General guidelines for treatment of diarrheal diseases

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As outlined in the various sections of this chapter (see also Chapter 37), the treatment of the majority of infectious diarrheal episodes is supportive, with ORS representing the cardinal intervention to minimize life-threatening dehydration, particularly in young children.105 Breast feeding should be continued, as it may confer protection. Intravenous rehydration should be reserved for high-risk patients who are unable to tolerate enter-als due to recurrent vomiting or diminished mental status. The use of antimotility agents, such as bismuth subsalicylate (Pepto-BismolĀ®), loperamide (ImodiumĀ®), and atropine sulfate with diphenoxylate hydrochloride (LomotilĀ®) should be discouraged, owing to the possible risk of sali-cylate intoxication, ileus, toxic megacolon, bowel perforation, and HUS in subjects infected with EHEC. Probiotics, such as Lactobacillus GG, have been recently shown to be effective both in the prevention, and in the treatment of viral (rotavirus) and antibiotic-associated (C. difficile) diarrheas, as well documented by two recent meta-analyses.106,107


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