salicylates and atropine-sulfate-diphenoxylate-hydrochloride-drug-combination

Along with the dizzying rise in the world's population and economic globalization, travel activity has also increased. Travelers' diarrhea, caused by changed sanitary conditions, has a very different pathogenic spectrum and clinical course from those of our native forms of infectious enterocolitis. Awareness of the warning signs of complications in the clinical course and of the differential diagnoses is therefore a prerequisite for rational therapy. This covers oral rehydration, motility inhibitors, adsorbents, antisecretory agents, probiotics, and last but not least the use of antibiotics, which make an essential contribution if correctly used. There are interesting developments in the form of nonabsorbable antibiotics and new antisecretory agents, which inhibit protein synthesis and enzymes and are increasingly used as antidiarrheal agents with few side effects. In the combination of various therapeutic options in travelers' diarrhea there is still much scope for research. The priority is the correct implementation of the options available today, in order to avoid, as far as possible, therapeutic setbacks and the development of resistance.

Topics: Adult; Anti-Bacterial Agents; Atropine; Bismuth; Child; Cross-Sectional Studies; Diphenoxylate; Drug Combinations; Dysentery; Fluid Therapy; Fluoroquinolones; Humans; Loperamide; Organometallic Compounds; Probiotics; Risk Factors; Salicylates; Travel

More than 97% of pediatric exposures reported to the AAPCC in 2001 had either no effect or mild clinical effects. Despite the large number of exposures, only 26 of the 1074 reported fatalities occurred in children younger than age 6. These findings reflect the fact that, in contrast to adolescent or adult ingestions, pediatric ingestions are unintentional events secondary to development of exploration behaviors and the tendency to place objects in the mouth. Ingested substances typically are nontoxic or ingested in such small quantities that toxicity would not be expected. As a result, it commonly is believed that ingestion of one or two tablets by a toddler is a benign act and not expected to produce any consequential toxicity. Select agents have the potential to produce profound toxicity and death, however, despite the ingestion of only one or two tablets or sips. Although proven antidotes are a valuable resource, their value is diminished if risk after ingestion is not adequately appreciated and assessed. Future research into low-dose, high-risk exposures should be directed toward further clarification of risk, improvements in overall management strategies,and, perhaps most importantly, prevention of toxic exposure through parental education and appropriate safety legislation.

Topics: Alcohols; Algorithms; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Antidepressive Agents, Tricyclic; Antidotes; Antihypertensive Agents; Atropine; Calcium Channel Blockers; Camphor; Child; Child, Preschool; Clonidine; Decision Trees; Diagnosis, Differential; Diphenoxylate; Drug Combinations; Emergency Medicine; Emergency Treatment; Gastrointestinal Agents; Humans; Infant; Pediatrics; Poisoning; Salicylates; Sulfonylurea Compounds; United States

Many commonly used medications have serious toxicity in children when ingested in small doses. The toxicologic characteristics of methyl salicylate, camphor, topical imidazolines, benzocaine, and diphenoxylate-atropine are striking examples. All of these medications except Lomotil are over-the-counter and therefore, are often perceived as minimally harmful when ingested. For all of these substances, however, doses as little as 1/4 teaspoon or 1/2 tablet can have serious or fatal consequences. Thus, referral to an emergency department is prudent for ingestions involving these products. Options for initial gastrointestinal (GI) decontamination are variable, depending on the estimated amount and time of the ingestion. Induction of emesis is contraindicated for significant camphor, topical imidazoline, and Lomotil ingestions. Activated charcoal should be administered in all cases. Finally, the emergency physician must recognize the potential seriousness of these ingestions, as well as their clinical presentations to provide expeditious evaluation and treatment.

Topics: Atropine; Benzocaine; Camphor; Child; Diphenoxylate; Drug Combinations; Gastrointestinal Agents; Humans; Imidazoles; Nonprescription Drugs; Salicylates

Topics: Adult; Anti-Bacterial Agents; Antidiarrheals; Atropine; Bismuth; Child; Cross-Sectional Studies; Diarrhea; Diphenoxylate; Drug Combinations; Dysentery; Fluid Therapy; Fluoroquinolones; Humans; Loperamide; Organometallic Compounds; Probiotics; Risk Factors; Salicylates; Travel