GASTROENTERITIS

PHARMACOTHERAPEUTICS OF GASTROENTERITIS

1. GASTROINTESTINAL INFECTIONS V. S. Swathi Assistant Professor VIPT, Duvvada

2. Definition Gastroenteritis is a non invasive infection of the small/ large bowel that manifests clinically as diarrhoea and vomiting

3. Epidemiology In 2015, nearly 2 billion cases of gastroenteritis observed in world. Among them nearly 1.3 million deaths occur due to gastroenteritis Among 1.3 million deaths of gastroenteritis, 80% of total deaths were in India

4. Types Escherichia coli  infection  – This is a common problem for travellers to countries with poor sanitation. Infection is caused by drinking contaminated water or eating contaminated raw fruits and vegetables Campylobacter  infection  – This is caused due to bacteria which are found in animal faeces ( poo ) and uncooked meat, particularly poultry. Infection is caused by, for example, consuming contaminated food or water, eating undercooked meat (especially chicken), and not washing your hands after handling infected animals

5. Cryptosporidium  infection  – This is caused by parasites which are found in the bowels of humans and animals. Infection is caused by, for example, swimming in a contaminated pool and accidentally swallowing water, or through contact with infected animals. An infected person may spread the parasites to food or surfaces if they don’t wash their hands after going to the toilet Giardiasis  – This is caused by parasites transmitted by drinking contaminated water, handling infected animals or changing the nappy of an infected baby and not washing your hands afterwards.

6. Salmonellosis  – This infection is caused by bacteria, which is found in animal faeces. Infection is caused by eating contaminated food or handling infected animals. An infected person may also spread the bacteria to other people or surfaces by not washing their hands properly Shigellosis  – It is caused by bacteria, found in human faeces. An infected person may spread the bacteria to food or surfaces if they don’t wash their hands after going to the toilet Viral gastroenteritis  – This infection is caused by virus, through person-to-person contact such as touching contaminated hands, faeces or vomit, or by drinking contaminated water or food.

7. Risk factors Infants, Children Elders Immunocomprimised patients Travallers Poor hygiene Improperly stored and cooked food Non Vegetarians Persons who take raw food Swimming

8. Etiology Bacillus cereus Campylobacer Clostridium perfringes Clostridium difficile Clostridium botulicum E . coli Salmonella enterica Shigella Staphylococcus aureus Vibrio cholera Giardia Cryptospordium Entmeba histolytica Virus Bacteria Protozoa

9. Pathogenesis Bacteria , Virus , Protozoa ↓ Food/ Water/ Air ↓ Enter in to GIT ↓ Release

10. Conti……. Cytotoxins - Destroy mucosa of GIT Enterotoxin -Damage intestinal mucosal cells leads to net loss of fluids and electrolytes Neurotoxin- Blocks release of Ach Verotoxin - Damage small blood vessels Emetotoxin - Induce emesis ↓ Inflammatory changes in mucosa ↓ Damage to mucosa

11. Clinical Presentation General Vomiting Diarrhea with or without pus or blood Abdominal pain

12. Typhoid Head ache Malaise Abdominal distension Fever Diarrhoea Rose spots on trunk Haemorrhage and perforation of GIT

13. Botulism Diplopia Dysphagia Symmetrical descending motor paralysis

14. Complications Dehydration Electrolyte imbalance Kidney failure Sepsis Inflammatory bowel syndrome Ulcerative colitis Reactive arthritis Haemolytic uremic syndrome ( Anemia + Thrombocytopenia+ Renal Failure)

15. Diagnosis Clinical presentation Vomit culture Blood culture Faecal exam Sigmoidoscopy Endoscopy

16. Non Pharmacological Treatment Good Hygiene Hydration with fluids

17. Viral Gastroenteritis Nausea Vomiting Fever Abdominal Pain Conscious – Oral fluids (ORS) Unconscious- IV fluids Paracetamol-SOS Ibuprofen –SOS Symptoms usually resolve within 2-3 Days

18. Bacterial Gastroenteritis Nausea Vomiting Fever Abdominal Pain Diarrhea with or without blood Conscious – Oral fluids (ORS) Unconscious- IV fluids Paracetamol-SOS Ibuprofen –SOS Faecal Exam Stool culture Consider antibiotics

19. Drug Category Mode of action Dose Adverse effects Ciprofloxacin Fluroquinolone Inhibit DNA synthesis in bacteria 500mg-BD 7-10 days (Enteric fever) GI disturbances Changes in LFT and RFT Rashes Restlessness Azithromycin Macrolide Inhibit protein synthesis in bacteria 500mg-OD 3 days GI disturbances Vaginitis Dyspepsia Malaise Flatulence Trimethoprim Sulphanamide Inhibit folic acid synthesis in bacteria 100mg-BD Fever Pruritis Phototoxic skin eruptions Changes in RFT and LFT Rifaximine Miscellaneous antibiotic Inhibit DNA synthesis in bacteria 200mg-TID for 3 days Flatulence Headache Defecation urgency Abdominal pain Rectal tenesmus Cotrimoxazole (Trimethoprim+ Sulphamethoxazole) Sulphanamide Inhibit folic acid synthesis in bacteria 80+400mg or 160+800mg for 5 days Anorexia Vertigo Hyperkelemia Hyponatremia peripheral neuritis Steven Johnson syndrome Drugs used in treatment of Gastroenteritis

20. Chloramphenicol Miscellaneous antibiotic Inhibit protein synthesis in bacteria 50mg/kg/day- QID for 14 days (Enteric fever) Head ache Enterocolitis Bone marrow suppression Peripheral Neuropathy Gray baby syndrome Tetracycline Tetracycline Inhibit protein synthesis in bacteria 250mg-QID GI disturbances Discoluration of teeth photosensitivity Hepatotoxicity Bone marrow supression Doxycycline Tetracycline Inhibit protein synthesis in bacteria 100mg-OD Anorexia Teeth discoloration GI disturbances Hepatotoxicity Bone marrow supression Vancomycin Glycopeptide antibiotic Inhibit cell wall synthesis in bacteria 125mg-QID for 10 days Vomiting Diarrhea Pyrexia UTI Peripheral edema Metronidazole Miscellaneous antibiotic Inhibit DNA synthesis in bacteria 800mg-TID for 5 days Anorexia GI disturbances Candidiasis Dark urine Furry tongue

21. Resources https://www.sciencedirect.com/science/article/pii/S1876034119300681 https://www.sciencedirect.com/science/article/pii/S2214109X19302074 https://www.sciencedirect.com/science/article/pii/S0264410X17312306 https://www.sciencedirect.com/science/article/pii/S0264410X17315955 https://www.sciencedirect.com/science/article/pii/S0264410X19309272