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[Effect of loperamide on fecal flora of children with severe prolonged diarrhea]
Insights
Loperamide effectively treated severe protracted diarrhea in infants, with rapid clinical resolution. While fecal flora showed some changes, no harmful bacterial overgrowth occurred during treatment.
Area of Science:
- Pediatric Gastroenterology
- Microbiology
- Pharmacology
Background:
- Severe protracted diarrhea in infants poses significant clinical challenges.
- Loperamide is a potential therapeutic agent for managing infant diarrhea.
Purpose of the Study:
- To evaluate the clinical efficacy and impact of loperamide on fecal microbiota in infants with severe protracted diarrhea.
- To assess the safety and tolerance of loperamide treatment in this population.
Main Methods:
- A study involving 19 infants with severe protracted diarrhea treated with loperamide (0.5 mg/kg/d).
- Clinical parameters (tolerance, stool frequency, transit time) and fecal flora (aerobic and anaerobic bacteria) were analyzed before and during treatment.
- Comparison with 5 control subjects was performed.
Main Results:
- Rapid clinical resolution of diarrhea (less than 24 hours) was observed in 9 out of 14 patients.
- Ileus occurred in 2 cases, resolving upon loperamide discontinuation.
- Significant alterations in fecal counts of Streptococcus D and Proteus were noted, but no bacterial overgrowth was detected.
Conclusions:
- Loperamide demonstrates rapid clinical efficacy in treating severe protracted diarrhea in infants.
- Despite observed changes in specific bacterial populations, loperamide treatment did not lead to bacterial overgrowth.
- Close monitoring for adverse events like ileus is recommended during loperamide therapy in infants.
Abstract:
Loperamide has recently been proposed in the management of infants with severe protracted diarrhea. The purpose of this study was to determine the effect of loperamide (0.5 mg/kg/d) on fecal flora in 19 cases of severe protracted diarrhea. Criteria analysed were: clinical tolerance (vomiting and abdominal distension) and efficacy (number of stools, transit time and Na/k in stools); complete identification and counts of aerobic and strict anaerobic bacteria in fresh stools before and 4 to 8 days after the beginning of loperamide. Parental and/or oral alimentation remained unchanged during the entire study. Clinical resolution of diarrhea was rapid (less than 24 h) in 9 of 14 patients. In 2 cases ileus was observed and resolved when loperamide was discontinued. Although important changes in specific fecal flora counts was noticed for streptococcus D and proteus as compared to 5 controls, no bacterial overgrowth appeared or was worsened during loperamide treatment.