Antimotility agents

Antimotility agents should be expected to reduce stool frequency and control diarrhea. 

Rifaximin is likely to be effective in the treatment of milder forms of shigellosis and has been shown to be effective at preventing infection owing to S. flexneri.10 Antimotility agents are not recommended because they can worsen dysentery and may be related to the development of toxic megacolon. No vaccines are licensed currently for the prevention of shigellosis. 

Salmonella gastroenteritis is usually self-limited, and antibiotics have no proven value. Patients respond well to ORT. Symptoms typically diminish in 3 to 7 days without sequelae. Antibiotic use may result in a higher rate of chronic carriage and relapse. Antimicrobial use should be limited to preemptive therapy among patients at higher risk for extraintestinal spread or invasive disease (Table 73-3). Antimotility agents should not be used. 

The only current treatment of EHEC infection is supportive, including fluid and electrolyte replacement, often in the form of ORT. Most illnesses resolve in 5 to 7 days. Patients should be monitored for the development of HUS. Antibiotics are currently contraindicated because they can induce the expression and release of toxin. Antimotility agents should be avoided because they may delay clearance of the pathogen and toxin. This, in turn, may increase the risk of systemic complications. 

Although antimotility agents are effective at shortening the duration of illness, they do not eradicate microorganisms and should not be used in moderate to severe cases with systemic symptoms unless in combination with an antibiotic. The combination of an antimotility agent and an antibiotic can reduce the duration of illness to a few hours.28... 

All opiate derivatives are associated with constipation, but the degree of intestinal inhibitory effects seems to differ between agents. Orally administered opiates appear to have greater inhibitory effect than parenterally administered agents oral codeine is well known as a potent antimotility agent. 

Antimotility agents such as diphenoxylate are not recommended because they can worsen dysentery. 

Increased motility of the gastrointestinal tract and decreased absorption of fluid are major factors in diarrhea. Antidiarrheal drugs include antimotility agents, adsorbents, and drugs that modify fluid and electrolyte transport (Figure 24.8). 

Q5 Different treatments can be prescribed depending on the type or cause of diarrhoea. These include oral rehydration, absorbents, antimotility agents such as opioids or intestinal flora modifiers. In all cases maintaining fluid intake helps to improve symptoms. 

The most useful antimotility agent for adults is loperamide because it has specific effects on the gastrointestinal (GI) tract. It is not recommended for children as it decreases the clearance of the pathological organism from the... 

The role of anion exchange resins (colestyramine and colestipol), which bind C. difficile toxin, is still controversial (172). If ion exchange resins are given at all, they should not be given together with vancomycin, because they also bind the antibiotic (173). Attempts to restore the intestinal flora with Lactobacillus GG (174), or with fecal enemas (175) from healthy volunteers have shown some favorable results in less severe cases. However, esthetic and infectious concerns may be an obstacle. It also has been suggested that treatment with Saccharomyces bou-lardii may help prevent the development of antibiotic-associated diarrhea (176). Its value in the prevention and treatment of relapses has still to be demonstrated. Antimotility agents have been associated with an increased incidence of antibiotic-related diarrhea and can worsen symptoms when the disease is already estab-hshed (177). They should therefore be avoided. 

Loperamide should not be used in patients with fever or dysentery because antimotility agents are contraindicated in... 

Antimotility agents such as diphenoxylate are not recommended because they can worsen bacillary dysentery and could be involved in the development of toxic dilatation of the colon. Oral vaccines currently in development contain attenuated strains of Shigella and provide protection against shigellosis in human challenges. ... 

Diarrhea can be severe and life threatening treat aggressively with antimotility agents leucovorin can worsen 5-FU diarrhea special caution in elderly females Deficiency of dihydropyrimidine dehydrogenase (DPD) correlates with increased toxicity DPD required to metabolize 5-FU Drug interaction with warfarin increased anticoagulant effect monitor closely... 

Acute diarrhea is best treated or prevented with atropine delayed diarrhea managed with antimotility agents (loperamide 4 mg at first sign of diarrhea then 2 mg every 2 hours until no diarrhea for 12 hours) octreotide is not usually effective ensure that patients have a supply of antimotility agents to take with the first symptoms of diarrhea ensure fluid and electrolyte replacement in patients with severe diarrhea... 

It is important to indicate that most forms of diarrhea are treated in the clinic with antimotility agents and antibiotics. A number of opioid... 

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