Lecture presentation for BSc Nursing 1st year 2020

1. Drugs used in Diarrhoea
Dr. Pravin Prasad
MBBS, MD Clinical Pharmacology
Assistant Professor, Department of Clinical
Pharmacology
Maharajgunj Medical Campus, Kathmandu
25 June 2020 (11 Asar 2077), Thursday

2. By the end of this discussion, BSN 1st
year students will be able to:
 List the mechanisms of diarrhoea
 List the therapeutic options for the management of
diarrhoea
 Explain the basis of use of oral rehydration salts in
management of diarrhoea
 Explain the role of antibiotics in diarrhoea
 List other drugs used in the management of diarrhoea

3. Diarrhoea
 3 or more loose or watery stools in a 24 hour period
 Occurs due to:
Decreased electrolyte and water absorption
Increased secretion by intestinal mucosa
Increased luminal osmotic load
Inflammation of mucosa and exudation into lumen

4. Absorption Mechanism of Water and
Electrolytes in Intestines
• Different segments absorb electrolytes and water by
different mechanisms
• Can be absorbed primarily
• Na+ absorption in ileum using Na+-K+ ATPase
• Can be absorbed secondarily
• Na+ absorption secondary to absorption of
nutrients (glucose) in multiple segments
• Water mainly follows iso-osmotically
• Non-absorbable solutes in lumen increases water
content of stool

5. Management: Principles
 Treatment of fluid depletion, shock and acidosis
Oral Rehydration Solution; Intravenous Fluids
Zinc
 Maintenance of Nutrition
 Drug Therapy
Specific antimicrobial drugs
Probiotics
Drugs of Inflammatory Bowel Disease
Nonspecific anti-diarrhoeal drugs

6. Treating fluid depletion, shock and
acidosis
 Oral Rehydration:
Mild (5-7%) or Moderate (5-7.5%) fluid loss
Based on integrity of “glucose coupled Na+
absorption”
Composition:
o Isotonic/hypotonic to the fluid lost
o Ratio of glucose and Na+
o Amount of K+ and HCO3-

7. Oral Rehydrating Solution
Components WHO Recommended NEW Formulation
Na+ 75 mM
K+ 20 mM
Cl- 65 mM
Citrate 10 mM
Glucose 75 mM
Total Osmolarity 245 mOsm/L
Remarks Risk of Hyponatremia in adults with
cholera

8. Treating fluid depletion, shock and
acidosis
 Intravenous fluids: crystalloids (Dhaka Fluid, Ringer’s
Lactate)
Indicated only in cases of severe dehydration
o >10% body weight or losing @ >10ml/kg/hr
10% Body weight over 2-4 hrs
o Titrated with rate of fluid loss

9. Zinc Supplementation
 Reduces the duration and severity of diarrhoea in
children
 Continued supplementation for 10-14 days following
episode of diarrhoea reduces recurrences for next 2-3
months
 Probably acts by:
Reducing fluid secretion from intestinal cells
Strengthen immune response
Helps regeneration of intestinal epithelium

10. Antimicrobials in Diarrhoea
 Specific Antimicrobial Drugs
Are of NO VALUE in:
o Irritable Bowel Syndrome (IBS)
o Coeliac Disease
o Pancreatic Enzyme Deficiency
o Tropical Sprue
o Thyrotoxicosis

11. Antimicrobials in Diarrhoea
 Specific Antimicrobial Drugs
Useful in severe diseases due to:
o Traveller’s Diarrhoea (Rifaximin)
o EPEC, Shigella infections
o Nontyphoid Salmonella
o Yersinia enterolytica
o Salmonella infection

12. Antimicrobials in Diarrhoea
 Specific Antimicrobial Drugs
Useful in all cases of:
Condition Rationale Antimicrobials
Vibrio cholera Reduce stool volume
significantly
Tetracycline,
Norfloxacin
Campylobacter jejuni Control diarrhoea,
eradicate organism
Erythromycin,
Norfloxacin
Clostridium difficile Prevent
pseudomembranous colitis
Metronidazole, oral
vancomycin
Diverticulitis Eradicate inflammation
causing bacteria
Tetracycline,
Metronidazole
Amoebiasis Eradicate organisms Metronidazole,
diloxanide furoateGiardiasis

13. Drug Therapy in Diarrhoea
 Probiotics in Diarrhoea:
Microbial cell preparation
o Lactobacillus sp., Bifidobacterium, Strept.
faecalis, Enterococcous sp., Saccharomyces
boulardii
Live cultures or lypophilised powder
 Restore and maintain healthy gut flora
 Useful in certain diarrhoeas
 Can very rarely cause infection (immunocompromised
individuals), acidosis

14. Nonspecific Anti-diarrhoeal Drugs: Anti-
motility Drugs
 Opioids
Increases small intestine tone and segmenting
activity, reduces propulsive movements, diminishes
intestinal secretion, enhances absorption
 Symptomatic relief in diarrhoea
 Action mediated by μ receptor located in enteric
neuronal network
 Examples: Loperamide, Codeine, Diphenoxylate

15. Nonspecific Anti-diarrhoeal Drugs
 Absorbants
Isaphgula, methyl cellulose, carboxymethyl cellulose
Absorb water and swell  Modifies consistency and
frequency of stool; apparent improvement
Used in diarrhoeal phase of IBS, Colostomy patients
Non fermentable products preferred

16. Drug Therapy in Diarrhoea
 Drugs for Inflammatory Bowel Disease (IBD):
 5-amino salicylic acid (5-ASA)
o Sulfasalazine, Mesalazine
 Corticosteroids
o Prednisolone
 Immunosuppressants
o Azathiaprine, Cyclosporine
o Methotrexate
 TNF α inhibitors
o Infliximab

17. Conclusion
 Diarrhoea can be due four different mechanisms
 Replacement of lost fluid is the mainstay of treatment
of diarrhoea
 Rehydration solution should be chosen in such a way
that its composition is similar to the fluid lost in
diarrhoea
 Antibiotics have a limited role in the treatment of
diarrhoea
 Non-specific drugs can have adjuvant role in treatment
of diarrhoea

18. Questions??
Thank You