Treatment of diarrhoea

• Rehydratation: It is of utmost importance to get an adequate fluid and salt intake to avoid dehydration. This can be achieved by salt solutions, though tea, soup, soft drinks and fruit juices, supplemented with salt crackers, are more palatable. Commercial salt solution products are available on the market, though they can be made simply by adding 5 coffeespoonfuls of sugar and half a coffeespoonful of salt per litre of pure water. Intravenous rehydration will seldom be necessary, but can be lifesaving.

• Transit inhibitors: Administration of a "transit inhibitor" (e.g. loperamide) can greatly reduce the number of defaecations, which means a substantial alleviation of the symptoms. Loperamide (Imodium®) may be used only by adults and older children and only in ordinary non-bloody diarrhoea in a dosage of one capsule after each loose defaecation, with a maximum of 4 capsules per day.

• Aetiological treatment

• Antibiotics: Indicated if there is proof or suspicion of a bacterial cause (before the result of coproculture is known): (1) if there is blood, mucus or pus in the faeces or (2) if the diarrhoea has shown no sign of alleviation after 48 hours and is accompanied by high fever (above 38.5°C) or severe abdominal pain or if there are more than 6 defaecations per 24 hours and if defaecation occurs at night. As antibiotics ciprofloxicin and ofloxacin are used.

• Specific medication depending on aetiology (Giardia, Entamoeba histolytica, Cyclospora).

• Food: Easily digestible, preferably low-fibre food is indicated. A lactose-free diet is temporarily advised in cases of secondary lactase deficiency (e.g. giardiasis). No alcohol if nitro-imidazoles (e.g. tinidazole, metronidazole) are used.

Category: Medicine Notes