Acute diarrhea in developed countries

Article Abstract:

In developed countries, acute diarrhea is a common, nonlife-threatening, condition characterized by the frequent passage of unformed, watery stool, and typically lasts only a few days. Since these episodes of acute diarrhea are brief and resolve spontaneously, instead of consulting a physician, most patients attempt to treat themselves with over-the-counter medications. It has been reported that the average American has one bout of diarrhea each year, and infants and children in day care centers have about four episodes each year. In Houston, parents of children who attend day care lose almost five work days each year to stay home and care for their children when they (the children) have diarrhea. This equals almost a $33 million productivity loss for the city. In the United States, infant diarrhea is most commonly caused by a virus known as rotavirus, which often affects children 6 to 24 months of age. Children in day care centers often develop diarrhea as a result of an infection with the microorganism Giardia lamblia. Homosexual men with diarrhea are usually infected with many types of bacteria and can develop the 'gay bowel syndrome'. Diarrhea attributable to problems involving the small intestine is characterized by an abundance of water and a modest increase in the number of bowel movements. If the large intestine is involved, the patient may have an increased urgency to defecate, but only a small amount of feces may be expelled. Anti-microbial drugs can be used to kill known infective organisms, but this is not effective in the majority of cases (because the organisms are not identified). Most importantly, patients with diarrhea should be given fluids to replace what has been lost. Non-prescription agents that bind intestinal irritants, such as attapulgite, or decrease intestinal movement, such as loperamide, are useful, inexpensive and effective in the treatment of acute diarrhea. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Demographic aspects

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Comparative efficacy of loperamide hydrochloride and bismuth subsalicylate in the management of acute diarrhea

Article Abstract:

In developed countries, acute diarrhea is a transient, common condition, characterized by the frequent passage of unformed, watery stools. Causative factors include viral or bacterial infections; intestinal irritants, such as spicy foods or alcohol; and anxiety. Acute diarrhea caused by bacteria can be treated with antimicrobial agents if the type of bacteria is known, but this is usually not the case. Most patients do not consult a physician, instead, they self-medicate themselves with over-the-counter (OTC) anti-diarrheal medications. Some OTC agents, such as bismuth, bind and inactivate the irritating substances, while others, such as loperamide, decrease intestinal movement. The latter increases the transit time of food passing through the intestine and allows more water to be reabsorbed from the stool. A recent study compared the effectiveness of loperamide and bismuth in the management of acute diarrhea. Over a two-day study period, patients with acute diarrhea received a maximal amount of eight milligrams a day of loperamide or five grams of bismuth. Loperamide was significantly more effective than bismuth in decreasing the frequency of unformed, watery stools, and this effect was maximal 12 hours after receiving the first dose. A single dose of loperamide also provided longer relief from diarrhea than bismuth, and patients rated it higher at the end of the first 24 hours of treatment. Both medications had a low incidence of side effects, which included nausea, vomiting, and cramps. These results demonstrate that loperamide produces faster, more effective relief from acute diarrhea than bismuth. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Nonprescription drugs, Bismuth subsalicylate

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Safety and efficacy of loperamide

Article Abstract:

Acute or transient diarrhea is a condition characterized by the frequent passage of watery, unformed stools, and may result from bacterial or viral infections; intestinal irritants, such as spicy foods or alcohol; and anxiety. Since acute diarrhea is normally brief and resolves spontaneously, most patients do not consult a physician and try to treat themselves with over-the-counter antidiarrheal medications. Agents such as bismuth bind and inactivate offending intestinal irritants while others, such as diphenoxylate, decrease intestinal movement and the amount of water in the stool. In 1977, loperamide was initially marketed as a prescription drug for the management of diarrhea, but in 1988, it was approved as an over-the-counter remedy for the treatment of this disorder. A number of clinical studies indicate that a 4 milligram dose of loperamide is more effective than diphenoxylate in the management of acute diarrhea. Side effects of loperamide include nausea, vomiting, cramps and stomach pain, but these symptoms may result from the underlying cause of diarrhea and not the drug. Clinical studies indicate that even though loperamide is similar in chemical structure to narcotics, it is free of abuse potential. In conclusion, loperamide is safe, effective and may be the drug of choice for the over-the-counter drug management of acute diarrhea. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Dosage and administration, Antidiarrheals

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