From the Guidelines
Treatments for diarrhea include oral rehydration, antimotility agents like loperamide, and antisecretory agents.
Treatment Options
- Oral rehydration is useful in all ages and is the first line of treatment for acute infectious diarrhea 1.
- Loperamide, a locally acting opioid receptor agonist, is effective in reducing diarrhea prevalence and total duration of diarrhea in adults and children, but its use is not recommended in children under 3 years old due to the risk of adverse events 1.
- Antiemetic agents like ondansetron can reduce vomiting in children and reduce the need for hospitalization for rehydration, but may increase stool volume 1.
- Bismuth subsalicylate is mildly effective, while racecadotril reduces stool volume but is not available in North America 1.
- Octreotide and uridine triacetate may be used in specific cases, such as chemotherapy-induced diarrhea 1.
- Bile acid sequestrants like cholestyramine may be used in cases of bile salt malabsorption 1.
- Probiotic agents and oral budesonide may be suggested for treatment of chemotherapy-induced diarrhea that is refractory to loperamide 1.
Important Considerations
- Patients should be advised about medications that may increase the risk of complications from diarrhea, particularly antidiarrheal and antimicrobial agents 1.
- Medical intervention is recommended for the management of acute diarrhea in the frail, elderly, persons with concurrent chronic disease, and children, as well as in cases of severe dehydration, abdominal distension, or dysentery 1.
From the Research
Treatments for Diarrhea
- Pharmacologic agents for chronic diarrhea include:
- Loperamide, a synthetic opiate agonist, which decreases peristaltic activity and inhibits secretion, resulting in the reduction of fluid and electrolyte loss and an increase in stool consistency 2
- 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, which have significant benefits in patients with irritable bowel syndrome (IBS) with diarrhea 2
- Cholestyramine, a bile acid sequestrant, which is generally considered as the first-line treatment for bile acid diarrhea 2
- Probiotics, which may have a role in the prevention of antibiotic-associated diarrhea, but data on their role in the treatment of chronic diarrhea are lacking 2
- Diosmectite, an absorbent, which can be used for the treatment of chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea 2
- Antispasmodics, including alverine citrate, mebeverine, otilonium bromide, and pinaverium bromide, which are used for relieving diarrheal symptoms and abdominal pain 2
- Rifaximin, which can be effective for chronic diarrhea associated with IBS and small intestinal bacterial overgrowth 2
- Loperamide is an effective therapy for a variety of diarrheal syndromes, including acute, nonspecific (infectious) diarrhea; traveler's diarrhea; and chemotherapy-related and protease inhibitor-associated diarrhea 3
- Treatment options for functional diarrhea include dietary and lifestyle modification, pharmacologic therapies, and alternative modalities, and should be approached in an individualized manner 4
- Loperamide can be used as monotherapy or as an adjunct to antibiotic treatment in immunocompetent adults with acute infectious traveler's diarrhea or community-acquired diarrhea without severe comorbidities 5
- Antidiarrheal drugs, such as loperamide, cholestyramine, bulking agents, probiotics, anticholinergic agents, and opioids, can be used for symptomatic management of chronic diarrhea, and can be prescribed long-term with an acceptable side effect profile if used properly 6