Guidelines for adults on self‐medication for the treatment of acute diarrhoea

Abstract

Acute uncomplicated diarrhoea is commonly treated by self‐medication. Guidelines for treatment exist, but are inconsistent, sometimes contradictory, and often owe more to dogma than evidence. An ad hoc multidisciplinary group has reviewed the literature to determine best practice. In general it is recognized that treatment of acute episodes relieves discomfort and social dysfunction. There is no evidence that it prolongs the illness. Self‐medication in otherwise healthy adults is safe. Oral loperamide is the treatment of choice. Older anti‐diarrhoeal drugs are also effective in the relief of symptoms but carry the risk of unwanted adverse effects. Oral rehydration solutions do not relieve diarrhoea, and confer no added benefit for adults who can maintain their fluid intake. Probiotic agents are, at present, limited in efficacy and availability. Antimicrobial drugs, available without prescription in some countries, are not generally appropriate for self‐medication, except for travellers on the basis of medical advice prior to departure. Medical intervention is recommended for the management of acute diarrhoea in the frail, the elderly (> 75 years), persons with concurrent chronic disease, and children. Medical intervention is also required when there is no abatement of the symptoms after 48 h, or when there is evidence of deterioration such as dehydration, abdominal distension, or the onset of dysentery (pyrexia > 38.5 °C and/or bloody stools).

Antibiotic-Prescribing Practices of Primary Care Prescribers for Acute Diarrhea in New Delhi, India

“…Viral pathogens such as rotavirus account for 70% to 80% of all diarrheal episodes [4]. In the majority of episodes of acute residential diarrhea, the cause usually remains unknown because of the self-limiting nature of the disease and the difficulty and delay in identifying the pathogen, and so the routine use of antimicrobials is not recommended [5]. The joint statement by the World Health Organization (WHO) and the United Nations International Children's Emergency Fund in 2004 recommended the use of low osmolarity oral rehydration solution (ORS) along with zinc for the treatment of acute diarrhea in children [6,7].…”

Loperamide dependence and abuse

“…Loperamide is a commonly used antidiarrhoeal considered safe over a range of dosages 1 2. Available over-the-counter in the US since 1988, loperamide is considered devoid of abuse potential because of rapid metabolism and poor blood–brain barrier penetration 2.…”

Auditing of prescriptions in relation to diarrhea in children below 5 years of age: a multicenter study

“…1 In the pediatric patient audit, the major problem of childhood illness were identified acute watery diarrhea, acute respiratory infection and viral fever 2 and in the developing countries large part of population (9.3%) are infants and children. 3 The guidelines published for the management of acute diarrhea in 2004, which were further revised in 2006 by the Indian Academic of Pediatric. 4 Rehydration therapy is considered an adequate, safe and successful treatment of diarrhea due to any etiology and in all age groups.…”