From the Guidelines
For inpatient diarrhea, the primary treatment approach should focus on rehydration using reduced osmolarity oral rehydration solution (ORS) as the first-line therapy for mild to moderate dehydration, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The treatment strategy depends on the severity of dehydration and the patient's ability to tolerate oral intake.
- For patients with mild to moderate dehydration, reduced osmolarity ORS is the preferred treatment, and it should be continued until clinical dehydration is corrected 1.
- In cases of severe dehydration, shock, or altered mental status, isotonic intravenous fluids such as lactated Ringer’s and normal saline solution should be administered 1.
- Once the patient is rehydrated, maintenance fluids should be administered, and ongoing losses in stools should be replaced with ORS until diarrhea and vomiting are resolved 1.
- Ancillary treatments like antimotility or antinausea agents may be considered in specific cases, but their use should not substitute for fluid and electrolyte therapy, and loperamide should not be given to children <18 years of age with acute diarrhea 1.
- It's essential to address the underlying cause of diarrhea, whether it's infectious, medication-induced, or related to underlying conditions, and to monitor fluid status, electrolytes, and response to treatment for effective management.
From the FDA Drug Label
Loperamide hydrochloride capsules are indicated for the control and symptomatic relief of acute nonspecific diarrhea in patients 2 years of age and older and of chronic diarrhea in adults associated with inflammatory bowel disease. The answer is Loperamide (PO), as it is indicated for the control and symptomatic relief of acute nonspecific diarrhea in patients 2 years of age and older. 2
- Key considerations:
- Loperamide hydrochloride is contraindicated in pediatric patients less than 2 years of age due to the risks of respiratory depression and serious cardiac adverse reactions.
- Dehydration and fluid and electrolyte depletion often occur in patients who have diarrhea, and administration of appropriate fluid and electrolytes is very important.
- The use of loperamide hydrochloride does not preclude the need for appropriate fluid and electrolyte therapy. 2
From the Research
Treatment Options for Inpatient Diarrhea
- Oral rehydration solutions (ORS) are a common treatment for diarrhea, as they help to prevent dehydration and have been shown to decrease mortality associated with acute diarrheal illnesses in children 3.
- Loperamide is an antidiarrheal medication that can be used to control diarrhea symptoms, and is available without a prescription 4.
- The combination of loperamide and ciprofloxacin has been studied as a treatment for travelers' diarrhea, with some benefit seen in the first 24 hours of treatment 5.
- Oral rehydration therapy plus loperamide has been compared to loperamide alone in the treatment of traveler's diarrhea, with equivalent clinical responses seen in both groups 6.
Considerations for Treatment
- The use of oral rehydration therapy with a rehydration solution can be effective in treating diarrhea in children with mild to moderate dehydration 7.
- Probiotics can be used to shorten the course of diarrhea, and good handwashing can reduce the incidence of acute gastroenteritis 7.
- Loperamide can be an effective treatment for patients with painless diarrhea, but may not be suitable for all patients, such as those with bloody diarrhea or those who have received antidiarrheal medications before entry into treatment 4, 5.