piperidines and Diarrhea--Infantile

Topics: Adult; Child, Preschool; Clinical Trials as Topic; Diarrhea, Infantile; Double-Blind Method; Humans; Infant, Newborn; Loperamide; Piperidines; Placebos; Random Allocation

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.

Topics: Child, Preschool; Diarrhea, Infantile; Feces; Humans; Infant; Loperamide; Piperidines

Infants aged 4 to 36 months with acute diarrhoea (rotavirus 66%) were treated as outpatients with oral fluids and a rapid return to full feedings. In addition, the infants were randomized to receive for 3 days either cholestyramine 2 g twice daily (N = 10), an equivalent placebo 2 g twice daily (N = 15), or loperamide 0.10 mg/kg divided in three doses (N = 16). The duration of watery diarrhoea from the beginning of treatment was 0.9 +/- 1.0 days in the cholestyramine group, 2.5 +/- 1.3 days in the loperamide group, and 3.3 +/- 1.6 days in the placebo group (p less than 0.001 cholestyramine vs. placebo, p less than 0.005 cholestyramine vs. loperamide). The infants receiving cholestyramine also had a better weight gain than those receiving the placebo, and their metabolic acidosis was corrected sooner. There was no hyperchloraemia associated with the cholestyramine treatment. It is concluded that cholestyramine 2 g twice daily for 3 days can be safely used to shorten the course of acute diarrhoea. The use of loperamide in acute infantile diarrhoea does not appear justified.

Topics: Acute Disease; Ambulatory Care; Child, Preschool; Cholestyramine Resin; Clinical Trials as Topic; Diarrhea; Diarrhea, Infantile; Fluid Therapy; Humans; Infant; Loperamide; Piperidines; Water-Electrolyte Balance

Topics: Clinical Trials as Topic; Dehydration; Diarrhea, Infantile; Double-Blind Method; Feces; Humans; Infant; Loperamide; Male; Piperidines; Vomiting

Topics: Child; Child, Preschool; Clinical Trials as Topic; Diarrhea, Infantile; Enteritis; Female; Humans; Infant; Infant, Newborn; Male; Piperidines

This study was designed to assess the effect of loperamide, given to infants in higher than recommended doses, on the severity and duration of acute diarrhea. Thirty infants with acute diarrhea and dehydration were given loperamide (0.8 mg/kg/day), in addition to standard fluid therapy, for 48 hours after admission to the hospital. The stool output in grams per kilograms of body weight per day and the duration of diarrhea in these infants were compared with those in 30 matched control infants receiving only standard fluid therapy. Two infants given loperamide had to be withdrawn from the trial because ileus developed in one and the other had persistent severe vomiting. In four other infants receiving loperamide, drowsiness developed but resolved rapidly on discontinuation of the drug. Infants receiving loperamide had a shorter duration of diarrhea (median 2.5 vs 6.0 days) and lower daily stool output than the control subjects had. The study confirmed the efficacy of loperamide in reducing the duration and severity of diarrhea but raised doubts regarding its safety in the treatment of young infants.

Topics: Administration, Oral; Diarrhea, Infantile; Drug Evaluation; Feces; Fluid Therapy; Humans; Infant; Loperamide; Male; Piperidines

Topics: Diarrhea, Infantile; Female; Humans; Infant; Loperamide; Piperidines

Loperamide has been recently indicated in the management of infants with severe protracted diarrhea. The purpose of this study was to determine the effect of loperamide on fecal flora in severe protracted diarrheas. 19 children aged 1 to 36 months, with severe protracted diarrhea were studied: 14 received loperamide (0.5 mg/kg/d) and 5 were without loperamide treatment. Criteria analysed were: clinical tolerance (vomiting and abdominal distention); efficacy (number of stools, transit time and Na+/K+ in stools) and effect on fecal flora, with differential qualitative and quantitative analysis method (complete identification and counts of aerobic and strict anaerobic bacteria in fresh fecal samples before and 4 to 8 days after the beginning of loperamide). Parenteral and/or oral alimentation remain constant during the study. Results show a rapid (24 h) efficacy in 9/14. Although important changes in specific fecal flora counts was noticed for streptococcus D and Proteus as compared to five controls, no bacterial overgrowth appeared or was increased during loperamide treatment.

Topics: Child, Preschool; Diarrhea, Infantile; Electrolytes; Enterobacteriaceae; Enterococcus faecalis; Escherichia coli; Feces; Humans; Infant; Loperamide; Piperidines; Pseudomonas; Staphylococcus

Aspirin reduced plasma concentrations of prostaglandin (PG) F alpha in 11 of 12 children with toddler diarrhoea, and usually, but not always, controlled the symptom. Loperamide consistently controlled toddler diarrhoea in 10 patients but had no effect on plasma PGF alpha. In eight patients experiencing spontaneous remission of symptoms, plasma PGF alpha was significantly lower than during diarrhoeal episodes. These results suggest that (a) toddler diarrhoea is in some cases mediated by PG, and (b) the effect of loperamide is independent of PG levels.

Topics: Antidiarrheals; Aspirin; Child, Preschool; Cyclooxygenase Inhibitors; Diarrhea; Diarrhea, Infantile; Humans; Infant; Loperamide; Piperidines; Prostaglandins F

Topics: Diarrhea, Infantile; Humans; Infant; Loperamide; Male; Piperidines

Six infants with severe life-threatening protracted diarrhoea were treated with loperamide. Steady-state perfusion studies of the jejunum showed that in 2 of them the small intestine was in a net secretory state with respect to water, and in the others this was inferred from the fact that the diarrhoea persisted despite nothing by mouth. Loperamide resulted in a prompt and impressive improvement in the condition of each infant. We conclude that this drug has an important role in the management of protracted diarrhoeal states in some infants who are unresponsive to current treatments, and that its effect is related to its antisecretory action.

Topics: Child, Preschool; Chronic Disease; Diarrhea, Infantile; Female; Humans; Infant; Jejunum; Loperamide; Male; Perfusion; Piperidines; Water

Topics: Diarrhea, Infantile; Humans; Infant; Loperamide; Male; Piperidines; Seizures

Topics: Adenoma, Islet Cell; Diarrhea, Infantile; Female; Humans; Infant; Loperamide; Pancreatic Neoplasms; Piperidines; Vipoma

Topics: Child; Diarrhea; Diarrhea, Infantile; Humans; Intestinal Mucosa; Loperamide; Piperidines; Receptors, Opioid

Topics: Child; Diarrhea, Infantile; Humans; Loperamide; Piperidines

Topics: Diarrhea, Infantile; Humans; Infant; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Loperamide; Piperidines

Topics: Child, Preschool; Diarrhea, Infantile; Humans; Infant; Loperamide; Piperidines

Topics: Central Nervous System; Diarrhea, Infantile; Female; Humans; Infant; Loperamide; Naloxone; Piperidines

Topics: Diarrhea, Infantile; Humans; Infant; Infant, Newborn; Loperamide; Piperidines

Topics: Child, Preschool; Diarrhea, Infantile; Humans; Infant; Loperamide; Piperidines

Topics: Acute Disease; Bacterial Infections; Butyrates; Child; Child, Preschool; Diarrhea, Infantile; Enteritis; Gastroenteritis; Gastrointestinal Agents; Humans; Infant; Infant, Newborn; Piperidines; Virus Diseases