What is the role of antidiarrheals in gastroenteritis treatment?

Updated: Feb 10, 2017
  • Author: Arthur Diskin, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Answer

These agents have traditionally been discouraged because of concerns with causing bacteremia; however, they appear to have a role in the symptomatic treatment of mild-to-moderate diarrhea, especially with nonbloody and traveler's diarrhea.

The most common agents include bismuth subsalicylate (Pepto-Bismol). For patients older than 14 years, give 2 tablets or 20 mL PO q30min as needed to a maximum of 8 doses. Loperamide (Imodium) is useful as an adjunct to rehydration for symptomatic relief. The American Academy of Pediatrics (AAP) does not recommend this for children.

Octreotide (Sandostatin), an analog of somatostatin, may be used subcutaneously and intravenously to control severe secretory diarrhea. It has been approved for this purpose in the treatment of carcinoid tumors and VIPomas. Octreotide is under investigation for other uses, including secretory diarrhea associated with acquired immunodeficiency syndrome (AIDS), short bowel syndrome, dumping syndrome, radiation, and chemotherapy.


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