Antimotility drugs

Consider quinolonc for suspected shigellosis in adults (fever, inflammation) macrolidc for suspected resistant Campylobacter avoid antimotility drugs, sulfonamides or quinolones if suspected EHEC (afebrile, bloody diarrhea). 

Most patients with enterocolitis require no therapeutic intervention. The most important part of therapy for Salmonella enterocolitis is fluid and electrolyte replacement. Antimotility drugs should be avoided because they increase the risk of mucosal invasion and complications. 

Erythromycin is considered the drug of choice for treatment. Clarithromycin or azithromycin is equally effective. Antimotility drugs are contraindicated. 

Loperamide is an antimotility drug indicated for diarrhoea. Side-effects of loperamide include skin reactions and abdominal cramps. 

Antimotility drugs are opioid drugs. They increase small bowel smooth muscle tone and segmentation activity. They also reduce propulsive movements and decrease intestinal secretions while increasing absorption. They mediate these actions through p receptors. 

Most cases can be adequately treated by assiduous attention to oral intake, but fluid and electrolyte depletion is especially dangerous in children and intravenous fluid replacement in hospital may be needed. Antimotility drugs are inappropriate for severe diarrhoea in young children any marginal effect they may have is liable to be covmterbalanced by hazardous adverse effects (see below). 

Warning. Antimotility drugs should not be used for acute diarrhoea in children, especially babies, or in patients with active inflammatory bowel disease, for there is danger of causing paralytic ileus and, in babies, respiratory depression. 

Acute watery diarrhoea in adults can usually be controlled by oral rehydration solutions and one of the antimotility drugs, although in mild cases the abdominal bloating produced by the latter may be less acceptable than the loose stools. While diarrhoea usually lasts only 2-3 days, this may stiU be socially inconvenient, and if s5rmptomatic remedies fail, an aminoquinolone, e.g. ciprofloxacin 500 mg b.d. will be effective. The use of antimicrobials for travellers diarrhoea continues to evoke controversy (see below) but most sufferers will appreciate the relief that even one or two tablets can bring. 

Diarrhoea can be treated with an antimotility drug such as loperamide, the dose being adjusted to symptoms. Codeine phosphate is effective although it may cause sedation. 

Symptomatic diverticular disease often responds to an increase in dietary fibre, and addition of a stool bulking agent. Antispasmodic drugs are helpful in controlling the pain of colon spasm but antimotility drugs encourage stasis of bowel contents, increase intracolonic pressure, and should be avoided. Diverticulitis requires treatment with broad spectrum antimicrobials for 7-10 days (e.g. 

Gastrointestinal system. Antacids that contain large quantities of sodium can precipitate fluid retention to cause ascites. Aluminium- and Ccilcium-based preparations cause constipation and may thereby precipitate hepatic encephalopathy, as can antimotility drugs. 

Laxatives and antimotility drugs may be used to control diarrhoea and constipation. 

Various drugs have been used to treat diarrhea (Table 23-4). These drugs are grouped into several categories antimotility, adsorbents, antisecretory compounds, antibiotics, enzymes, and intestinal microflora. Usually, these drugs are not curative but palliative. 

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). 

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... 

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