Pharmacoterapy of

Diarrhoeal
Andi Alfia MT
Pharmacology Department, Medical Faculty
Universitas Tadulako
2020

1
Epidemiology
Epidemiology
 Definition
• Diarrhoea is the passage of unusually loose or watery
stools, usually at least three times in a 24 hour
period (WHO).

• Its is the consistency of the stools rather than the

number that is most important.

• Many diarrhoeal deaths are caused by dehydration

 Clinical Types
acute watery diarrhoea
• including cholera, which lasts several hours or days
• the main danger is dehydration

acute bloody diarrhoea

• called dysentery
• the main dangers are damage of the intestinal mucosa, sepsis and malnutrition

persistent diarrhea
• lasts 14 days or longer
• the main danger is malnutrition and serious non-intestinal infection

diarrhoea with severe malnutrition

• the main dangers are severe systemic infection, dehydration, heart failure and vitamin
and mineral deficiency
Pathophysiology
Etiology
 Diagnosis

History and
Physical
patterns of
examination
symptoms

Diagnostic
testing
History and Patterns of Symptoms
• presence of blood in the stool
• duration of diarrhea
• number of watery stools per day
• number of episodes of vomiting
• presence of fever, cough, or other important problems (e.g.
convulsions, recent measles)
• pre-illness feeding practices
• type and amount of fluids (including breastmilk) and food
taken during the illness
• drugs or other remedies taken
• immunization history
 Physical Examination
Look!
• General condition  alert; restless or irritable; lethargic or unconscious?
• The eyes  normal or sunken
• The stool
• Malnourished/-
• Another infection

Feel!
• Skin turgor

Take
• The temperature

Determine the degree of dehydration

Physical Examination
Treatment /
Management
Treatment /
Management
Treatment /
Management
Treatment / Management
Treatment / Management
 Oral Rehydration Therapy

MoA

• replace the missing body fluids together with feces

• glucose facilitates the absorption of sodium on a 1:1 molar basis in the small
intestine
• sodium and potassium are needed to replace
• citrate corrects th acidosis that occurs
Oral Rehydration Therapy
 Zinc
MoA

• inhibits cAMP-induced, chloride-dependent fluid secretion by inhibiting basolateral potassium (K) channels
• improves regeneration of the intestinal epithelium,
• increases the levels of brush border enzymes,
• enhances the immune response,  better clearance of the pathogens

PK

• Absorption  poorly absorbed (only 20 to 30%)

• Distribution  widely distributed throughout the body.
• Elimination  mainly in the feces (90%) and only traces are found in the urine

Aes

• interfere the metabolism and absorption of other essential minerals

• stomach upset, heartburn, and nausea
 Adsorbents
MoA

• Coat the walls of the GI tract

• Bind to the causative bacteria or toxin, which is then eliminated through the stool

Agents

• bismuth subsalicylate (Pepto-Bismol), kaolin-pectin, activated charcoal, attapulgite (Kaopectate)

Aes

• Increased bleeding time

• Constipation, dark stools
• Confusion, twitching
• Hearing loss, tinnitus, metallic taste, blue gums
 Adsorbent

Interactions

• Adsorbents decrease the absorption of many

agents, including digoxin, clindamycin, quinidine,
and hypoglycemic agents
• Adsorbents cause increased bleeding time when
given with anticoagulants
 Anticholinergics
MoA

• Decrease intestinal muscle tone and peristalsis of GI tract

• Result: slowing the movement of fecal matter through the GI tract

Agents

• belladonna alkaloids (Donnatal), atropine

Aes

• Urinary retention, hesitancy, impotence

• Headache, dizziness, confusion, anxiety, drowsiness
• Dry skin, rash, flushing
• Blurred vision, photophobia, increased intraocular pressure
• Hypotension, hypertension, bradycardia, tachycardia
 Anticholinergics

Interactions

• Antacids can decrease effects of anticholinergic

antidiarrheal agents

Caution
• Anticholinergics should not be administered to
patients with a history of glaucoma, BPH, urinary
retention, recent bladder surgery, cardiac
problems, myasthenia gravis
 Intestinal Flora Modifiers

MoA

• Bacterial cultures work by:

• Supplying missing bacteria to the GI tract
• Suppressing the growth of diarrhea-causing bacteria

Agents

• L. acidophilus (Lactinex), Bifidobacterium, Saccharomyces boulardii

 Opiates

MoA

• increase colonic phasic segmenting activity through inhibition of presynaptic cholinergic nerves in the
submucosal and myenteric plexuses
• Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed

Agents

• loperamide (Imodium), diphenoxylate (Lomotil)

 Opiates

AEs

• Drowsiness, sedation, dizziness, lethargy

• Nausea, vomiting, anorexia, constipation
• Respiratory depression
• Bradycardia, palpitations, hypotension
• Urinary retention
• Flushing, rash, urticaria
 Racecadotril

MoA

• a potent enkephalinase inhibitor

• enkephalins by activating the δ opioid receptor, inhibit the secretion of Cl – and fluids thus
reducing the loss of fluids and electrolytes during diarrhea

Clinical Use

• acute diarrhea of both infectious and noninfectious origin

 Racecadotril

AEs

• less constipation
• itching
• children below two years of age 
depression
Thank You