ANTI DIAREANTI DIAREDharma Permana, PhD, AptDharma Permana, PhD, Apt

Anti DiareAnti Diare In diarrhea, the food and fluids you ingest In diarrhea, the food and fluids you ingest

pass too quickly or in too large an amount pass too quickly or in too large an amount — or both — through your colon— or both — through your colon

The most common causes of The most common causes of diarrhea include:diarrhea include:

Viruses.Viruses. Common viruses that cause diarrhea are the Common viruses that cause diarrhea are the Norwalk virus, cytomegalovirus, viral hepatitis and the Norwalk virus, cytomegalovirus, viral hepatitis and the herpes simplex virus. Rotavirus is the most common herpes simplex virus. Rotavirus is the most common cause of acute childhood diarrhea. Viral diarrhea cause of acute childhood diarrhea. Viral diarrhea spreads easily. spreads easily.

Bacteria and parasites.Bacteria and parasites. Contaminated food or water can Contaminated food or water can transmit bacteria and parasites to your body.transmit bacteria and parasites to your body.

- Parasites such as Giardia lamblia and cryptosporidium - Parasites such as Giardia lamblia and cryptosporidium can cause diarrhea. can cause diarrhea.

-Common bacterial causes of diarrhea include -Common bacterial causes of diarrhea include campylobacter, salmonella, shigella, vibrio cholerae and campylobacter, salmonella, shigella, vibrio cholerae and Escherichia coli. Escherichia coli.

This type of diarrhea can be common for people This type of diarrhea can be common for people traveling to developing countries. traveling to developing countries.

Common causes of traveler’s diarrheaCommon causes of traveler’s diarrhea

BacteriaBacteria (70%) (70%) Parasites Parasites Viruses VirusesE. coliE. coli Giardia lamblia Giardia lamblia Noro-viruses Noro-virusesSalmonellaSalmonella spp spp Cryptosporidium parvumCryptosporidium parvum Rotavirus RotavirusCampylobacter jejuniCampylobacter jejuni Entamoeba hystoliticaEntamoeba hystoliticaShigellaShigella spp spp Cyclospora cayetanensisCyclospora cayetanensisVibrio cholVibrio choleeraerae and other sp and other sppp

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 diareObat obat anti diare

OralitOralit Adsorben dan Pembentuk masa Adsorben dan Pembentuk masa Anti Spasmodik/ anticholinergicAnti Spasmodik/ anticholinergic Anti MotilitasAnti Motilitas Anti MicrobaAnti Microbabakteri, amubabakteri, amuba

OralitOralitPertolongan pertama pada diarePertolongan pertama pada diare Komposisi oralitKomposisi oralit Glukosa anhidrat 4Glukosa anhidrat 4 NaCl 0,7NaCl 0,7 Na sitrat dihydrat 0.58Na sitrat dihydrat 0.58 aqua ad 200 mlaqua ad 200 ml

- Oralit tidak menghentikan diare, tetapi mengantikan Oralit tidak menghentikan diare, tetapi mengantikan cairan tubuh yg hilang bersama tinjacairan tubuh yg hilang bersama tinja

- Tiap kali BAB diberi Oralit Tiap kali BAB diberi Oralit Dehidrasi ringan/ Dehidrasi ringan/ sedangsedang

< 1th min 300 ml, 1-4 th min 600ml< 1th min 300 ml, 1-4 th min 600ml 5-12 th min 1,2 L dan Dewas5-12 th min 1,2 L dan Dewasaa 2,4 L 2,4 L

Adsorben dan Pembentuk masaAdsorben dan Pembentuk masa AdsorbenAdsorben NoritNorit tdk diserap usus, eksresi melalui tdk diserap usus, eksresi melalui tinjatinja -menyerap toksin-menyerap toksin Pembentuk Masa TinjaPembentuk Masa Tinja -Kaolin-Kaolin -Attapulgit-Attapulgittdk diserap usus, eksresi melalui tdk diserap usus, eksresi melalui tinjatinja

Anti SpasmodikAnti Spasmodik Menghambat peristaltik usus dan lambungMenghambat peristaltik usus dan lambungPenghambatan thd asetilkolin eksogen ( ester Penghambatan thd asetilkolin eksogen ( ester

kolin)kolin)- Bekerja pada reseptor muskarinikBekerja pada reseptor muskarinik anti muskarinikanti muskarinik-Mudah diserap, eksresi melalui ginjal (sebagian -Mudah diserap, eksresi melalui ginjal (sebagian

dlm bentuk asal )dlm bentuk asal )-Efek samping-Efek sampingmulut kering, dilatasi pupil mulut kering, dilatasi pupil dan rasa hausdan rasa haus

Obat obat anti spasmodikObat obat anti spasmodik

AtropinAtropin0,25mg dan 0,5 mg Inj dan tab0,25mg dan 0,5 mg Inj dan tab Ekstrak belladonEkstrak belladon10 mg/tab10 mg/tab Hyosin n-butil bromidaHyosin n-butil bromida 10 mg/tab dan 10 mg/tab dan

20mg/tab20mg/tab Papaverin HClPapaverin HCl 40 mg/tab 40 mg/tab

Anti MotilitasAnti Motilitas Memperlambat motilitas saluran cerna dgn Memperlambat motilitas saluran cerna dgn

mempengaruhi otot sirkuler dan mempengaruhi otot sirkuler dan longitudinal ususlongitudinal usus

decreases colonic mass movements and decreases colonic mass movements and suppresses the suppresses the gastrocolicgastrocolic reflex reflex

Berkaitan dgn reseptor opiBerkaitan dgn reseptor opioioidd uu reseptor reseptor Kontraksi sal cerna berkurangKontraksi sal cerna berkurang

Obat obat anti motilitasObat obat anti motilitas1.Loperamid1.Loperamid (Imodium) (Imodium)Tidak diserap baik secara oral Tidak diserap baik secara oral ekresi ( tinja)ekresi ( tinja)Loperamide is a synthetic anti-diarrheal indicated for the Loperamide is a synthetic anti-diarrheal indicated for the

control and symptomatic relief of acute nonspecific control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with diarrhea and of chronic diarrhea associated with inflammatory bowel disease. inflammatory bowel disease.

Sediaan tab 2mg & sirup 1 mg/5 mlSediaan tab 2mg & sirup 1 mg/5 mlTdk dianjurkan utk anak2Tdk dianjurkan utk anak2Side effects: Side effects: constipation; difficulty breathing constipation; difficulty breathing , , dizziness dizziness , ,

drowsiness drowsiness

22..Codein PhospatCodein PhospatTdk dianjurkan utk anak2Tdk dianjurkan utk anak23.Morfin3.Morfin

Zinc and DiarrheaZinc and Diarrhea In May 2004, WHO/UNICEF issued a joint In May 2004, WHO/UNICEF issued a joint

statement recommending the use of zinc, an statement recommending the use of zinc, an essential micronutrient for human growth, essential micronutrient for human growth, development and maintenance of the immune development and maintenance of the immune system, and a new formulation oral rehydration system, and a new formulation oral rehydration solution (ORS), with reduced levels of glucose solution (ORS), with reduced levels of glucose and salt, as a two-pronged approach to and salt, as a two-pronged approach to improved case management of acute diarrhea in improved case management of acute diarrhea in children. children.

WHO and UNICEF recommend 20 mg of zinc WHO and UNICEF recommend 20 mg of zinc per day for ten -14 days for infants and children, per day for ten -14 days for infants and children, 1010 mg for infants under six months of age. mg for infants under six months of age.

ZINC SUPPLEMENTS REDUCE THE SEVERITY AND ZINC SUPPLEMENTS REDUCE THE SEVERITY AND

DURATION OF DIARRHOEADURATION OF DIARRHOEA Twelve studies examined the impact of zinc supplements Twelve studies examined the impact of zinc supplements

on the management of acute diarrhoea. Eleven of these on the management of acute diarrhoea. Eleven of these showed a reduction in the duration of the diarrhoeal showed a reduction in the duration of the diarrhoeal episode; the reduction was statistically significant. episode; the reduction was statistically significant.

The data shows that zinc supplementation during and The data shows that zinc supplementation during and until cessation of diarrhoea (either syrup containing 20 until cessation of diarrhoea (either syrup containing 20 mg of elemental zinc per 5 ml, or tablets of 20 mg zinc mg of elemental zinc per 5 ml, or tablets of 20 mg zinc such as zinc sulphate, gluconate or acetate) has a such as zinc sulphate, gluconate or acetate) has a significant and beneficial impact on the clinical course of significant and beneficial impact on the clinical course of acute diarrhoea, reducing both its duration and severity. acute diarrhoea, reducing both its duration and severity.

Diarrheal Disease Control website at Diarrheal Disease Control website at www.eddcontrol.orgwww.eddcontrol.org,,

Pharmacokinetics of ZincPharmacokinetics of Zinc Zn and its salts are poorly absorbed from GITZn and its salts are poorly absorbed from GIT

ZincZinc is absorbed and is widely distributed throughout the is absorbed and is widely distributed throughout the body and excreted mainly in the feces and only traces body and excreted mainly in the feces and only traces are found in the urine since kidney has little role in are found in the urine since kidney has little role in regulating body Zn content. Endogenous Zn be regulating body Zn content. Endogenous Zn be reabsorbed in ileum and colon creating enterohepatic reabsorbed in ileum and colon creating enterohepatic circulation of Zncirculation of Zn

ZincZinc is primarily stored in muscle, bone,Skin, Kidneys, is primarily stored in muscle, bone,Skin, Kidneys, Liver, Pancreas,retina, prostate Liver, Pancreas,retina, prostate

Zn supplements is usually administered 1 hour before or Zn supplements is usually administered 1 hour before or 2 hours after food. In the presence of gastric irritation Zn 2 hours after food. In the presence of gastric irritation Zn has to be given with food.has to be given with food.Read more:Read more:

SIDE/ADVERSE EFFECTS OF SIDE/ADVERSE EFFECTS OF ZINC:ZINC:

--Gastrointestinal abnormalities - Dyspepsia Gastrointestinal abnormalities - Dyspepsia - Epigastric pain & heart burn- Epigastric pain & heart burn- - NNauseaausea· - leucopenia (fever, chills, sore throat)· - leucopenia (fever, chills, sore throat)- Neutropenia (continuing ulcers & sores in - Neutropenia (continuing ulcers & sores in mouth and throat)mouth and throat)- Sideroblastic anemia (unusual - Sideroblastic anemia (unusual weakness/tiredness)weakness/tiredness)--Zinc overdose - HypotensionZinc overdose - Hypotension

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