotics is recommended for: Shigella (resistance testing!) or Salmonella.
- Antibiotics should be avoided for: Infections with Campylobacter, Yersinia and Escherichia coli.
- Use of antibiotics is discussed for: EHEC (Enterohemorrhagic Escherichia coli).
- See also under “gastroenteritis” gastroenteritis, if applicable.
- See also under “Further therapy“.
Further recommendations [see below guideline no 2].
- Probiotic supplementation may reduce the severity and duration of diarrhea in immunocompetent patients.
- Oral zinc supplementation reduces the duration of diarrhea in children six months to five years of age who may be zinc deficient.
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.
