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Antidiarrheal Therapy by Dr.Hamed Daghzghzadeh

Antidiarrheal Therapy by Dr.Hamed Daghzghzadeh. Diarrhea is loosely defined as passage of abnormally liquid or unformed Stool at an increased frequency . For adults on a typically western Diet, stool weight exceeding 200g/d Can generally be considered diarrheal.

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Antidiarrheal Therapy by Dr.Hamed Daghzghzadeh

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  1. Antidiarrheal Therapy by Dr.Hamed Daghzghzadeh

  2. Diarrhea is loosely defined as passage ofabnormally liquidor unformed Stool at an increased frequency. For adults on a typically western Diet, stool weight exceeding 200g/d Can generally be considered diarrheal.

  3. Epidemiology of Acute Diarrhea

  4. Worldwide >1000,000,000 people/year

  5. 5-8million deaths / year in developing countries

  6. Pathophysiologic classification of diarrhea • Secretory diarrhea • Osmoticdiarrhea • Inflammatory( exudative ) diarrhea • Motility ( dismotile ) diarrhea • Anatomic( absorptive surface)

  7. Major Causes of Acute Diarrhea 8 • INFECTIONS(Including Travelers Diarrhea) Bacterial : Campylobactre Species, C.difficile, E.coli, Salmonella eneritides , Shigella Species Parasitic/protozoal: E. histolytica, Giardia lambilia,Cryptosporidium ,Cyclospoa Viral :Adenovirus , Norwalk virus , Rotavirus ,AIDS, Others Fungal • FOOD POISONING :B.Cereus , C . Perfringens , Salmonella species , S .aureus, Vibrio species, Shigella species , Camppylobacter.jejuni, E.coli • MEDICATIONS • RECENT INGESTION OF LARGE AMOUNT OF POORLY ABSORBABLE SUGARS • INTESTINAL ISCHEMIA • FECAL IMPACTION • PELVIC INFLAMMATION • GRAFT VS HOST DISEASE

  8. Most acute diarrheas are due to infectious diseases that have limited courses from a few days to a few weeks.

  9. MAJOR CAUSES OF CHRONIC DIARRHEA • IBS • IBD • Ischemic bowel disease • Chronic bacterial / mycobacterial infection • Parasitic & fungal infections • Radiation enteritis • Malabsorption Syndromes • Medications, Alcohol • Colon cancer , Villous Adenoma ,intestinal Lymphoma • Diverticulitis • Previous Surgery ( gastrectomy, vagatomy, intestinal resection ) • Endocrine causes • Fecal impaction • Heavy metal poisoning • Epidemic idiopathic chronic diarrhea

  10. NONSPECIFIC Rx OF DIARRHEA

  11. The most important Rx for diarrhea is to ensure that fluid and electrolyte deficits are replenished with IV or oral rehydration solution.

  12. ORS

  13. The rate of replacement should match the clinical presentation.

  14. Empiric Therapy of Acute Diarrhea

  15. Aminoacid & Glucose absorption accelerates sodium and fluid absorption in the jejunum.

  16. Saline solutions containing glucose or amino acids will be absorbed readily

  17. Oral rehydration solutions increase fluid and electrolyte absorption; they are not designed to reduce stool output, so stool weight actually may increase with their use.

  18. Infection is a frequent cause of acute diarrhea.

  19. If the prevalence of bacterial or protozoal infection is high in a community or in a specific situation,empiric use of antibiotics islogical.

  20. as in the treatment of travelers' diarrhea

  21. Even without bacteriologic proof of infection.

  22. Empiric antibiotic therapy is often also logically used for more severely ill patients while awaiting bacterial culture results. Adachi JA, Zeichner LO, DuPont HL, Ericsson CD: Empirical antimicrobial therapy for traveler's diarrhea. Clin Infect Dis 31:1079, 2000.

  23. Ciprofluxacine 500 mg Q12h ( 3 days) Or Azythromycin1000 mg single dose

  24. Experts also advise against empiric treatment of salmonellosis unless enteric fever is present. Sirinavin S, Garner P: Antibiotics for treating salmonella gut infections. Cochrane Database Syst Rev 30:CD001167, 2000.

  25. Nonspecific antidiarrheal agents can reduce stool frequency and stool weight and can reduce coexisting symptoms, such as abdominal cramps

  26. Opiates, such as loperamide, or diphenoxylate with atropine frequently are employed. Schiller LR: Review article: Anti-diarrhoeal pharmacology and therapeutics. Aliment Pharmacol Ther 9:87, 1995.

  27. Intraluminal agents, such as bismuth subsalicylate and adsorbents (e.g., kaolin) also may help reduce the fluidity of bowel movements. Schiller LR: Review article: Anti-diarrhoeal pharmacology and therapeutics. Aliment Pharmacol Ther 9:87, 1995.

  28. Empiric Therapy of Chronic Diarrhea is used in three situations: Initial treatment before diagnostic testing; After diagnostic testing has failed to confirm a diagnosis When a diagnosis has been made but no specific treatment is available or specific treatment has failed to produce a cure.

  29. Generally, empiric antibiotic therapy is less useful in chronic diarrhea than in acute diarrhea.

  30. In chronic diarrhea anempiric course of metronidazole or a fluoroquinolone before extensive diagnostic testing, is not recommended.

  31. Remember that diarrhea can be a prominent symptom of malaria.

  32. Other drugs

  33. VERAPAMIL • NIFEDIPENE REDUCE MOTILITY INCREASE ABSORBTION

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