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Purpose This review provides a summary of the currently available clinical data on drug-drug interactions (DDIs) involving over-the-counter (OTC) medicines. It aims to educate and increase awareness among healthcare providers, and to support decisions in daily practice. Methods An extensive literature search was performed using bibliographic databases available through PubMed.gov. An initial structured search was performed using the keywords "drug-drug-interaction AND (over-the-counter OR OTC)", without further restrictions except for the language. The initial results were screened for all described DDIs involving OTC drugs, and further information was gathered specifically on these drugs using dedicated database searches and references found in the bibliography from the initial hits. Results From more than 1200 initial hits (1972-June 2021), 408 relevant publications were screened for DDIs involving OTC drugs, leading to two major findings: first, certain types of drug regimens are more prone to DDIs or have more serious DDI-related consequences such as antiretroviral, anti-infective, and oral anticancer therapies. Second, while most DDIs involve OTC drugs as the perpetrators, some prescription drugs (statins, phosphodiesterase-5 inhibitors) that currently have OTC status can be identified as the victims in DDIs. The following groups were identified to be frequently involved in DDIs: non-steroidal anti-inflammatory drugs, food supplements, antacids, proton-pump inhibitors, H2-antihistamines, laxatives, antidiarrheal drugs, and herbal drugs. Conclusion The most significant finding was the lack of high-quality evidence for commonly acknowledged interactions. High-quality interaction studies involving different phenotypes in drug metabolism (cytochrome P450) and distribution (transporters) are urgently needed. This should include modern and critical drugs, such as oral anti-cancer medications and direct oral anticoagulants.

Gastroenteritis is one the most common diseases worldwide, and it’s more dangerous in children, although in most time it’s self-limited, it can be fatal in case of children, the most dangerous side of GE is diarrhea and the dehydration that follows it. Since dehydration is the most dangerous symptom of the Gastroenteritis Oral rehydration solutions and even intravenous solution intake (in case of severe dehydration) is the main treatment, followed by symptomatic treatment such anti-emetics or antidiarrheal drugs, although caution should be considered for drugs used in children. The need to make cost-effective diagnostic and treatment decisions, avoid unnecessary investigation and referral, provide long-term effective control of symptoms, and minimize the risk of complications constitute the main challenges that PCPs face. During the last few years, the role of primary care physicians in the diagnosis and management of gastroenteritis has been recognized as very important, and it has been suggested that they have all the available resources in order to ensure high standard of care for their patients. In particular, clearly articulated clinical practice guidelines, effective medications, accurate noninvasive investigations, and evidence-based primary care management plans are available to support PCPs who want to raise their threshold for referring patients with GI symptoms.

Рассмотрены механизмы действия основных групп антидиарейных препаратов: агонистов опиоидных рецепторов, ингибиторов энкефалиназ, энтеросорбирующих средств, блокаторов хлорных каналов, активируемых кальцием и др. Представлены потенциальные мишени и рассмотрены направления поиска новых групп антидиарейных средств.

Acute and chronic diarrhea are severe clinical syndromes that can be observed in various diseases of internal organs. The unidentified cause of diarrhea syndrome hampers administration of the etiotropic therapy. The effective and timely treatment promotes the improvement of quality of life and prevents complications’ development. Smectalia is a new form of diosmectite, an antidiarrheal drug used to treat infectious and inflammatory bowel diseases, as well as diarrheal syndrome of various etiologies. Owing to its spatial structure and high plastic viscosity, diosmectite possesses a high enveloping capacity along the gastrointestinal mucosa. By interacting with mucosal glycoproteins, it increases the mucus layer thickness, mucin viscosity and decrease its solubility, restores the mucosa cytoprotective properties, thus raising its resistance to the effects of damaging factors (bile acids, free radicals, bacterial toxins). Diosmectite binds some of the bacterial and viral toxins that is believed to be a promoter for its antidiarrhea effects. There were some evidence-based clinical reports about the diosmectite effects on from the diarrhea in patients with the inflammatory intestinal diseases. Thus, it reduced diarrhea induced by endogenous agents, especially inflammatory cytokines or other factors, including at the inflammatory intestinal diseases. The literature reports the effective use of the dioctahedral smectite for the treatment of diarrhea at the endocrine pathology, and diarrhea resulting from radiotherapy, chemotherapy and procalcitonin acquired immunodeficiency syndrome. The understanding of the antidiarrheal diosmectite effects can open new possibilities for the treatment of acute and chronic diarrhea in the internal medicine clinic., Острая и хроническая диарея — тяжелые клинические синдромы, которые могут наблюдаться при разных заболеваниях внутренних органов. Неустановленная причина диарейного синдрома затрудняет назначение этиотропной терапии. Эффективное и своевременное лечение способствует улучшению качества жизни и препятствует развитию осложнений. «Смекталия» — новая форма диоктаэдрического смектита, антидиарейного препарата, применяемого для лечения инфекционно-воспалительных заболеваний кишечника, а также диарейного синдрома разной этиологии. Благодаря пространственной структуре и высокой пластической вязкости диосмектит имеет высокую обволакивающую способность по отношению к слизистой оболочке желудочно-кишечного тракта. Взаимодействуя с гликопротеинами пристеночной слизи, увеличивает толщину муцинового слоя, повышает вязкость муцина и уменьшает его растворимость, восстанавливая цитопротективые свойства слизистой оболочки, в результате чего возрастает ее резистентность к воздействию повреждающих факторов (желчных кислот, свободных радикалов, бактериальных токсинов). Диосмектит связывает некоторые бактериальные и вирусные токсины, что, как полагают, способствует его антидиарейному эффекту. Сообщалось о клинических доказательствах влияния диосмектита на диарею у больных с воспалительными заболеваниями кишечника. Так, он уменьшал диарею, индуцированную эндогенными агентами, особенно воспалительными цитокинами или другими факторами, в том числе при воспалительных заболеваниях кишечника. В литературе имеются сообщения об эффективном применении диоктаэдрического смектита для лечения диареи при эндокринной патологии, диарее, развившейся в результате лучевой терапии, химиотерапии и синдрома приобретенного иммунодефицита прокальцитонина. Понимание антидиарейных эффектов диосмектита может открыть новые возможности для лечения острой и хронической диареи в клинике внутренних болезней., Гостра і хронічна діарея — тяжкі клінічні синдроми, які можуть спостерігатися при різних захворюваннях внутрішніх органів. Невстановлена причина діарейного синдрому ускладнює призначення етіотропної терапії. Ефективне та своєчасне лікування сприяє поліпшенню якості життя і запобігає розвит­ку ускладнень. «Смекталія» — нова форма діоктаедричного смектиту, антидіарейного препарату, який застосовують для лікування інфекційно-запальних захворювань кишечника, а також діарейного синд­рому різної етіології. Завдяки просторовій структурі і високій пластичній в’язкості діосмектит має високу обволікаючу здатність щодо слизової оболонки шлунково-кишкового тракту. Взаємодіючи із глікопротеїнами пристінкового слизу, збільшує товщину муцинового шару, підвищує в’язкість муцину і зменшує його розчинність, відновлюючи цитопротективні властивості слизової оболонки, в результаті чого зростає її резистентність до впливу ушкоджувальних чинників (жовчних кислот, вільних радикалів, бактеріальних токсинів). Діосмектит зв’язує деякі бактеріальні та вірусні токсини, що, як вважають, сприяє його антидіарейному ефекту. Повідомлялося про клінічні докази впливу діосмектиту на діарею у хворих із запальними захворюваннями кишечника. Так, він зменшував діарею, індуковану ендогенними агентами, особливо запальними цитокінами або іншими чинниками, зокрема при запальних захворюваннях кишечника. У літературі є повідомлення про ефективне застосування діоктаедричного смектиту для лікування діареї при ендокринній патології, діареї, яка виникла внаслідок променевої терапії, хіміотерапії та синдрому набутого імунодефіциту прокальцитоніну. Розуміння антидіарейних ефектів діосмектиту може відкрити нові можливості для лікування гострої і хронічної діареї в клініці внутрішніх хвороб.

Critical states developed during infectious diseases are amongst main causes of lethal outcomes in children. The objective of the study: to find major signs of iatrogenic risk of critical states during infectious diseases in children. Subjects and methods. The examination protocols of 1 237 children in the age from 3 months to 15 years old were studied, all children had sepsis and were staying in central district hospitals and managed by doctors from emergency wards and planned care units from 2007 to 2011. Results of the study. The retrospective analysis proved the significance of the delayed start of intensive care for the risk of unfavorable outcome of gastrointestinal infections in children. The maximum permissible time of 45 minutes before the start of intensive care was substantiated. The risk factors of unfavorable outcome of gastrointestinal infections were defined for the period of treatment before the transfer to anesthesiology and intensive care wards: early prescription of intestinal antiseptics during in-take of antidiarrheal drugs (OR=4.0) and use of paracetamol and ibuprofen (OR=3.2). Conclusion: intensive care started as early as possible in children with infectious diseases and initiated within 15 minutes after the admission to intensive care ward is associated with the reduced risk of a lethal outcome.

The aim of this study is to evaluate antidiarrheal activity of SKB_Gutbiotic against Castor oil and E.coli induced diarrhea in Swiss albino mice and Sprague Dawley rats. In present study three doses of SKB_Gutbiotic were tested against castor oil induced diarrhea in mice. Its effect on co-administration with l-arginine was studied. SKB_Gutbiotic delayed onset of diarrhea, reduced fecal output and fecal weight. In Gastrointestinal transit time and Castor oil induced enteropooling, SKB_Gutbiotic significantly reduced peristaltic index and volume of intestinal content respectively. In E.coli induced diarrhea model, E.coli suspension was administered for 3 days for inducing diarrhea. SKB_Gutbiotic significantly and dose dependently reduced fecal output, improved fecal consistency, reduced fecal water content and improved WBC count. Histopathological images showed improvement in damage caused to the mucosal epithelium due to E.coli and also improved complete crypt cell architecture and integrity of goblet cells. These results indicated that SKB_Gutbiotic can be used as an antidiarrheal agent against castor oil and E.coli induced diarrhea. It inhibits colonization of E.coli bacteria on colonic epithelium which results into decreased intestinal hypersecretion and motility which is very useful in the management of infectious diarrhea. Thus SKB_Gutbiotic could be an effective alternative to standard antidiarrheal drugs.

The mortality rate from diarrhea for children younger than 5 years has decreased from almost five million in the 1980s to over 600,000 in 2015. This remarkable decrease was achieved through the int...

OBJECT It appears to be possible to measure the outbreak of infectious diseases with accompanying diarrhea by early detection of an outbreak. However, because some diseases are reported weekly from sentinel medical institutions, early detection of outbreaks might be inadequate. In this study, we examined the number of patients with diarrhea assessed with prescription surveillance and validated its association with the number of patients who have infectious diseases with diarrhea. METHODS The number of patients who were prescribed an antidiarrheal drug or intestinal drug was estimated for each prefecture using the prescription surveillance system from April 1, 2011 through March 31, 2014. Moreover, we examined the association between the prevalence of diarrhea in prescription surveillance and the number of patients with diarrheal infectious diseases. RESULTS Results showed a positive correlation between the prevalence of diarrhea in prescription surveillance and the number of reported cases per sentinel with gastrointestinal infections. However, no positive correlation was found with the others infectious diseases. CONCLUSION Estimation of the number of patients with diarrhea in prescription surveillance might facilitate early detection of an outbreak of gastrointestinal infections.

Approximately 10 % of travelers to tropical destinations visit their doctors upon return, with diarrheal processes the most common reason for the visits. The etiology of imported diarrhea can be divided into infectious, postinfectious and noninfectious. Traveler's diarrhea occurs during the first week of their stay and resolves spontaneously in a few days. The 3 fundamental pillars of treatment are fluid therapy, antibiotics and antidiarrheal drugs. The persistence of diarrhea beyond a month after experiencing traveler's diarrhea is uncommon. The most common cause is infection; however, there are other etiologies such as postinfections and the start of chronic gastrointestinal diseases such as inflammatory bowel disease.

Chronischer Diarrhoe konnen zahlreiche Ursachen zugrunde liegen, so dass eine geeignete Basisdiagnostik erforderlich ist. Wann immer moglich sollte entsprechend eine spezifische Therapie durchgefuhrt werden. Ist keine spezielle Therapie moglich, kann eine symptomatische Therapie eingeleitet werden, um dem massiven Elektrolyt- und Wasserverlust entgegenzuwirken und eine Besserung der Lebensqualitat des Patienten zu erreichen. Zum Einsatz kommen insbesondere Loperamid, Colestyramin, Quellstoffe/Ballaststoffe, Probiotika, Anticholinerika und bei schweren Verlaufen Opioide. Bei sachgemasem Einsatz der o. g. Medikamente ist selbst eine Dauertherapie mit einem niedrigen Nebenwirkungspotential verbunden.

In the article the results of a comprehensive expert evaluation of drugs for the treatment of viral diarrhea (VD) in children as an important stage in the development of regulatory socioeconomic lists (SEL) are presented. In particular the results of calculations of expert competency were given and was found that among the totality of respondents almost 15% of the experts have experience in the specialty for over 20 years, 50% - from 10 to 20 years of service, indicating the high experience of the physicians surveyed. In addition, 92% of experts have higher or the first qualification category, which confirms the high professional level of the respondents. It was established that 76% of the sample LP evaluated by competent experts were recommended for inclusion in recommended SEL for the treatment of VD in children. The calculations allowed to found the inclusion to recommended SEL of the last 19 drugs by trade names corresponding to the 5th pharmacological groups and an additional 3 drugs by INN. The results can be used in future to create the recommended insurance (primary and secondary) lists of drugs for pharmacotherapy VD in children if provided additional pharmacoeconomic studies that question remains relevant national health care system in the implementation of health insurance., В статье представлены результаты комплексной экспертной оценки ЛП для лечения вирусных диарей (ВД) у детей, как одного из важных этапов в разработке системы регулирующих социально-экономических перечней (СЭП). В частности, приведены результаты расчетов показателей компетентности детских инфекционистов и установлено, что среди общей совокупности опрошенных респондентов почти 15% экспертов имели стаж работы по специальности более 20 лет, 50% - от 10 до 20 лет стажа, что свидетельствует о высоком профессионализме опрошенных врачей. Кроме того, 92% экспертов имели высшую или первую квалификационную категорию, что подтверждает высокий профессиональный уровень респондентов. Установлено, что 76% выборки ЛП, которые оценивались компетентными экспертами, были рекомендованы для дальнейшего изучения относительно включения в СЭП для лечения ВД у детей. По результатам расчетов по обоснованию рекомендованного СЭП ЛП для лечения ВД у детей установлена возможность включения в последний 19 ЛП по торговыми названиями, соответствующие 5-и фармакотерапевтическим группам и дополнительно ЛП по 3-м INN. Представленные результаты могут быть использованы в дальнейшем для создания рекомендованных страховых (основного и дополнительного) перечней ЛП для фармакотерапии ВД у детей с учетом дополнительных фармакоэкономических исследований, что остается актуальным вопросом отечественной системы здравоохранения в условиях внедрения медицинского страхования, У статті представлені результати комплексної експертної оцінки ЛП для лікування вірусних діарей (ВД) у дітей, як одного з важливих етапів у розробці системи регулюючих соціально-економічних переліків (СЕП). Зокрема наведені результати розрахунків показників компетентності дитячих інфекціоністів та встановлено, що серед загальної сукупності опитаних респондентів майже 15% експертів мали стаж роботи за спеціальністю понад 20 років, 50% - від 10 до 20 років стажу, що свідчить про високу досвідченість опитаних лікарів. Окрім того, 92% експертів мали вищу або першу кваліфікаційну категорію, що підтверджує високий професійний рівень респондентів. Встановлено, що 76% вибірки ЛП, що оцінювалися компетентними експертами було рекомендовано до включення у рекомендований для подальшого вивчення СЕП для лікування ВД у дітей. За результатами розрахунків щодо обґрунтування рекомендованого СЕП ЛП для лікування ВД у дітей встановлено можливість включення в останній 19 ЛП за торгівельними назвами, що відповідають 5-м фармакотерапевтичним групам та додатково ЛП за 3-ма INN. Представлені результати можуть бути використані в подальшому для створення рекомендованих страхових (основного та додаткового) переліків ЛП для фармакотерапії ВД у дітей за умови додаткових фармакоекономічних досліджень, що залишається актуальним питанням вітчизняної системи охорони здоров’я в умовах впровадження медичного страхування

Introduction Worldwide, acute gastroenteritis in children, usually caused by viruses, leads to considerable morbidity and mortality. The treatment is aimed at preventing and treating dehydration, promoting weight gain after rehydration, and reducing the duration and severity of diarrhoea. Effective and inexpensive interventions that could add to the effect of oral rehydration therapy are of interest. Recently, in many European countries, gelatine tannate is being widely marketed for treating acute gastroenteritis. Gelatine tannate is a complex of tannic acid, which possesses astringent and anti-inflammatory properties, and a protective gelatine. Currently, there is no evidence to support the use of gelatine tannate for treating acute gastroenteritis in children and only scant evidence to support the use of gelatine tannate in adults. We aim to assess the efficacy of gelatine tannate for the treatment of acute gastroenteritis in children. Methods and analysis This will be a blind, placebo-controlled, randomised trial. Children younger than 5 years of age with acute gastroenteritis defined as a change in stool consistency to loose or liquid form (according to the Bristol Stool Form scale or Amsterdam Stool Form scale) and/or an increase in the frequency of evacuations (typically ≥3 in 24 h), lasting for no longer than 5 days, will be recruited. A total of 158 children will be randomised to receive either gelatine tannate (children younger than 3 years of age will receive 250 mg, 4 times/day, and those older than 3 years of age will receive 500 mg, 4 times/day) or matching placebo for 5 days. The primary outcome measure is the duration of diarrhoea. Ethics and dissemination The Bioethics Committee approved the study protocol. The findings of this trial will be submitted to a peer-reviewed paediatric journal. Abstracts will be submitted to relevant national and international conferences. Trial registration number NCT02280759; Pre-results.

Diarrhea is one of the most common causes for thousands of deaths every year. Therefore, identification of new source of antidiarrheal drugs becomes one of the most prominent focuses in modern research. Our aim was to investigate the antidiarrheal and cytotoxic activities of methanolic extract ofMaranta arundinacealinn. (MEMA) leaves in rats and brine shrimp, respectively. Antidiarrheal effect was evaluated by using castor oil-induced diarrhea, enteropooling, and gastrointestinal motility tests at 200 mg/kg and 400 mg/kg body weight in rats where the cytotoxic activity was justified using brine shrimp lethality bioassay at different concentrations of MEMA. The extract showed considerable antidiarrheal effect by inhibiting 42.67% and 57.75% of diarrheal episode at the doses of 200 and 400 mg/kg, respectively. MEMA also significantlyp<0.01reduced the castor oil-induced intestinal volume (2.14 ± 0.16 to 1.61 ± 0.12 mL) in enteropooling test as well as intestinal transit (33.00 to 43.36%) in GI motility test, compared to their respective control. These observed effects are comparable to that of standard drug loperamide (5 mg/kg). On the other hand, in brine shrimp lethality test after 24 h, surviving brine shrimp larvae were counted and LD50was assessed. Result showed that MEMA was potent against brine shrimp with LD50value of 420 µg/mL. So the highest dose of 400 µg/mL of MEMA was not toxic to mice. So these results indicate that bioactive compounds are present in methanolic extract ofMaranta arundinacealeaves including significant antidiarrheal activity and could be accounted for pharmacological effects.

BACKGROUND: The major burden of acute gastroenteritis (AGE) in childhood is related to its high frequency and the large number of hospitalizations, medical consultations, tests and drug prescriptions. The adherence to evidence-based recommendations for AGE management in European countries is unknown. The purpose of the study was to compare hospital medical interventions for children admitted for AGE with recommendations reported in the European Societies of Pediatric Gastroenterology, Hepatology and Nutrition and Pediatric Infectious Diseases guidelines. METHODS: A multicenter prospective study was conducted in 31 Italian hospitals. Data on children were collected through an online clinical reporting form and compared with European Societies of Pediatric Gastroenterology, Hepatology and Nutrition and Pediatric Infectious Diseases guidelines for AGE. The main outcomes were the inappropriate hospital admissions and the percentage of compliance to the guidelines (full >90%, partial >80% compliance) based on the number and type of violations to evidence-based recommendations. RESULTS: Six-hundred and twelve children (53.6% male, mean age 22.8 ± 15.4 months) hospitalized for AGE were enrolled. Many hospital admissions (346/602, 57.5%) were inappropriate. Once admitted, 20.6% (126/612) of children were managed in full compliance with the guidelines and 44.7% (274/612) were managed in partial compliance. The most common violations were requests for microbiologic tests (404; 35.8%), diet changes (310; 27.6%) and the prescription of non-recommended probiotics (161; 14.2%), antibiotics (103; 9.2%) and antidiarrheal drugs (7; 0.6%). CONCLUSIONS: Inappropriate hospital admissions and medical interventions are still common in the management of children with AGE in Italy. Implementation of guidelines recommendations is needed to improve quality of care

Individual drugs and classes of drugs page 431 Analgesics and adjuvant analgesics 431 Antibiotics 439 Anticoagulants and protamine 450 Antidiarrheal drugs 456 Antiemetics 458 Antifungal agents: systemic use 458 Antifungal agents: Topical oral use 462 Antifungal agents: Topical dermatologic use 463 Antineoplastic agents 466 Antivirals 471 Electrolytes 476 Immunosuppressive agents 480 Targeted Therapies 487 Miscellaneous 488 Further reading 491 The list of side effects discussed in this chapter is far from complete; the specialized literature, databases and package inserts should always be carefully consulted. Individual drugs and classes of drugs Analgesics and adjuvant analgesics Effective control of pain, especially from oropharyngeal mucositis secondary to the pretransplant conditioning regimen or posttransplant methotrexate, is essential in the BMT unit. Some of the most common medications used for pain are reviewed in this section. Acetaminophen Acetaminophen (Paracetamol) is an analgesic and antipyretic, but has no anti-inflammatory activity. It is well-absorbed orally and rectally, and comes in dosage forms including tablets, capsules, oral liquid, and suppositories. Acetaminophen is metabolized in the liver, and its metabolites are excreted in urine. Its duration of action is about 4 hours. Acetaminophen does not cause gastric irritation and is the analgesic of choice for mild pain. The maximum recommended daily dose of acetaminophen is 4 g. In some cases, such as in the palliative care setting or for acute pain, higher doses can be given for short durations. In these situations, risk factors must be taken into account, and patients must be monitored carefully.

Diarrhea represents a major health problem for travelers to developing countries. Although the syndrome is usually self-limited and recovery occurs in the majority of cases without any specific form o

Diarrhea represents a major health problem for travelers to developing countries. Although the syndrome is usually self-limited and recovery occurs in the majority of cases without any specific form o

Objective: In this study, we aimed to assess knowledge, attitude, and practice of community pharmacists toward administration of over-the-counter (OTC) antidiarrheal drugs in our city pharmacies, Shiraz, Iran. Methods: In this descriptive cross-sectional study, 90 pharmacies among 128 pharmacies in our city were randomly chosen. The study was designed into two phases: A standard questionnaire to determine the level of knowledge and attitude of pharmacists and a simulated client method to evaluate practice among them. An educational pamphlet was then given to the pharmacists. One month later, knowledge, attitude, and performance of studied pharmacists were evaluated again using the same method. Findings: Our results showed that an average consultation time by female pharmacists was considerably more than male pharmacists (P < 0.001). Before intervention, only 37.8% of pharmacists performed appropriately by prescribing the proper medicine while this increased to 58.44% after intervention. The average score of pharmacists′ knowledge was statistically increased (P < 0.001) and the pharmacists′ performance was significantly improved (P < 0.001) after the educational intervention. In related to the attitude, pharmacists′ tendency toward prescribing oral rehydration salt solutions (ORS) (P < 0.001) and their belief about the great effect of ORS on the treatment of diarrhea increased significantly after the intervention. Conclusion: It is concluded that training programs such as educational pamphlets and continuing educational seminars may play important roles in increasing pharmacists′ knowledge and therefore improving their performance in prescribing OTC medicines.

Age limits and exclusion criteria for transplantation page 237 Commonly used upper age limits for transplantation 237 Exclusion criteria for transplantation 237 SCT-specific comorbidity index 238 General pretransplant workup 240 Definition of disease chemosensitivity 241 Mobilization of autologous blood stem cells 241 Mobilization protocols 241 When to start leukapheresis 241 Venous access for leukapheresis 242 How many cells to collect 242 Alternative cytokines/chemokines for stem cell mobilization 242 Reasons for poor leukapheresis yields 243 Approach to patients who are poor mobilizers 243 Advantages and disadvantages of blood stem cell transplantation 244 Allogeneic donor workup 244 Choice of allogeneic donor 245 Commonly used prophylactic medications 245 Treatment of CNS leukemia pretransplant 246 Central venous catheter management 247 Triple-, double-, and single-lumen right atrial catheters 247 Insertion of the catheter 248 Safe management of the catheter 249 Management of a dislodged catheter 249 Dressing the catheter exit site 250 Drawing blood from a catheter 251 Capping and flushing the catheter 252 Removing the catheter 253 Management of a nonfunctioning catheter 253 Other potential problems 256 Medications and special considerations regarding conditioning regimens 257 Fluid regime for conditioning regimens 257 Antiemetic regime for conditioning regimens 258 Total-body irradiation 259 Protocol for the day of transplant 259 The marrow donor 259 The recipient 260 Bone marrow harvest 260 Obese donors 261 Marrow cell dose 262 Transfusion guidelines for bone marrow infusion 264.

A diarréia constitui uma das principais causas de morbi-mortalidade na infância. As farmácias são locais bastante procurados pela população para resolução de problemas de saúde. Visando contribuir para o uso racional de medicamentos, mediante promoção da TRO, foi realizado um estudo de intervenção em farmácias de Corumbá e Ladário. Os medicamentos mais indicados foram SRO (50%), antidiarréicos (39%), Sulfametoxazol/Trimetoprim (27%) e levedo (22%) na entrevista semi-estruturada; SRO (75%), Sulfametoxazol/Trimetoprim (25%) e levedo (25%) nas respostas ao questionário, demonstrando a importância do uso de mais de uma metodologia para a obtenção de dados fidedignos. A intervenção educativa foi realizada em 86,7% das farmácias. Os resultados mostraram que mesmo tendo adquirido conhecimento do manejo adequado da diarréia, os trabalhadores de farmácia ainda recomendam outros medicamentos e não SRO exclusivamente. O trabalho evidencia que para conseguir a adesão dos trabalhadores de farmácia aos protocolos oficiais para episódios diarréicos, necessita-se também de medidas normativas em relação aos medicamentos contra-indicados para crianças e reformular as atividades da farmácia e do farmacêutico.

Methods Adult patients under LPV/r SGC Tx for at least 6 months, and with >95% adherence, were included. Following data were collected: overall GI side-effects; presence and gradation of diarrhea according to WHO severity scale; antidiarrheal drugs administration during the last month under LPV/r SGC Tx, and during 2nd and 6th month after switching to LPV/r tablets. Also, patient Tx satisfaction grade and preferences data were gathered.

Objective: (1) To determine the extent to which antibiotics and antidiarrhea1 drugs are prescribed to children with acute diarrhea and to detect any urban/rural difference in prescribing pattern. (2) Determine most common forma of antibiotics and anridiarrheal drugs prescribed to those children. This is a pre-Intervention study to determine the current treatment practice of acute gastroenreritis. Design: A cross-sectIonal study using prospective data. The following data were collected for each patient : age, sex, temperature, blood and mucus in stools, ancihmtics and antidiarrheal prescribed. Setting: 10 urhan and 10 rural primary health care government fdcilities Participants: 30 consecutive cases of acute gastroenteritis in mfants and children less rhan 3 years were taken from each facdity. At the end of the study, information was available for 512 children. Intervention: None. Main Outcome Measure(s): Antibiotics and antidiarrheal drugs prescribed. Results: Antibiotics were prescribed m 244 children (49%). Out of those who received annbiotics, 31% had no blood and mucus in stools. Antidiarrhcals were prescribed ro 288 children (56%). No urban/rural difference was found regarding antibiotics or antidiarrheals prescribing (OR 0.62, 95% Cl 0.36-1.06 for antibiotics and OR 1.04, 95% Cl 0.61-1.78 for antidiarrheals).The mosr common antibiotic used was metronidazole (61%), followed by trimethoprim and sulphamethoxazole (32%). The most common antidiarrheal prescribed was kaolin and pectin (85%). Logistic regression showed that factors associated with antibiotics mescribing are: blood and mucus in stools (OR 66, 95% Cl 15.35-283.95); male sex(OR 2.1, 95% Cl l.ll4.02). and older age (OR 1.1, 95% Cl 1.02-1.1). Conclusion: Amyhmtics and amidiarrheal drugs are overused in treating acute diarrhea. There is a great need for an intervention program focusing on a more rational use of such drugs.

We review the use of antidiarrheal medications in inflammatory bowel disease, commenting on potential underlying immunologic mechanisms as a background for discussion of the clinical usage of antidiarrheal medications in this disease spectrum. We comment on new directions for the development of more effective therapeutic approaches and discuss the mechanism of action of antidiarrheal drugs, with emphasis on synthetic opiates.

The chronically prepared gut with strain-gauge transducers is a useful model to evaluate the effects of drugs affecting the digestive motility in fed and fasted animals. This paper describes a rapid and reproducible on-line microcomputerized technique to evaluate continuously, 23 hr per day, the level of gut motility using a portable compact microcomputer (EPSON HX 20). The gastric, intestinal, and colonie motility indexes were automatically determined from the surface of the contractile waves from eight different sites over periods of time varying from 1 to 120 min. This system has been successfully used to investigate the motor effects of spasmolytic or antidiarrheal drugs intravenously (N-butyl-hyoscine, trospium, secoverine, and prifinium) or orally (trimebutine, loperamide) administered in conscious, fed dogs.

Visitors to developing areas of the world are at high risk for contracting travelers' diarrhea (TD). Despite proven effectiveness in the prevention of TD, prophylactic use of antidiarrheal agents is controversial. Most authorities recommend against the routine use of drugs for the prevention of TD. This article presents data from surveys of pharmacists and their spouses participating in vacation-study tours to countries associated with a high risk of TD. Patterns of antidiarrheal drug use are compared with the recommended practices regarding both prophylactic and symptomatic therapy. Generally, the subjects in this study adhered closely to recommended practices. Nevertheless, although a majority employed dietary restrictions for TD prevention, 22.8 percent took antidiarrheal drugs prophylactically. Nearly half took antidiarrheal agents for symptomatic use. The ingredients most frequently mentioned matched current recommendations. Inappropriate practices included the use of prophylactic agents without dietary restrictions, and the use of antimotility agents prophylactically. Patterns of dietary and antidiarrheal drug use are compared, including intended versus actual, prophylactic versus symptomatic, and prescription versus nonprescription product use. The controversy regarding the use of prophylactic drug therapy for TD is discussed.

A castor oil model of induced diarrhea was used to evaluate dose regimens of the standard antidiarrheal polycarbophil. The study population consisted of 100 healthy volunteers, divided into five groups of 20 each, in whom diarrhea was induced by 120 ml flavored 36.4% castor oil. The polycarbophil dose regimens evaluated were 1, 1.5, 2, or 3 gm at 30-min intervals after castor oil to total the usual prescribed dose of 6 gm/day. One gram taken every 30 min for six doses lowered the number of bowel movements and also induced the least number of cramps and lowest cramp severity rating (reported by subjects). The same total dose over a different dosing interval was no more effective than placebo. Clinical Pharmacology and Therapeutics (1982) 31, 766–769; doi:10.1038/clpt.1982.108

In a consecutive series of 46 possible candidates for total colectomy, mucosal proctectomy, and ileal reservoir to an anal anastomosis, we have compared the clinical outcome of group I, with a long efferent leg (12 cm), and group II, with a short efferent leg (3-5 cm). The surgical procedure was done in three steps: first, a total colectomy; second, mucosal proctectomy and construction of an 'S-shaped' ileal reservoir with a temporary loop ileostomy; and, third, closing of the ileostomy. Nine patients with a long efferent leg and eight patients with a short leg were observed for 2-51 months with a functioning ileal reservoir. The overall mortality was zero. The results showed that the short efferent leg was important for low fecal urgency, spontaneous evacuation of stools, minimal soiling, independence of reservoir catheterization, and use of antidiarrheal drugs. The length of the efferent leg did not influence the function of the anal sphincter itself. The postoperative sexual life was unchanged, and all patients in group II had a better resocialization than those in group I. The selection of candidates for ileal reservoir operations from among patients with ulcerative colitis or familiar polyposis is most important because of a relatively long postoperative course and high incidence of surgical complications.

Diarrhea is a disease characterized by an increase in the frequency of defecation more than three times a day accompanied by changes in shape and consistency of feces of patients. Bacterial, viral or parasitic infections can cause diarrhea. This study aimed to determine the profile of the use of antidiarrheal drugs for one semester in 3 South Barito District Health Centers namely Bangkuang Health Center, Sababilah Health Center, and Buntok Health Center. The results showed that there were differences in the use of drugs in each Health Center. Based on the type of drug that is most widely used, namely for the Bangkuang Health Center was Zink (1300 prescription), for Sababilah Health Center was Metronidazole (1350 prescription), and for Buntok Health Center was Cotrimoxazole (4650 prescriptions). Based on the age of patients aged 18-60 years for Bangkuang Health Center as many as 120 people, 279 people for Sababilah Health Center, and 315 people for Buntok Health Center. Based on male and female sex, for Bangkuang Health Center were 98 males and 167 females, for Sababilah Health Center were 233 males and 258 females, and for Buntok Health Center were 298 males and 398 females. Further research needed for a long time regarding the use of antidiarrheal drugs in other Health Centers.

Gelatin tannate (GT) is a complex of tannic acid, which possesses astringent, antibacterial, and anti-inflammatory properties, and a protective gelatin. It is increasingly being marketed as an antidiarrheal drug. Our aim was to review data on the effectiveness of GT in treating acute gastroenteritis (AGE) in children and adults. The MEDLINE, EMBASE, and the Cochrane Library databases were searched in July 2013, with no language restrictions, for controlled clinical trials. Additional references were obtained from reviewed articles. Two trials met the inclusion criteria. In adults, one randomized controlled trial involving 40 subjects (mean age: 43±13 years) found that, compared with placebo, GT may be more effective at reducing some symptoms of AGE in the first 48 h after initiation of treatment. In children, one poor quality study (no randomization and no blinding) involving 211 children (mean age: 2.5±2.4 years) reported some beneficial effect of GT at 12 h after initiation of treatment. None of the studies evaluated the effect of GT on the primary outcome measures for this review such as stool output, duration of diarrhea, admission to hospital, duration of hospital stay, and (in children) weight gain after rehydration. Currently, there is no evidence to support the use of GT for treating AGE in children and only sparse evidence to support the use of GT in adults. Further well-designed trials, with sufficient power, adequate follow-up periods, and clinically relevant outcome measures, are needed. These include stool volume, duration of diarrhea, admission to hospital, duration of hospital stay, weight gain after rehydration, and adverse effects.