ANTI DIAREDharma Permana, PhD, Apt

Anti DiareIn diarrhea, the food and fluids you ingest pass too quickly or in too large an amount or both through your colon

The most common causes of diarrhea include:Viruses. Common viruses that cause diarrhea are the Norwalk virus, cytomegalovirus, viral hepatitis and the herpes simplex virus. Rotavirus is the most common cause of acute childhood diarrhea. Viral diarrhea spreads easily. Bacteria and parasites. Contaminated food or water can transmit bacteria and parasites to your body. - Parasites such as Giardia lamblia and cryptosporidium can cause diarrhea. -Common bacterial causes of diarrhea include campylobacter, salmonella, shigella, vibrio cholerae and Escherichia coli. This type of diarrhea can be common for people traveling to developing countries.

Common causes of travelers diarrhea

Bacteria (70%) Parasites VirusesE. coli Giardia lamblia Noro-virusesSalmonella spp Cryptosporidium parvum RotavirusCampylobacter jejuni Entamoeba hystoliticaShigella spp Cyclospora cayetanensisVibrio cholerae and other spp

Other causes of diarrhea:

Lactose. A sugar found in milk and milk products, lactose is a common cause of diarrhea in some people. Medications. Diarrhea can also be a side effect of many medications, particularly antibiotics. Antibiotics destroy both good and bad bacteria, which can disturb the natural balance of bacteria in your intestines. This disturbance sometimes leads to an infection with bacteria called Clostridium difficile, which can also cause diarrhea. Artificial sweeteners. Sorbitol and mannitol, artificial sweeteners found in chewing gum and other sugar-free products, can cause diarrhea in some otherwise healthy people. Surgery. Some people may experience diarrhea after undergoing abdominal surgery or gallbladder removal surgery. Other digestive disorders. Chronic diarrhea has a number of other causes, such as Crohn's disease, ulcerative colitis, celiac disease and irritable bowel syndrome.

Obat obat anti diareOralitAdsorben dan Pembentuk masa Anti Spasmodik/ anticholinergicAnti MotilitasAnti Microbabakteri, amuba

OralitPertolongan pertama pada diareKomposisi oralit Glukosa anhidrat 4 NaCl 0,7 Na sitrat dihydrat 0.58 aqua ad 200 ml

Oralit tidak menghentikan diare, tetapi mengantikan cairan tubuh yg hilang bersama tinjaTiap kali BAB diberi Oralit Dehidrasi ringan/ sedang < 1th min 300 ml, 1-4 th min 600ml 5-12 th min 1,2 L dan Dewasa 2,4 L

Adsorben dan Pembentuk masaAdsorben Norit tdk diserap usus, eksresi melalui tinja -menyerap toksinPembentuk Masa Tinja -Kaolin -Attapulgittdk diserap usus, eksresi melalui tinja

Anti SpasmodikMenghambat peristaltik usus dan lambungPenghambatan thd asetilkolin eksogen ( ester kolin)Bekerja pada reseptor muskarinik anti muskarinik-Mudah diserap, eksresi melalui ginjal (sebagian dlm bentuk asal )-Efek sampingmulut kering, dilatasi pupil dan rasa haus

Obat obat anti spasmodikAtropin0,25mg dan 0,5 mg Inj dan tabEkstrak belladon10 mg/tabHyosin n-butil bromida 10 mg/tab dan 20mg/tabPapaverin HCl 40 mg/tab

Anti MotilitasMemperlambat motilitas saluran cerna dgn mempengaruhi otot sirkuler dan longitudinal ususdecreases colonic mass movements and suppresses the gastrocolic reflex Berkaitan dgn reseptor opioid u reseptor Kontraksi sal cerna berkurang

Obat obat anti motilitas1.Loperamid (Imodium)Tidak diserap baik secara oral ekresi ( tinja)Loperamide is a synthetic anti-diarrheal indicated for the control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with inflammatory bowel disease. Sediaan tab 2mg & sirup 1 mg/5 mlTdk dianjurkan utk anak2Side effects: constipation; difficulty breathing , dizziness , drowsiness 2.Codein PhospatTdk dianjurkan utk anak23.Morfin

Zinc and DiarrheaIn May 2004, WHO/UNICEF issued a joint statement recommending the use of zinc, an essential micronutrient for human growth, development and maintenance of the immune system, and a new formulation oral rehydration solution (ORS), with reduced levels of glucose and salt, as a two-pronged approach to improved case management of acute diarrhea in children. WHO and UNICEF recommend 20 mg of zinc per day for ten -14 days for infants and children, 10 mg for infants under six months of age.

ZINC SUPPLEMENTS REDUCE THE SEVERITY AND DURATION OF DIARRHOEA Twelve studies examined the impact of zinc supplements on the management of acute diarrhoea. Eleven of these showed a reduction in the duration of the diarrhoeal episode; the reduction was statistically significant. The data shows that zinc supplementation during and until cessation of diarrhoea (either syrup containing 20 mg of elemental zinc per 5 ml, or tablets of 20 mg zinc such as zinc sulphate, gluconate or acetate) has a significant and beneficial impact on the clinical course of acute diarrhoea, reducing both its duration and severity.

Diarrheal Disease Control website at www.eddcontrol.org,

Pharmacokinetics of Zinc Zn and its salts are poorly absorbed from GIT Zinc is absorbed and is widely distributed throughout the body and excreted mainly in the feces and only traces are found in the urine since kidney has little role in regulating body Zn content. Endogenous Zn be reabsorbed in ileum and colon creating enterohepatic circulation of Zn Zinc is primarily stored in muscle, bone,Skin, Kidneys, Liver, Pancreas,retina, prostate Zn supplements is usually administered 1 hour before or 2 hours after food. In the presence of gastric irritation Zn has to be given with food. Read more:

SIDE/ADVERSE EFFECTS OF ZINC: -Gastrointestinal abnormalities - Dyspepsia - Epigastric pain & heart burn - Nausea - leucopenia (fever, chills, sore throat) - Neutropenia (continuing ulcers & sores in mouth and throat) - Sideroblastic anemia (unusual weakness/tiredness) -Zinc overdose - Hypotension

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