Nonantibiotic therapy and pharmacotherapy of acute infectious diarrhea

The most important aspect of nonantibiotic treatment of diarrhea is to prevent or repair dehydration and thus prevent significant morbidity or death. Although intravenous fluid therapy is effective, it is expensive and requires personnel and equipment. ORT has saved millions of lives in emerging nations and should be more commonly used in developed countries. Although the simple concept of glucose-stimulated Na+ and fluid absorption remains the basic tenet of such ORT, grain-based solutions appear to have added efficacy and nutritional value. Mild, nondysenteric diarrheas can be safely and reasonably effectively treated either with loperamide or with bismuth subsalicylate compounds. Effective adjunctive therapy for severe secretory diarrheas has thus far escaped discovery. Somatostatin analogues such as octreotide have approximately 50% efficacy in reduction of the moderate secretory diarrheas such as those present in AIDS. There are pharmacologic leads that should be explored to develop more gut specific antisecretory forms of alpha 2-adrenergic agents, somatostatin, or phenothiazines. In addition, Cl- channel blockers still hold great theoretic promise. Effective antisecretory therapy has been sought for the past 20 years. It is disappointing that no effective new drugs have yet emerged. Undoubtedly, this speaks of our inexact understanding of the mechanisms that result in secretory diarrheas. Because of the continued loss of life from diarrhea in emerging nations, better understandings of these mechanisms and effective therapies remain appropriate goals for medical science.