1. Pharmacotherapy of infectious diarrheas PharmDr. Ondřej Zendulka, Ph.D.

2. Infectious diarrhea Epidemiology diet or direct contact with pathogen Etiology variety of pathogens – bacteria, viruses, parasites ATB therapy induction most common Salmonella sp., Campylobacter sp. Pathogen20052006200720082009 Salmonella3292725102182041100910805 Shigella278289349229178 Other enteral bact.27042471283133053178 Campylobacter3026822713242542017520371 Viral intest. inf.36705597602566396066

3. Infectious diarrhea Pathophysiology dehydration, electrolyte and acidobasic imbalance nausea and vomitus usually present exudative diarrhea with inflammation, rarely secretory diarrhea (cholera) Symptoms abdominal discomfort – loss of appetite, flatulence number of stools from 1 to tens per day sometimes only painful tenesmuses fever

4. Infectious diarrhea Salmonella most common is S. enteritidis source: infected food incubation period: 8-48h symptoms: abdominal pain, fever, stool gets dark green colour therapy: cotrimoxazol, quinolones, aminopenicillines http://www.youtube.com/watch?v=j5GvvQJVD_Y

5. Infectious diarrhea Campylobacter 90% by C. jejuni source: infected food or direct transfer incubation period: 1-7 days therapy: macrolides, (quinolones)

6. Infectious diarrhea Shigella 95% by S. sonnei source: infected food or direct transfer incubation period: 1-3(7) days symptoms: fever, abdominal pain prior defecation, vomiting therapy: serious infections ATB (aminopen, cotrimoxazol, quinolones), rehydratation

7. Infectious diarrhea Viral diarrheas pathogen: rota-, adeno-, astro-,kalci-, toroviruses source: contaminated objects, direct contact incubation period: 1-2 days symptoms: mild infections, !children, elderls therapy: symptomatic

8. Infectious diarrhea Parasitic diarrheas rarely: Giardia lamblia, Ascaris lumbricoides therapy: metroniadzole, mebendazole, albendazole

9. Infectious diarrhea ATB associated diarrheas type of ATB and period of administration plays role intestinal dysmicrobia pseudomembraneous colitis linkosamides, penicillines, cephalosporines, quinolones therapy: metronidazole, vancomycin

10. Infectious diarrhea - therapy Rehydration black tea, still mineral water (nonlaxative) rehydration solution: 1L of water 8 spoons of sugar 1 spoon of salt juice from 2 oranges drink 250-500 ml/hour

11. Infectious diarrhea - therapy Diet individual with regard to tolerance lipid restriction possible decrease in absorption of drugs (peroral contraception) diet bisquits, potatoes, rice, bananas, apples

12. Infectious diarrhea - therapy Eubiotics increase of intestinal enzyme activity intreference with pathogen microflora immunomodulants probiotics – Lactobacillus, Bifidobacterias, Sacharomycetes prebiotics – oligo- and polysacharides

13. Infectious diarrhea - therapy rifaximin (NORMIX) inhibits DNA dependent RNA polymerase wide spectrum absorption from GIT 1% flatulence, abdominal pain, loss of weight prophylaxis prior to surgery on intestine

14. Infectious diarrhea - therapy nifuroxazid (Endiex, Ercefuryl) interferes with synthesis of NA and bacterial metabolism not active against: Proteus, Pseudomonas, Enterobacter not absorbed from GIT flatulence, abdominal pain, loss of weight prophylaxis prior to surgery on intestine

15. chloroxine (Endiaron) significant bacteriostatic, fungistatic and antiprotozoal properties does not induce resistance does not influence natural intestinal flora not for children less than 40kg Infectious diarrhea - therapy

16. Antimotility agents loperamide (Imodium, Loperon) opioid receptor agonist no influence on microflora high afinity to intestine, low bioavalability, high first pass effect urticaria, rush, constipation + diosmectite (Imodium plus) - natural silicate, intestinal absorbent

17. Infectious diarrhea - therapy Antimotility agents diphenoxylate (Reasec) pethidin similar + atropin in subtherapeutic dose Intestinal absorbents diosmectite (Smecta) activated charcoal (Carbocit, Carbosorb) - 1-2 tablespoons, 3-4x day