Pharmacotherapy of infectious diarrheas

1. Pharmacotherapy of infectious diarrheas PharmDr. Ondřej Zendulka, Ph.D.

2. Infectious diarrhea Epidemiology • diet or direct contact with pathogen Etiology • variety of pathogens – bacteria, viruses, parasites • ATB therapy induction • most common Salmonella sp., Campylobacter sp.

3. Infectious diarrhea Pathophysiology • dehydration, electrolyte and acidobasic imbalance • nausea and vomitus usually present • exudative diarrhea with inflammation, rarely secretory diarrhea (cholera) Symptoms • abdominal discomfort – loss of appetite, flatulence • number of stools from 1 to tens per day • sometimes only painful tenesmuses • fever

4. Infectious diarrhea Salmonella • most common is S. enteritidis • source: infected food • incubation period: 8-48h • symptoms: abdominal pain, fever, stool gets dark green colour • therapy: cotrimoxazol, quinolones, aminopenicillines http://www.youtube.com/watch?v=j5GvvQJVD_Y

5. Infectious diarrhea Campylobacter • 90% by C. jejuni • source: infected food or direct transfer • incubation period: 1-7 days • therapy: macrolides, (quinolones)

6. Infectious diarrhea Shigella • 95% by S. sonnei • source: infected food or direct transfer • incubation period: 1-3(7) days • symptoms: fever, abdominal pain prior defecation, vomiting • therapy: serious infections ATB (aminopen, cotrimoxazol, quinolones), rehydratation

7. Infectious diarrhea Viral diarrheas • pathogen: rota-, adeno-, astro-,kalci-, toroviruses • source: contaminated objects, direct contact • incubation period: 1-2 days • symptoms: mild infections, !children, elderls • therapy: symptomatic

8. Infectious diarrhea Parasitic diarrheas • rarely: Giardia lamblia, Ascaris lumbricoides • therapy: metroniadzole, mebendazole, albendazole

9. Infectious diarrhea ATB associated diarrheas • type of ATB and period of administration plays role • intestinal dysmicrobia • pseudomembraneous colitis • linkosamides, penicillines, cephalosporines, quinolones • therapy: metronidazole, vancomycin

10. Infectious diarrhea - therapy Rehydration • black tea, still mineral water (nonlaxative) • rehydration solution: 1L of water 8 spoons of sugar 1 spoon of salt juice from 2 oranges drink 250-500 ml/hour

11. Infectious diarrhea - therapy Diet • individual with regard to tolerance • lipid restriction • possible decrease in absorption of drugs (peroral contraception) • diet bisquits, potatoes, rice, bananas, apples

12. Infectious diarrhea - therapy Eubiotics • increase of intestinal enzyme activity • intreference with pathogen microflora • immunomodulants • probiotics – Lactobacillus, Bifidobacterias, Sacharomycetes • prebiotics – oligo- and polysacharides

13. Infectious diarrhea - therapy rifaximin (NORMIX) • inhibits DNA dependent RNA polymerase • wide spectrum • absorption from GIT 1% • flatulence, abdominal pain, loss of weight • prophylaxis prior to surgery on intestine

14. Infectious diarrhea - therapy nifuroxazid (Endiex, Ercefuryl) • interferes with synthesis of NA and bacterial metabolism • not active against: Proteus, Pseudomonas, Enterobacter • not absorbed from GIT • flatulence, abdominal pain, loss of weight • prophylaxis prior to surgery on intestine

15. Infectious diarrhea - therapy chloroxine (Endiaron) • significant bacteriostatic, fungistatic and antiprotozoal properties • does not induce resistance • does not influence natural intestinal flora • not for children less than 40kg

16. Infectious diarrhea - therapy Antimotility agents loperamide (Imodium, Loperon) • opioid receptor agonist • no influence on microflora • high afinity to intestine, low bioavalability, high first pass effect • urticaria, rush, constipation + diosmectite (Imodium plus) - natural silicate, intestinal absorbent

17. Infectious diarrhea - therapy Antimotility agents diphenoxylate (Reasec) • pethidin similar + atropin in subtherapeutic dose Intestinal absorbents • diosmectite (Smecta) • activated charcoal (Carbocit, Carbosorb) - 1-2 tablespoons, 3-4x day