Therapy



Optimal therapy is to cure the underlying dis­order. However, if this is not possible, certain drugs may ameliorate the disease (prednisone in inflammatory bowel disease) or treat the diarrhea (cholestyramine to bind bile acids). Specific an­tisecretory drugs are not yet available; however, supportive and symptomatic therapy is often re­quired. Fluid and electrolyte replacement is an important aspect of therapy for diarrhea, partic­ularly in infants and elderly individuals. Oral so­diumglucose solutions or intravenous fluids may be required. Opiates (codeine, diphenoxylate, or loperamide) reduce urgency, frequency, and stool volume in a wide range of diarrheal illnesses, probably via decreased gut motility and increased contact time. Opiates should not be used in pa­tients with severe ulcerative colitis and impend­ing toxic megacolon, and they may actually pro­long illness in patients with infectious diarrhea (shigellosis). However, they are extremely useful agents in patients with chronic, disabling diar­rhea.

Antibiotics are generally not indicated for acute or traveler’s diarrhea, as these are self-limited pro­cesses and antibiotics usually do not shorten the duration of the illness.