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PubMed2001

In vitro effects of wood creosote on enterotoxin-induced secretion measured electrophysiologically in the rat jejunum and colon.

Secretory diarrhea occurs when the balance between intestinal absorption and secretion is disturbed by excessive secretion caused by enterotoxins produced by the pathogen. Wood creosote has long been used as a traditional antidiarrheal remedy. The goal of our study was to extend our knowledge about the antisecretory action of wood creosote against Escherichia coli enterotoxin-induced secretion in the small intestine and colon. Experiments were performed in mucosal sheets of rat jejunum and colon which were stripped of the external muscle layers to eliminate interactions with smooth muscle activity and local blood flow. Mucosal sheets were placed in modified Ussing chambers and hypersecretory conditions were induced by heat-labile (LT) or heat-stable (STa) E. coli enterotoxins added cumulatively (0.01-10 microg/ml) to the mucosal bathing solution. Intestinal secretion was monitored electrophysiologically as transmucosal short circuit current (Isc). LT induced a concentration-dependent increase in Isc in the rat jejunum, with no effect in the colon. In contrast, STa induced a significant increase in colonic Isc, without causing any change in Isc across the jejunum. In separate experiments the effects of increasing concentrations of wood creosote (0.1-50 microg/ml), added to the mucosal or serosal bathing solution, were examined against the secretory responses induced by LT or STa. In the small intestine the antisecretory activity of wood creosote against LT-induced secretion was more potent following serosal application, whereas in the colon wood creosote inhibited STa-induced secretion with equal potency following either serosal or mucosal addition. In summary, our findings demonstrate that wood creosote possesses antidiarrheal activity suppressing E. coli enterotoxin-induced secretion in both the small intestine and colon.

Animals↗
PubMed1998

[Effects of an antidiarrhoeica containing an extract from geranium herb on astringent action and short-circuit current across jejunal mucosa].

A consists of berberine chloride and an extract from geranium herb. To clarify mechanisms of the antidiarrheal effect of Phelloberin-A, we investigated the astringent action by determining its binding activity to rabbit hemoglobin and effects on active transport, which was indicated by short-circuit current (Isc), in rat jejunum by the Ussing chamber technique. The effects of berberine chloride and geranium herb on both the binding activity to hemoglobin and the electrophysiological parameters such as Isc were compared with those of the antidiarrhoeicas, tannic acid, albumin tannate and bismuth subnitrate. Geranium herb, tannic acid and bismuth subnitrate increased significantly the binding activity to hemoglobin at concentrations of > 1 mg/ml, > 0.3 mg/ml and 10 mg/ml, respectively, but berberine or albumin tannate did not. Geranium herb and tannic acid dose-dependently and moderately increased Isc in rat jejunal mucosa and the increase became significant at a concentration of 10 mg/ml. Neither berberine chloride, albumin tannate nor bismuth subnitrate affected Isc. In contrast, cholera toxin, which increases the secretion from intestinal mucosa to the lumen and induces diarrhea, decreased Isc at a concentration of 0.1 mg/ml. The decrease of Isc induced by cholera toxin was antagonized by pretreatment with geranium herb (10 mg/ml), indicating that geranium herb inhibited the toxin-induced increase in secretion. These results suggest that geranium herb possesses an astringent action and moderately increases Isc across the intestinal mucosa. Therefore, the effects may support an antidiarrheal effect of both geranium herb and Phelloberin-A.

Animals↗
PubMed2004

Differences in rates of diarrhea in patients with human immunodeficiency virus receiving lopinavir-ritonavir or nelfinavir.

STUDY OBJECTIVE: To determine and compare rates of diarrhea in patients receiving an antiretroviral regimen containing lopinavir-ritonavir versus nelfinavir and in patients who received these drugs sequentially. DESIGN: Retrospective cohort analysis. SETTING: Hospital-based human immunodeficiency virus (HIV) clinic. PATIENTS: Four hundred one participants in the HIV Atlanta VA Cohort Study who were prescribed lopinavir-ritonavir or nelfinavir from 1996-2002. MEASUREMENTS AND MAIN RESULTS: Chart review identified episodes of diarrhea that potentially were associated with an antiretroviral agent. Data collected included antidiarrheal agents dispensed, baseline viral load and CD4+ cell counts, demographic variables, and previous therapy Diarrhea associated with an antiretroviral regimen occurred in 175 (49%) of 354 patients receiving nelfinavir and 17 (17%) of 99 patients receiving lopinavir-ritonavir (p < 0.001). Treatment for the diarrhea occurred in 118 (33%) of 354 patients receiving nelfinavir and 9 (9%) of 99 receiving lopinavir-ritonavir (p < 0.001). Patients in the lopinavir-ritonavir group were more likely to have received highly active antiretroviral therapy and azithromycin than patients receiving nelfinavir, and they had lower baseline CD4+ cell counts (p < or = 0.01 for each comparison). The average number of months/person-year of diarrhea treatment was 2.0 for the nelfinavir group and 0.13 for the lopinavir-ritonavir group. Of the 10 antiretroviral-naive patients who received lopinavir-ritonavir, none needed treatment for diarrhea, whereas 78 (36%) of 217 antiretroviral-naive patients who received nelfinavir required treatment for diarrhea. Of the 52 patients who had been taking nelfinavir and were switched to lopinavir-ritonavir, they were more likely to start antidiarrheal treatment while taking nelfinavir (14 [27%]) than while receiving lopinavir-ritonavir (3 [6%]) (p = 0.004). CONCLUSIONS: Patients receiving lopinavir-ritonavir were significantly less likely to have diarrhea or to require treatment for diarrhea than patients receiving nelfinavir. The same results occurred when the drugs were given to the same patients sequentially (nelfinavir followed by lopinavir-ritonavir). The diarrhea associated with lopinavir-ritonavir was less frequent, less severe, and shorter in duration than diarrhea associated with nelfinavir.

Adult↗
PubMed1981

Pharmacodynamics of subcutaneously administered diacetylmorphine, 6-acetylmorphine and morphine in mice.

Diacetylmorphine (DAM) and 6-acetylmorphine (AM) exhibit virtually identical dose-response and time-action profiles in studies in antinociceptive, excitatory, antidiarrheal and antidiuretic activity after subcutaneous administration to mice. In antinociceptive (Haffner tail clip, phenylquinone writhing and hot plate) and excitatory (Straub tail) tests, both drugs are 3 to 10 times more potent than morphine (M) and reach their peak effect more rapidly than M. Analysis of these data by graded and quantal methods establishes the comparability of the results obtained, while confirming the greater efficiency of the graded method. The durations of action of DAM and AM are shorter than that of M, yielding significant differences in potency estimates based upon peak vs. total effect. DAM and AM are only twice as potent as M in the suppression of prostaglandin E2-induced diarrhea and in antidiuretic activity. These pharmacodynamic studies, along with prior dispositional studies, suggest that the ability of DAM and AM to rapidly cross the blood-brain barrier determines their potency and time-action differences from M in centrally mediated bioassays. In contrast, DAM and AM are only slightly more potent than M in th antidiarrheal and antidiuretic test. These studies support the concept that the pharmacological effects of DAM are mediated principally by metabolically formed AM.

Analgesics↗
PubMed1995

A pharmacological approach to secretory diarrhea.

Secretory diarrhea is characterized by painless, large volume, watery diarrhea (usually > 1 L), minimal effect on fasting, and a stool osmolality gap of less than 40. There are numerous causes of secretory diarrhea, including secretagogues, laxatives, medications, endogenous detergents, and bacterial enterotoxins. There are no controlled data on the efficacy of any specific therapy. Conservative measures, including fluid and electrolyte replacement, should be provided for all patients, and antidiarrheal therapy is indicated in more severe cases. No specific pharmacological therapy has proved effective in most cases, and antidiarrheal therapy is relatively nonspecific.

Adrenergic alpha-Agonists↗
PubMed1997

Collagenous colitis: histopathology and clinical course.

OBJECTIVES: Collagenous colitis is a chronic diarrheal disease characterized by a normal or near-normal mucosa endoscopically and microscopic inflammation in the lamina propria, surface epithelial injury and a thick subepithelial collagen layer. The symptoms of collagenous colitis vary in duration and intensity, and long periods of remission have been described, but long-term follow-up data are limited. Our goal was to determine the natural clinical history of collagenous colitis and to determine whether there was a relationship between histopathologic changes and course of disease. METHODS: Cases were identified at the University of Michigan Hospitals using surgical pathology records before 1992. All charts, including medical records from other hospitals, were reviewed, and a telephone interview was conducted with each locatable patient (pt). Biopsy specimens were reviewed by two pathologists for degree of collagen layer thickness, epithelial damage, and inflammation. RESULTS: There were 31 patients (26 F, 5 M) with a mean age of 66 yr (range 33-83) and a mean duration of symptoms of 5.4 yr at the time of diagnosis. Of the 31 patients, 18 (56%) had some form of arthritis, and 22 (71%) were using NSAIDS regularly at the time of diagnosis. Follow-up interviews were conducted at least 2 yr after diagnosis (mean 3.5 yr, range 2-5 yr) with 27 of 31 patients (3 could not be located, 1 died). Two definable groups of patients were identified: (1) those with either spontaneous or treatment-related symptom resolution (63%), and (2) those with ongoing or intermittent symptoms requiring at least intermittent therapy (37%). There was no significant difference between the two groups with regard to sex, age, associated diseases, and use of medications. Patients with symptom resolution (mean duration 3.1 yr) had been treated with antidiarrheals (6), sulfasalazine (3), discontinuation of NSAIDS (3), reversal of jejunoilial bypass (1), or nothing (4). Those with ongoing symptoms experienced a wide range of symptom severity. Two required only antidiarrheals, but five required or failed steroids, azathioprine, or sandostatin. There was no significant difference in collagen thickness, epithelial damage, and inflammation between the two groups, but Paneth cell metaplasia was seen more often in those with ongoing symptoms. In 24 of 27 patients, diagnostic changes were present in left-sided biopsies. CONCLUSIONS: In our cohort of patients, 63% had lasting resolution of symptoms after a mean 3.5 yr follow-up. There was a high incidence of arthritis and NSAID use in our population, but there was no relationship between these entities and clinical course or histology. Initial histology, except possibly for Paneth cell metaplasia, did not reliably predict severity or course of disease. Finally, although variable in clinical presentation, treatment-free remissions are common in collagenous colitis.

Adult↗
PubMed1975

Effect of loperamide, haloperidol and methadone in rats trained to discriminate morphine from saline.

In an operant procedure of lever pressing at FR10 schedule of food reinforcement, rats were trained to respond differentially in order to discriminate the effects of morphine (10 mg/kg) injections from those of saline injection. These rats learned to press a lever on one side after morphine injection and a lever on the opposite side after saline injection. In subsequent testing, these rats reliably emitted responses on the morphine lever after 10 or 20 mg/kg of morphine IP, 50 mg/kg of morphine given orally or 2 mg/kg methadone. Two mg/kg of morphine (or 10 or 20 mg/kg given orall) was recognized as saline. In contrast, after either loperamide (an antidiarrheal drug) given in doses up to 10 mg/kg or haloperidol (a neuroleptic) given in doses up to 0.32 mg/kg, all responses were made on the saline lever. Higher doses suppressed responding. Since neither the antidiarrheal activity nor the neuroleptic activity was sufficient to provide the discriminable cue associated with morphine, it is suggested that specific central effects produced only by narcotic analgesics are the basis for these morphine cues.

Animals↗
PubMed1996

Biofeedback therapy for excessive stool frequency and incontinence following anterior resection or total colectomy.

PURPOSE: Excessive stool frequency and incontinence after anterior resection (AR) or total colectomy (TC) can be refractory to expectancy and antidiarrheal agents. We prospectively assessed efficacy of anorectal biofeedback therapy (BF) in this clinical situation. METHODS: Thirteen patients (10 men and 3 women; mean age, 62.1 (standard error of the mean (SEM), 4.6) years) had more than six bowel movements per day and/or episodes of incontinence, which did not abate after antidiarrheal agents were given for at least six (mean, 27.9 (SEM, 6.3)) months after surgery. All underwent four sessions of outpatient BF. Assessment was by continence questionnaire and anorectal physiology tests, which were administered before and after BF. RESULTS: In seven AR patients, daily stool frequency was decreased (8.7 (SEM, 2.1) before and 4.6 (SEM, 1.2) after, P < 0.05), and daily incontinence episodes were reduced (2.7 (SEM, 0.9) before and 0.4 (SEM, 0.2) after, P < 0.05) after BF. Six TC patients also had decreased daily stool frequency (6.2 (SEM, 2.1) before, 3.3 (SEM, 1.6) after; P < 0.05) and incontinence episodes (2.4 (SEM, 0.9) before, 0.5 (SEM, 1) after; P < 0.05) after BF. There were no significant changes in anorectal physiology parameters after BF. At a mean follow-up of 10.6 (SEM, 2.5) months after BF, there were no regressions or complications. CONCLUSIONS: BF is a safe and effective option for refractory excessive stool frequency and/or incontinence following AR or TC.

Biofeedback, Psychology↗
PubMed2001

Long-term follow-up of patients undergoing colectomy for colonic inertia.

PURPOSE: Total abdominal colectomy with ileorectal anastomosis has been the procedure of choice for patients with the established diagnosis of colonic inertia. Previous studies with a limited follow-up of only one to two years have shown acceptable results and a high rate of patient satisfaction. The aim of this study was to evaluate the long-term results of total abdominal colectomy in these patients in terms of complications, bowel function, and overall patient satisfaction. METHODS: Access to the colorectal registry at the Cleveland Clinic Florida identified all patients who underwent total abdominal colectomy for colonic inertia between 1988 and 1993, with a minimum of five-year follow-up. Telephone interviews were designed to assess bowel function, concomitant use of any antidiarrheal medications, postoperative complications, persistence or development of preoperative symptoms such as pain or bloating, and overall satisfaction. Patients were asked to rate their outcome as excellent, good, fair, or poor. RESULTS: Fifty patients underwent total abdominal colectomy for the diagnosis of colonic inertia. Three patients died of unrelated causes and 30 (60 percent) were available for follow-up. The mean follow-up was 106 months, ranging from 61 to 122 months. All 30 patients reported the outcome of surgery as "excellent." The average frequency of spontaneous bowel movements was 2.5 (range, 1-6) per day. During the period of follow-up, six patients (20 percent) required admission for small-bowel obstruction, three of whom (10 percent) required laparotomy. Four patients complained of mild pelvic pain, only one of whom had the onset of pelvic pain postoperatively that persisted until the time of interview. In the other three patients the pain was present preoperatively but had decreased in intensity since the operation. Two patients (6 percent) still required assistance with bowel movements, one by laxatives and the other by enemas. Only two patients (6 percent) needed antidiarrheal medications to reduce bowel frequency. CONCLUSION: This long-term follow-up revealed a high degree of patient satisfaction and very good bowel habits, with an acceptable long-term rate of bowel obstruction. Based on these results, total abdominal colectomy can be recommended to patients with well-established colonic inertia with expectations of sustained benefit up to ten years after surgery.

Colectomy↗
PubMed2005

Chronic Diarrhea.

Chronic diarrhea can be due to any of several hundred conditions. When investigation fails to uncover a specific cause that can be treated successfully, nonspecific therapy is implemented. This includes dietary alterations if specific aggravating foods can be identified, enteral or parenteral nutrition if nutritional status is compromised, and use of oral rehydration solutions if diarrhea produces volume depletion. Strategic use of dietary fiber can improve stool consistency and can be of special value when fecal incontinence is present concurrently. Medications of value include opiate antidiarrheal drugs, clonidine, octreotide, and bile acid-binding agents. Less potent opiates such as loperamide and diphenoxylate should be tried first, with more potent agents such as codeine, opium, and morphine used in refractory cases. Clonidine has both proabsorptive and motility effects that facilitate its antidiarrheal effect, but its antihypertensive action limits its utility. Octreotide is of great value in treating diarrhea due to endocrine tumors and dumping syndrome; its efficacy in other conditions or in nonspecific diarrhea is less well established. Bile acid binders such as cholestyramine or colestipol have several specific uses but have limited utility in nonspecific chronic diarrhea.

Journal Article↗
PubMed1990

Safety and efficacy of loperamide.

Loperamide is a safe and effective antidiarrheal for the treatment of acute diarrhea. Efficacy data suggest that loperamide is more effective than the prescription drug diphenoxylate and an over-the-counter bismuth subsalicylate preparation. Loperamide is a safe drug, with few adverse reactions reported worldwide. It also lacks significant abuse potential. Loperamide may prove to be the antidiarrheal agent of choice when compared with currently available nonprescription treatments for acute diarrhea.

Acute Disease↗
PubMed1987

Influence of loperamide on the internal anal sphincter in the opossum.

The objective of this study was to examine the influence of the commonly used antidiarrheal agent loperamide on the internal anal sphincter of anesthetized opossums. Loperamide caused a rise in internal anal sphincter pressures, and a decrease in the rectal distention-induced internal anal sphincter relaxation. To define the mechanism of decrease in the rectal distention response of the internal anal sphincter, we examined the effects of sacral efferent nerve stimulation, local intramural stimulation, and ganglionic stimulant (which acts at the postganglionic inhibitory neuron). Loperamide caused a significant decrease in the internal anal sphincter relaxation caused by sacral nerve stimulation, but not in that caused by local intramural stimulation and nicotine. These effects of loperamide on the internal anal sphincter were antagonized by naloxone. These findings suggest that the therapeutic effects of loperamide on the internal anal sphincter as an antidiarrheal agent are due to a rise in the tone of the sphincter and the inhibition of its relaxation in response to rectal distention. Both of these actions are mediated by activation of opioid receptors. The inhibition of internal anal sphincter relaxation induced by rectal distention (which mimicks recto-anal reflex) is due to inhibition of release of neurotransmitter from the preganglionic sacral nerve fibers.

Anal Canal↗
PubMed1981

Prophylaxis against prostaglandin-induced gastrointestinal side effects.

Prostaglandin F2 alpha was administered intravenous drip in 130 patients with missed, incomplete inevitable and septic abortion, intrauterine death and vesicular mole and for therapeutic termination of midtrimester pregnancies. In 84 patients (control group), no prophylactic antiemetic or antidiarrheal drugs were administered, while in 46 patients (study group), an antiemetic (prochlorperazine) and an antidiarrheal (diphenoxylate hydrochloride with atropine sulfate) drug were administered prophylactically before and during prostaglandin infusion. The incidence in vomiting and diarrhea was statistically much less in the study group (P less than 0.0005 for vomiting and P less than 0.005 for diarrhea). There was no statistically significant difference in the success rate of prostaglandin induction in the two groups.

Abortion, Induced↗
PubMed1988

Regulation of gastrointestinal function by multiple opioid receptors.

Agonist and antagonist drugs possessing selectivity for individual types of opioid receptors have been employed in vitro and in vivo to determine the mechanisms by which opioids regulate gastrointestinal functions. Selective mu opioid agonists given by intracerebroventricular (i.c.v.) injection, by intrathecal (i.t.) injection, or by peripheral (s.c. or i.v.) injection in rats or mice decreased gastrointestinal transit and motility, inhibited gastric secretion, and suppressed experimentally-induced diarrhea. Selective delta agonists, by contrast, inhibited gastrointestinal transit after i.t., but not after i.c.v. or s.c. administration. Delta agonists also did not alter gastric secretion after i.c.v. or s.c. injection. However, delta agonists exhibited antidiarrheal effects after i.c.v., i.t., or s.c. administration. Kappa agonists given i.c.v. had no effect on gastrointestinal transit in rats or mice or on gastric secretion in rats, but exhibited antidiarrheal effects in mice. The kappa agonist U-50, 488H given peripherally increased gastric acid secretion. Different types of opioid receptors in different anatomical sites influence differently gastrointestinal motility and propulsion, gastric secretion, and mucosal transport. Brain, spinal cord, enteric neural and smooth muscle opioid receptors represent chemosensitive sites for regulation of gastrointestinal function.

Animals↗
PubMed1995

Treatment of childhood diarrhea in rural Egypt.

The Egypt National Control of Diarrheal Diseases Project, implemented between 1983 and 1991, is widely regarded as one of the most successful national oral rehydration programs. Data from a longitudinal household survey conducted in 1990-91 in rural Egypt indicate substantial increases in both knowledge and use of oral rehydration salts during the 1980s. However, the same data show that treatment of acute diarrheal episodes is still far from optimal. In particular, the use of oral rehydration during diarrheal episodes is far from universal, the prescription of antibiotics is still too frequent, and antidiarrheal drugs of no therapeutic value are still widely used. Analysis of the factors associated with different treatment patterns shows that children with severe diarrhea, those aged 6-23 months and those from poor households were more likely to be given ORS; boys were somewhat less likely to receive ORS than girls, but mother's education showed no consistent effects. The type of treatment received is strongly influenced by the source of care. Government clinics are more likely than private physicians or pharmacies to prescribe ORS, whereas children taken to the latter two sources of care are more likely to be given antibiotics and antidiarrheals. To improve diarrhea treatment patterns in Egypt, not only must the public service educational campaign be reinstated and strengthened, but training programs must also be targeted at the treatment practices of private physicians.

Child Health Services↗
PubMed2004

[Treatment of acute diarrhea: prescription patterns by private practice pediatricians].

UNLABELLED: Acute gastroenteritis remains a frequent illness in infants and children with still important morbidity and mortality rates. Oral rehydratation solutions (ORS) and early refeeding are the main recommendations. Indication of drugs remains limited. OBJECTIVE: To evaluate the management of acute diarrhea by private practice pediatricians of France. METHODS: A questionnaire concerning ORS, dietary formula, antidiarrheal diet, antibiotherapy, antidiarrheal drugs was sent to all 2907 private pediatricians of France. RESULTS: Six hundred twenty-nine questionnaires were analyzed (22%). Three hundred and ninety-seven pediatricians (63%) prescribed systematically an ORS, 294 (47%) changed formula, 412 (66%) prescribed a regimen. Antibiotic was prescribed after coproculture (81%), when glairy and bloody diarrhea (65%), associated infectious disease (63%), toxi-infectious syndrome (42%) or immunodeficiency were present (28%). Most pediatricians (97%) prescribed at least one drug: diosmectite (84%), Lactobacillus acidophilus (63%), Saccharomyces boulardii (62%), racecadotril (62%), loperamide (28%), attapulgite de Mormoiron (26%), nifuroxazide (20%). Drugs were prescribed more often for their effectiveness than for comfort. CONCLUSION: This study demonstrates the discrepancies that remain between recommendations and practical care in the treatment of acute diarrhea in children. Private French pediatricians often prescribe drugs.

Acute Disease↗
PubMed2004

Synthesis and electrophysiological characterization of cyclic morphiceptin analogues.

A challenge in opioid peptide chemistry and pharmacology is the possibility to develop novel peptides with peripheral selectivity. An enzymatically stable opioid peptide could involve an antidiarrheal effect. For this reason, we constrained the highly selective and potent tetrapeptide morphiceptin with a 6-atom bridge, resulting in a cyclic amide and an ester analogue, 2 and 3, respectively. Taking advantage of the functional coupling of the opioid receptor with the heteromultimeric G-protein-coupled inwardly rectifying K+ (GIRK1/GIRK2) channel, either the wild-type mu-, kappa-, delta- or a mutated mu-opioid receptor (hMORS329A) was functionally co-expressed with GIRK1/GIRK2 channels and a regulator of G-protein signaling (RGS4) in Xenopus laevis oocytes. The two-microelectrode voltage clamp technique was used to measure the opioid receptor activated GIRK1/GIRK2 channel responses. Both cyclic analogues were equally potent via the wild-type mu-opioid receptor hMORwt (EC(50) value 976.5 +/- 41.7 for 2 and 1017.7 +/- 60.7 for 3), while the EC(50) value for Tyr-Pro-Phe-D-Pro-NH(2) measured 59.3 +/- 4.8 nM. These three agonists displayed a four to five times decreased potency via hMORS329A as compared to the wild type. Interestingly, no effect on kappa- and delta-opioid receptors was observed. The intramolecular bridge created by cyclization of morphiceptin prevents dipeptidyl peptidase IV from interacting with these analogues. We conclude that constraining morphiceptin with a 6-atom bridge resulted in enzymatically stable peptidomimetics that are exclusively active on mu-opioid receptors. These analogues provide an interesting template in the promising approach for the design of potential antidiarrheal agents.

Animals↗
PubMed1991

Therapy for acute infectious diarrhea in children.

This article reviews current recommendations of therapy with antidiarrheal compounds and antimicrobial agents for acute infectious diarrhea in children. In most infants and children with acute infectious diarrhea, treatment with antidiarrheal compounds is not indicated. Many of these compounds interfere with identification of enteropathogens in stool specimens, and the antimotility class has an overdose potential. Antimicrobial therapy is given to reduce symptoms and to prevent the spread of infection by decreasing fecal shedding of organisms. Although effective therapy is not available for patients with enteric viruses, Cryptosporidium, and Microsporidium, therapy is useful for children with amebiasis, antimicrobial-associated colitis, cholera, giardiasis, various forms of Escherichia coli diarrhea and Salmonella disease, isosporiasis, shigellosis, and strongyloidiasis. For several other conditions, antimicrobial therapy is of questionable benefit (infection with Campylobacter jejuni or Yersinia enterocolitica, intestinal salmonellosis and enterohemorrhagic E. coli infection). Compounds such as the fluoroquinolones, which are effective in the treatment of acute infectious diarrhea in adults, are not approved for use in children because of potential side effects. Many bacterial, viral, and parasitic organisms cause acute infectious diarrhea; appropriate antimicrobial therapy requires the accurate, rapid identification of the offending enteropathogen. In children with an underlying illness such as acquired immunodeficiency syndrome, manifestations may be prolonged, severe, and recurrent despite appropriate therapy.

Acute Disease↗