Diarrhoea management: drug treatment.

The author proposes general guidelines for the use of drugs in the treatment of diarrhea. It is stressed that antidiarrheal drugs should never be used for the routine management of acute diarrhea, especially in children under 5 years of age; rather, fluid and electrolyte replacement should be the primary treatment. Antibiotics are not indicated in patients with watery diarrhea unless cholera is suspected, in which case tetracycline or another antimicrobial agent should be used. In patients with dysentery, especially children who are febrile or appear seriously ill, antimicrobials such as ampicillin or co-trimoxazole should be given. The choice of antibiotic should be based on known antimicrobial sensitivity patterns of Shigella strains in the geographic area. Antimotility drugs may give some symptomatic relief in adults, but are contraindicated in children under 5 years of age because of the risk of depressed respiration and altered consciousness. The antisecretory drugs chlorpromazine and berberine have not yet proven practical for routine use.