Diarrhea therapy

Vinci M, Gatto A, Giaglio A, Raciti T, D Avola G, Di Stefano B, Salanitri G, Di Stefano F Double-blind clinical trial on infectious diarrhea therapy Rifaximin versus placebo. Curr TherRes Clin Exp 1984 36 92-99. 

Diagnosis and alleviation of the cause, if possible, is of primary importance. Often, however, this is not possible and therapy is used to alleviate the inconvenience and pain of diarrhea. These compounds usually only mask the underlying factors producing the problem. Diarrhea may cause significant dehydration and loss of electrolytes and is a particularly serious problem in infants. Antidiarrheals do not usually prevent the loss of fluids and electrolytes into the large bowel and, although these may prevent frequent defecation, often the serious imbalance of body electrolytes and fluids is not significantly affected. 

Adverse side effects of gold treatments include stomatitis, rash, and proteinuria. Complete blood counts and urinalysis should be performed before each or every other injection of gold compounds. Pmritic skin rash and stomatitis are more common adverse effects that may resolve, if therapy is withheld for a few weeks and then restarted cautiously at a lower dose. Oral gold causes less mucocutaneous, bone marrow, and renal toxicity than injectable gold, but more diarrhea and other gastrointestinal reactions appear. 

Although immediate reactions of anaphylaxis, bronchospasm, and urticaria have been reported, most commonly patients exhibiting an adverse reaction develop a maculopapular rash, usually after several days of therapy. They may also develop fever and eosinophilia (80,219). Cefoperazone (34) and ceftriaxone (39), having greater biUary excretion than other cephalosporins, are associated with an increased risk of diarrhea, which may be caused by selection of cytotoxin producing stains of Clostridium difficile (219). 

As with all drugs, the specific side effects of the quinolones must be considered when they are chosen for treatment of bacterial infections [5]. Reactions of the gastrointestinal tract and the central neivous system are the most often observed adverse effects during therapy with quinolones. It should be underlined, however, that compared with many other antimicrobials, diarrhea is less frequently observed during quinolone treatment. Antibiotic-associated colitis has been observed rarely during quinolone therapy. Similarly, hypersensitivity reactions, as observed during therapy with penicillins and other (3-lactams, is less frequently caused by quinolones. Some other risks of quinolone therapy have been defined and must be considered if a drug from this class is chosen for treatment of bacterial infections. 

Other adverse reactions that may occur during therapy include nausea, vomiting, diarrhea, abdominal pain, chills, fever, and stomatitis (inflammation of the mouth). In some instances, these may be mild. Other times they may cause serious problems requiring discontinuation of the drug. Sulfasalazine may cause the urine and skin to be an orange-yellow color this is not abnormal. 

Therapy with cephalosporins may result in a bacterial or fungal superinfection. Diarrhea may be an indication of pseudomembranous colitis, which is one type of bacterial superinfection. See Chapter 7 for a discussion of bacterial and fungal superinfections and pseudomembranous colitis. 

An ongoing assessment is important in evaluating the patient s response to therapy, such as a decrease in temperature, the relief of symptoms caused by the infection (eg, pain or discomfort), an increase in appetite, and a change in the appearance or amount of drainage (when originally present). The nurse notifies the primany health care provider if symptoms of the infection appear to worsen. The nurse checks the patient s skin regularly for rash and is alert for any loose stools or diarrhea... 

Q Diarrhea related to superinfedion secondary to cephalosporin therapy... 

Monitoring and Managing Adverse Drug Reactions The nurse observes the patient at frequent intervals, especially during the first 48 hours of therapy. It is important to report to the primary health care provider the occurrence of any adverse reaction before the next dose of the drug is due The nurse should report serious adverse reactions, such as a severe hypersensitivity reaction, respiratory difficulty, severe diarrhea, or a decided drop in blood pressure, to the primary health care provider immediately because a serious adverse reaction may require emergency intervention. 

D Diarrhea related to superintedion secondary to antibiotic therapy, adverse drug reaction... 

MONITORING FOR DIARRHEA. Because superinfections and pseudomembranous colitis can occur during therapy widi tiiese dni, die nurse checks die patient s stools and reports any incidence of diarrhea immediately because tiiis may indicate a superinfection or pseudomembranous colitis. If diarrhea does occur and blood and mucus appear in the stool, the nurse should save a sample of die stool and test it for occult blood using a test such as Hemoccult. If die stool tests positive for blood, it is important to save die sample for possible additional laboratory tests. 

MANAGING DIARRHEA. Diarrhea may be a sign of a superinfection or pseudomembranous colitis, both of which are adverse reactions tiiat may be seen with the administration of any anti-infective. The nurse checks each stool and reports any changes in color or consistency. When vancomycin is given as part of the treatment for pseudomembranous colitis, it is important to record the color and consistency of each stool to determine the effectiveness of therapy. 

Administration may result in nausea, vomiting, diarrhea, rash, anemia, leukopenia, and thrombocytopenia Signs of renal impairment include elevated blood urea nitrogen (BUN) and serum creatinine levels. Periodic renal function tests are usually performed during therapy. 

Chloroquine Take this drug witii food or milk. Avoid foods diat acidify die urine (cranberries, plums, prunes, meats, cheeses, eggs, fish, and grains). This drug may cause diarrhea, loss of appetite, nausea, stomach pain, or vomiting. Notify die primary healtii care provider if these symptoms become pronounced. Chloroquine may cause a yellow or brownish discoloration to the urine this is normal and will go away when the drug therapy is discontinued. Notify the primary health care provider if any of the following occur ... 

The expected outcomes for the patient may include an optimal response to therapy, management of common adverse reactions, an absence of diarrhea, maintenance of an adequate intake of fluids, maintenance of adequate nutrition, an understanding of the therapeutic regimen (hospitalized patients), and an understanding of and compliance with the prescribed therapeutic regimen (outpatients). 

Most adverse effects of labetalol are mild and do not require discontinuation of therapy. Examples of the adverse reactions include fatigue, drowsiness, insomnia, weakness, hypotension, diarrhea, dyspnea, and skin rash. Adverse reactions of carvedilol include fatigue, hypotension, cardiac insufficiency, chest pain, bradycardia, dizziness, diarrhea, hypotension, and fatigue... 

Local irritation and headache may occur at tlie beginning of therapy. The patient is instructed to notify the primary health care provider if abdominal cramping, diarrhea, or excessive salivation occurs. 

The most common adverse reaction associated with phenobarbital is sedation, which can range from mild sleepiness or drowsiness to somnolence. These dru > may also cause nausea, vomiting, constipation, bradycardia, hypoventilation, skin rash, headache fever, and diarrhea Agitation, rather than sedation, may occur in some patients. Some of these adverse effects may be reduced or eliminated as therapy continues. Occasionally, a slight dosage reduction, without reducing the ability of the drug to control the seizures, will reduce or eliminate some of these adverse reactions. 

As with the barbiturates, the most common adverse reaction seen with the use of clonazepam (Klonopin), clorazepate (Tranxene), and diazepam (Valium) is sedation in varying degrees. Additional adverse effects may include anorexia, constipation, or diarrhea. Some adverse reactions are dose dependent, whereas others may diminish in intensity or cause few problems after several weeks of therapy. 

Abdominal pain, nausea, vomiting, anorexia, diarrhea, rash, drowsiness, dizziness, photosensitivity reactions, blurred vision, weakness, and headache may occur with the administration of nalidixic acid. Visual disturbances, when they occur, are noted after each dose and often disappear after a few days of therapy. 

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