Effect of loperamide on stool output and duration of acute infectious diarrhea in infants

Motala, C.; Hill, Ivor D.; Mann, Michael D.; Bowle, M.D.

doi:10.1016/s0022-3476(05)81100-x

Cited by 40 publications

(17 citation statements)

References 18 publications

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“…While four out of 13 studies defined diarrhea resolution as the time to the last unformed stool [16,17,26,31], four studies defined diarrhea resolution as change in stool consistency [22], <15 g of stool/kg/d [24], two or fewer liquid/soft stools/d [18], or return to normal bowel habits [21], and five studies did not report their criteria for diarrhea resolution [19,20,23,25,27]. …”

Section: Resultsmentioning

confidence: 99%

“…Only four studies specifically mentioned that some of their patients received intravenous fluid rehydration in addition to oral rehydration therapy [17–19,27]; two studies did not report the hydration method used [16,22]. Early refeeding was reported in four studies [23,24,26,31]; restriction to only oral rehydration therapy in the first 24 h was reported in two studies [20,25]; and six studies did not report on feeding practices [16–19,22,27]. …”

Section: Resultsmentioning

confidence: 99%

“…Allocation concealment was reported in seven studies [17,19–21,25,26,31]. Although nine trials were double-blind [16,17,19–21,25–27,31], four were open [18,22–24]. Most (11/13) trials reported inclusion of more than 90% of all randomized participants in their analysis [17–26,31].…”

Section: Resultsmentioning

confidence: 99%

“…Data on diarrhea continuing at 24 or 48 h were available in five studies [16–18,24,31]. In the four studies reporting diarrhea at 24 h, the prevalence of diarrhea among patients on loperamide was less than among patients on placebo; prevalence ratio 0.66 (95% CI: 0.57 to 0.78) (Figure 2) [16–18,31].…”

Section: Resultsmentioning

confidence: 99%

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Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis

2007

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BackgroundLoperamide is widely used in adults for acute diarrhea. However, its use in children has been discouraged by the World Health Organization and the American Academy of Pediatrics owing to concerns over safety and efficacy in young children.Methods and FindingsTo assess the efficacy and adverse effects of loperamide compared with placebo for acute diarrhea in children, we reviewed Medline, EMBase, the Cochrane Central Register of Controlled Trials, and bibliographies of known clinical trials and of review articles, and we also interviewed key investigators in the field. We undertook a systematic review and meta-analysis of randomized controlled trials of children younger than 12 y of age with acute diarrhea, comparing loperamide with placebo. Included trials reported data on diarrhea duration or severity, or provided data on adverse effects. Compared with patients who received placebo, patients allocated to loperamide were less likely to continue to have diarrhea at 24 h (prevalence ratio 0.66, 95% confidence interval [CI]: 0.57 to 0.78), had a shorter duration of diarrhea by 0.8 d (95% CI: 0.7 to 0.9 d), and had a lower count of stools at 24 h (0.84, 95% CI: 0.77 to 0.92). Results were similar when random-effects summaries were estimated. Serious adverse events, defined as ileus, lethargy, or death, were reported in eight out of 927 children allocated to loperamide (0.9%, 95% CI: 0.4% to 1.7%). Serious adverse events were not reported in any of the 764 children allocated to placebo (0%, 95% CI: 0% to 0.5%). Among the children allocated to loperamide, serious adverse events were reported only among children younger than 3 y.ConclusionsIn children who are younger than 3 y, malnourished, moderately or severely dehydrated, systemically ill, or have bloody diarrhea, adverse events outweigh benefits even at doses ≤0.25 mg/kg/d. In children who are older than 3 y with no/minimal dehydration, loperamide may be a useful adjunct to oral rehydration and early refeeding.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis

2007

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“…Even though the simulated case presented, and the result of their evaluation revealed acute diarrhea; antimicrobial agents, antibiotics, antispasmodics, and adsorbents were the mainstay of therapy. These agents have been proven ineffective in reducing fluid losses in acute diarrhea and could be dangerous in children 15,1617. According to the World Health Organization, the mainstay of management of acute diarrhea in children is ORT to avoid dehydration 1,5.…”

Section: Discussionmentioning

confidence: 99%

Management of acute diarrhea in children by community pharmacists in Lagos, Nigeria

Ogbo

Aina

Aderemi-Williams

2014

Pharmacy Practice (Internet)

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*Background: Acute diarrhea in children leads to dehydration and death if not appropriately managed. World Health Organization (WHO) recommends treating diarrhea with oral rehydration therapy (ORT), fluids and foods. Proper management is hinged on accurate assessment of patients to identify the acute watery diarrhea. Objective: To compare the knowledge and attitude of community pharmacists in the management of acute diarrhea in children with their observed practice. Methods: This study was carried out using two instruments: structured self-administered questionnaire to assess knowledge and attitude of community pharmacists in the management of acute diarrhea in children and simulated patient visits to evaluate assessment of patients, recommendation of products and instructions on feeding and fluid intake. The simulated patient visits were done in 186 pharmacies in the city of Lagos, Nigeria. Results: The study reveals that the knowledge and attitude of community pharmacists in the management of acute diarrhea in children was different from their observed practice. The difference was statistically significant (p<0.05). During the simulations, 23% carried out appropriate assessment before recommending any products, and 15% recommended ORT alone. Although information to the pharmacists indicated non-dysentery, non-cholera, acute watery diarrhea, antibiotics and antidiarrheals were irrationally recommended and these were the mainstay of symptoms' management in practice. Questionnaire data revealed that 24% of pharmacists knew the correct instructions to give on food and fluid intake during diarrhea, whereas 8% followed WHO guideline on food and fluid intake during the visits. Conclusions: Assessment of patients to determine acute diarrhea was inadequate. Observed practice in managing acute diarrhea in children was inappropriate and significantly different from their claims in the questionnaire. The recommendation of ORT was scanty and advice on food and fluid intake was inadequate and sometimes inappropriate. This study shows that only 15% of community pharmacists managed acute diarrhea in children according to the WHO guidelines.

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Acute Gastroenteritis

and¹,

Elliott²

2004

Evidence‐based Paediatrics

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Effect of loperamide on stool output and duration of acute infectious diarrhea in infants

Cited by 40 publications

References 18 publications

Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis

Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis

Management of acute diarrhea in children by community pharmacists in Lagos, Nigeria

Acute Gastroenteritis

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