syndrome p. 34 ). It may also occur when intestinal motility
or morphology is altered.
Prompt investigation is required to identify or exclude any
serious underlying cause if the child has any redflag
symptoms as such unexplained weight loss, rectal bleeding,
persistent diarrhoea, a systemic illness, has received recent
hospital treatment or antibiotic treatment, or following
foreign travel (other than to Western Europe, North
America, Australia or New Zealand).Aims of treatment
The priority in acute diarrhoea treatment, as in gastro-
enteritis, is the prevention or reversal offluid and electrolyte
depletion and the management of dehydration when it is
present. This is particularly important in infants, when
excessive water and electrolyte loss and dehydration can be
life-threatening.Treatment
Most episodes of acute diarrhoea will settle spontaneously
without the need for any medical treatment.gOral
rehydration therapy (ORT, such as disodium hydrogen
citrate with glucose, potassium chloride and sodium chloride
p. 591 ; potassium chloride with sodium chloride p. 588 ;
potassium chloride with rice powder, sodium chloride and
sodium citrate p. 591 ) is the mainstay of treatment to
prevent or correct diarrhoeal dehydration and to maintain
the appropriatefluid intake once rehydration is achieved—
see Fluids and electrolytes p. 583.
However, in children with severe dehydration and in those
unable to drink, immediate admission to hospital and urgent
replacement treatment with an intravenous rehydration
fluid is recommended—see Fluids and electrolytes p. 583.
ORT is recommended for children atincreased risk of
dehydrationand for thosewith clinical dehydration(including
hypernatraemic dehydration). If the child is unable to drink
the ORT, or vomits persistently, consider giving the solution
via a nasogastric tube.
In infants, after rehydration, encourage breast-feeding,
other milk feeds andfluid intake. In older children, after
rehydration, give full-strength milk straight away,
reintroduce the child’s usual solid food, and avoid giving
fruit juices and carbonated drinks until the diarrhoea has
stopped.
In children with gastroenteritis, butwithout clinical
dehydration, encouragefluid intake, continue breast-feeding
and other milk feeds, and discourage the drinking of fruit
juices and carbonated drinks.
In general, antidiarrhoeal drugs have no practical benefit
for children with acute or persistent diarrhoea and their use
is generally not recommended (side-effects include
drowsiness, abdominal distension and ileus).h
Racecadotril p. 49 is licensed, as an adjunct to rehydration,
for the symptomatic treatment of uncomplicated acute
diarrhoea in children over 3 months; it should only be used
when supportive measures, including oral rehydration, are
insufficient to control the condition.
Antibacterial drugs for acute diarrhoea
gAntibacterial treatment isnotrecommendedroutinely
for children with acute diarrhoea. Antibacterial treatment is
recommended in cases of extra-intestinal spread of bacterial
infection;Clostridum difficile-associated pseudomembranous
colitis; giardiasis, dysenteric shigellosis, dysenteric
amoebiasis, or cholera; in children under 6 months with
salmonella gastroenteritis; in children who are
malnourished or immunocompromised; and in children with
suspected or confirmed septicaemia. For children who have
recently been abroad, seek specialist advice about
antibacterial therapy.hRelated drugs
Other drugs used for diarrhoea: codeine phosphate p. 276 ,
colestyramine, p. 129 , methylcellulose p. 40.ANTIDIARRHOEALS›ANTIPROPULSIVES
eiiiiF 273Co-phenotrope
lINDICATIONS AND DOSE
Adjunct to rehydration in acute diarrhoea
▶BY MOUTH
▶Child 2–3 years: 0. 5 tablet 3 times a day
▶Child 4–8 years: 1 tablet 3 times a day
▶Child 9–11 years: 1 tablet 4 times a day
▶Child 12–15 years: 2 tablets 3 times a day
▶Child 16–17 years:Initially 4 tablets, followed by
2 tablets every 6 hours until diarrhoea controlled
Control of faecal consistency after colostomy or ileostomy
▶BY MOUTH
▶Child 2–3 years: 0. 5 tablet 3 times a day
▶Child 4–8 years: 1 tablet 3 times a day
▶Child 9–11 years: 1 tablet 4 times a day
▶Child 12–15 years: 2 tablets 3 times a day
▶Child 16–17 years:Initially 4 tablets, then 2 tablets
4 times a daylUNLICENSED USENot licensed for use in children under
4 years.
lCONTRA-INDICATIONSGastro-intestinal obstruction.
intestinal atony.myasthenia gravis (but some
antimuscarinics may be used to decrease muscarinic side-
effects of anticholinesterases).paralytic ileus.pyloric
stenosis.severe ulcerative colitis.significant bladder
outflow obstruction.toxic megacolon.urinary retention
lCAUTIONSPresence of subclinical doses of atropine may
give rise to atropine side-effects in susceptible individuals
or in overdosage.young children are particularly
susceptible tooverdosage; symptoms may be delayed and
observation is needed for at least 48 hours after ingestion
lINTERACTIONS→Appendix 1 : atropine.opioids
lSIDE-EFFECTSAbdominal discomfort.angioedema.angle
closure glaucoma.appetite decreased.arrhythmia.
cardiac disorder.depression.dry skin.dysuria.fever.
gastrointestinal disorders.lethargy.malaise.mucosal
dryness.mydriasis.restlessness.vision disorders
lPREGNANCYManufacturer advises caution.
lBREAST FEEDINGMay be present in milk.
lHEPATIC IMPAIRMENTAvoid in jaundice.
lDIRECTIONS FOR ADMINISTRATIONFor administrationby
mouthtablets may be crushed.
lPRESCRIBING AND DISPENSING INFORMATIONA mixture of
diphenoxylate hydrochloride and atropine sulfate in the
mass proportions 100 parts to 1 part respectively.
lEXCEPTIONS TO LEGAL CATEGORYCo-phenotrope
2. 5 / 0. 025 can be sold to the public for adults and children
over 16 years (provided packs do not contain more than
20 tablets) as an adjunct to rehydration in acute diarrhoea
(max. daily dose 10 tablets).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
▶Co-phenotrope (Non-proprietary)
Atropine sulfate 25 microgram, Diphenoxylate hydrochloride
2.5 mgLomotil 2. 5 mg/ 25 microgram tablets|
100 tabletPsm
Lofenoxal 2. 5 mg/ 25 microgram tablets| 20 tabletPsm48 Diarrhoea BNFC 2018 – 2019
Gastro-intestinal system1