Six major minefields for diarrhea, 90% of doctors stepped on the "thunder"

Only for medical professionals to read for reference.
Take stock of 6 irrational medications for diarrhea, and you may have committed them too
.

Autumn is the season of high incidence of diarrhea, among which acute bacterial enteritis is the most distressing
.

Diarrhea means that the frequency of bowel movements is significantly higher than the frequency of usual habits, the feces are thin, the water increases, the daily defecation volume exceeds 200g, or it contains undigested food, pus, blood, and mucus
.

Diarrhea is often accompanied by symptoms such as urgency to defecate, anal discomfort, and incontinence [1]
.

Clinically, according to the length of the disease, diarrhea is divided into acute and chronic categories
.

Acute diarrhea has a rapid onset, and the course of the disease is within 2 to 3 weeks, most of which are caused by infection
.

Chronic diarrhea refers to recurrent diarrhea that has a course of more than two months or an intermittent period of 2 to 4 weeks.
The cause of the disease is complicated and can be caused by infectious or non-infectious factors
.

Rational use of drugs is the key to disease treatment, and diarrhea is a common symptom.
In the course of its treatment, if unreasonable use of drugs occurs, it will affect the treatment effect and even aggravate the condition
.

Next, we have passed 1 quiz + 6 prescriptions, and we will discuss how to avoid diarrhea and 6 unreasonable medications
.

Self-test questions (multiple choice questions) Regarding the drug treatment of diarrhea, the following statement is correct: A.
Loperamide cannot be used for the basic treatment of acute bacterial enteritis with high fever and pus and blood in the stool; B.
Levofloxacin hydrochloride capsules It is forbidden for children under 18 years of age; C.
Racemic anisodamine is forbidden for patients with glaucoma; D.
Live Bacillus licheniformis granules and levofloxacin hydrochloride capsules should not be taken at the same time; E.
Montmorillonite powder should be used in combination with antibacterial drugs.
Tuoshi powder, then take antibacterial drugs
.

Correct answer: ABCD Irrational medication 1: Loperamide used in patients with acute bacterial enteritis▎ Case: Gastroenterology clinic, patient, male, 47 years old
.

Seeing a doctor for "fever, abdominal pain, diarrhea, pus and blood in the stool for 2 hours"
.

Body temperature: 39.
1℃
.

▎Diagnosis: Acute bacterial enteritis
.

▎Prescription: Levofloxacin hydrochloride capsules 0.
2g, twice a day, orally; loperamide hydrochloride capsules with the first dose of 4mg, orally, and then take 2mg for every diarrhea thereafter, until the diarrhea stops
.

▎Analysis: The effect of loperamide on intestinal smooth muscle is similar to that of opioids and diphenoxylate.
It can inhibit the contraction of intestinal smooth muscle and reduce intestinal peristalsis; it can also reduce the release of acetylcholine from nerve endings in the intestinal wall.
The local interaction of non-cholinergic neurons directly inhibits the peristaltic reflex
.

In patients with acute bacterial enteritis, pathogens produce a lot of toxins in the intestine.
If loperamide is used, it is not conducive to the elimination of toxins.
Toxins and pathogens stay in the intestine for a longer time, which may aggravate the condition
.

Loperamide cannot be used for the basic treatment of acute bacterial enteritis with high fever and pus and blood in the stool
.

For patients with acute bacterial enteritis, compound diphenoxylate can have similar effects
.

Recommendation: Use levofloxacin alone, and collect stool samples for fecal culture before using levofloxacin
.

Irrational medication 2: Levofloxacin in children with acute bacterial enteritis▎ Case: Pediatric clinic, patient, female, 16 years old
.

Seeing a doctor with "abdominal pain, diarrhea, pus and blood in the stool for 3 hours"
.

▎Diagnosis: Acute bacterial enteritis
.

▎Prescription: Levofloxacin Hydrochloride Capsule 0.
2g, 2 times a day, orally
.

▎Analysis: Levofloxacin hydrochloride can affect cartilage development
.

The mechanisms that cause cartilage damage include: interference with the synthesis and differentiation of cartilage matrix components such as glucosamine, collagen, protein, etc.
; destruction of DNA structure and inhibition of collagen fiber synthesis; in addition, it can also chelate Ca2+ and Mg2+ to cause cartilage damage [2]
.

The instructions of Levofloxacin Capsules require that it should be contraindicated in children under 18 years old.
The child is 16 years old.
It is a contraindication drug and it is not recommended to use it
.

The use of cefixime to treat children with bacterial enteritis can improve the symptoms of children more quickly, can more effectively control serum inflammation indicators, and has higher treatment safety.
Compared with cefaclor treatment, the clinical efficacy is better [3]
.

Suggestion: Use cefixime tablets (1.
5～3.
0mg/kg once, twice a day for 3 days)
.

Irrational drug use 3: Racemic anisodamine for glaucoma patients▎ Case: Gastroenterology clinic, patient, female, 61 years old
.

Seeing a doctor with "abdominal pain and diarrhea for 6 hours"
.

He has a history of "glaucoma" for 3 years
.

▎Diagnosis: ①Acute bacterial enteritis; ②Glaucoma
.

▎Prescription: Levofloxacin hydrochloride capsules 0.
2g, 2 times a day, orally; racemic anisodamine tablets 10mg, 3 times a day, orally
.

▎Analysis: Racemic anisodamine can be used to relieve pain caused by gastrointestinal spasm
.

Racean anisodamine tablets can shrink the pupil dilator muscles through anticholinergic effect, and make the iris recede to the outer edge of the surrounding area.
This can compress the anterior chamber angle, narrow it, and hinder the return of aqueous humor to the iris sinus, causing glaucoma.
The patient's intraocular pressure increased
.

For patients with glaucoma, racemic anisodamine is contraindicated
.

For glaucoma patients, the anticholinergic drugs belladonna, atropine, scopolamine, and propantheline bromide can have similar effects
.

Acupoint injection of menadione sodium bisulfite injection (vitamin K3 injection) for the treatment of abdominal cramping pain has a significant effect
.

The mechanism of action is that menadione sodium bisulfite selectively relaxes smooth muscles directly, and at the same time has a significant inhibitory effect on smooth muscle contraction caused by acetylcholine, and has sedative and analgesic effects.
Its analgesic mechanism is related to opioid receptors and endogenous Sexual opioid mediated related
.

Treatment method: Instruct the patient to take a supine or sitting position, straighten both lower limbs naturally, relax the muscles of both lower limbs, local disinfection at Zusanli point, use a 5ml syringe and a 6-gauge needle to withdraw menadione sodium bisulfite injection, each time for adults 8mg, 4mg for children each time, the injection is pierced into Zusanli acupoint with the needle perpendicular to the skin, and the needle is inserted 1.
0~2.
0cm, so that the needle will feel sore and swelling.
Withdraw it slightly to confirm that there is no blood return.
Sodium hydrogen menadione injection is injected into Zusanli point
.

After the operation, use a sterile cotton ball to press the acupoints for 1 to 5 minutes.
Generally, the injection takes 5 to 10 minutes and the effect can be maintained for 2 to 5 hours [4]
.

Recommendations: For those who have no adverse reactions and contraindications to the treatment of pain caused by gastrointestinal spasm with racemic anisodamine, acupoint injection of sodium bisulfite menadione injection can be used instead
.

Irrational medication 4: Levofloxacin combined with live Bacillus licheniformis▎ Case: Gastroenterology clinic, patient, male, 54 years old
.

Seeing a doctor because of "diarrhea, pus and blood in the stool for 1 day"
.

▎Diagnosis: Acute bacterial enteritis
.

▎Prescription: Levofloxacin hydrochloride capsules 0.
2g, twice a day, orally; 0.
5g live Bacillus licheniformis granules, three times a day, orally
.

▎Analysis: There are two major types of commonly used microecological preparations.
One is living bacteria preparations, which should not be taken together with antibacterial drugs
.

If it is necessary to combine the application of live microecological preparations with antibacterial drugs, the interval between the two drugs should be at least 3 hours; the other type is dead bacteria preparations (such as oral Lactobacillus LB powder and lactic acid bacteria), which can be taken together with antibacterial drugs[5,6 ]
.

There are two types of commonly used live bacteria preparations: one type of preparations includes live Bacillus licheniformis granules, Clostridium butyricum live bacteria tablets, Bacillus cereus live bacteria tablets, etc.
, which can consume a large amount of oxygen in the intestinal tract, create an anaerobic environment, and promote anorexia.
Oxygen bacteria grow to help restore the balance of the flora; another type of preparations include live bifidobacteria capsules, oral bifidobacteria, lactobacillus acidophilus, enterococcus triple live bacteria capsules, lactase production, etc.
, which directly supplement the intestinal tract Normal bacteria
.

Suggestion: Live Bacillus licheniformis granules and levofloxacin hydrochloride capsules should not be taken at the same time.
Levofloxacin hydrochloride capsules can be taken 3 hours after oral administration of Bacillus licheniformis live granules
.

Irrational medication 5: Levofloxacin combined with montmorillonite powder▎ Case: Gastroenterology clinic, patient, male, 36 years old
.

Seeing a doctor with "abdominal pain and diarrhea for 10 hours"
.

▎Diagnosis: Acute bacterial enteritis
.

▎Prescription: Montmorillonite powder 3g, 3 times a day, orally; Levofloxacin hydrochloride capsule 0.
2g, 2 times a day, orally
.

▎Analysis: Montmorillonite powder contains natural dioctahedral montmorillonite particles, which can cover the gastrointestinal mucosa, strengthen the mucosal barrier, chelate bile salts, remove pathogenic bacteria and toxins, and support normal intestinal flora and reduce Intestinal sensitivity and other effects are currently commonly used drugs for the treatment of diarrhea [7]
.

Antibacterial drugs are taken orally at the same time and can be absorbed by montmorillonite powder and eliminated from the body
.

At the same time, montmorillonite powder can form a protective film in the intestinal tract, thereby affecting the efficacy of antibacterial drugs [8]
.

In combination with antibacterial drugs, antibacterial drugs should be used first, followed by montmorillonite powder, with an interval of at least 2 hours between the two drugs
.

On the one hand, montmorillonite powder can adsorb bacteria, viruses and bile salts, and on the other hand, it can strongly fix and inhibit the viruses, bacteria and the toxins they produce in the digestive tract
.

Therefore, first use antibacterial drugs to kill bacteria, and then use montmorillonite powder to adsorb bacteria or various toxins (especially pathogenic gram-negative bacteria endotoxin)
.

Suggestion: Use levofloxacin hydrochloride capsules first, then montmorillonite powder, at least 2 hours apart
.

Irrational medication 6: Levofloxacin combined with hydrotalcite▎ Case: Gastroenterology clinic, patient, female, 43 years old
.

Seeing a doctor because of "diarrhea, pus and blood in the stool for 5 hours"
.

He had a history of "chronic gastritis" for 3 months
.

▎Diagnosis: ①Acute bacterial enteritis; ②Chronic gastritis
.

▎Prescription: Levofloxacin Hydrochloride Capsule 0.
2g, 2 times a day, orally; 1g hydrotalcite tablets, 3 times a day, orally
.

▎Analysis: Quinolone antibacterial drugs and drugs containing aluminum, magnesium, calcium, zinc, iron and other polyvalent cations (such as aluminum hydroxide, magnesium trisilicate, calcium carbonate, zinc gluconate, ferrous sulfate, etc.
) and zinc The combination of multivitamin preparations (such as multivitamins plus zinc chewable tablets, etc.
) can cause complexation reactions and reduce the bioavailability of quinolone antibacterial drugs [9,10]
.

Quinolone antibacterial drugs should be avoided in combination with drugs containing magnesium, aluminum, calcium, zinc, iron and other multivalent cations and zinc-containing multivitamin preparations, and must be used in combination with an interval of more than 2 hours
.

Levofloxacin Hydrochloride Capsules are commonly used drugs for the treatment of bacterial enteritis, with significant effects
.

Levofloxacin capsules are used in combination with hydromagnesium carbonate tablets, which contain aluminum and magnesium polyvalent cations
.

Aluminum and magnesium ions can combine with levofloxacin to form complexes that are insoluble and difficult to absorb, which significantly reduces the blood concentration of levofloxacin, thereby affecting the antibacterial effect of levofloxacin capsules
.

Sanjiuweitai granules are composed of trigeminal bitter, sage, liangmianzhen, woody, scutellaria, poria, rehmannia, and white peony, and are used to treat superficial gastritis, atrophic gastritis, and erosive gastritis
.

Sanjiuweitai granules have no similar interactions with quinolone antibacterial drugs
.

Recommendation: Avoid the combination of levofloxacin hydrochloride capsules and hydrotalcite tablets.
Sanjiuweitai granules (20g, twice a day, orally) can be used instead of hydrotalcite tablets, and continue to use levofloxacin capsules
.

When levofloxacin capsules and hydrotalcite tablets must be used in combination, the interval should be more than 2 hours
.

Key points of rational medication for diarrhea 1.
Loperamide cannot be used for the basic treatment of acute bacterial enteritis with high fever and pus and blood in the stool
.

2.
Quinolone antibacterial drugs are forbidden to children under 18 years of age
.

3.
Anticholinergics (racemic anisodamine, belladonna, atropine, scopolamine, propantheline bromide) are forbidden for patients with glaucoma
.

4.
Live microecological preparations should not be taken with antibacterial drugs; if combined application of live microecological preparations and antibacterial drugs, the interval between the two drugs should be at least 3 hours
.

5.
When montmorillonite powder is used in combination with antibacterial drugs, the antibacterial drugs should be used first, and then the montmorillonite powder should be taken at least 2 hours apart
.

6.
Avoid using quinolone drugs in combination with drugs containing multivalent cations such as magnesium, aluminum, calcium, zinc, and iron
.

References: [1] Miao Xiaohui, Ran Lu, Zhang Wenhong, et al.
Expert consensus on diagnosis and treatment of adult acute infectious diarrhea in 2013[J].
Chinese Journal of Digestion, 2013, 33(12): 793-802.
[2] Gu Xiaoying.
Levofloxacin Analysis of adverse reactions and experience in clinical rational drug use[J].
Journal of Clinical Rational Drug Use, 2020, 13(17): 143-144.
[3] Yao Jinxiu, Yao Leilei.
To explore the efficacy of cefixime in the treatment of children with acute bacterial enteritis[J] .
Systems Medicine, 2021, 6(3): 4-6.
[4] Wang Yue, Yao Jianchao.
Acupoint injection of vitamin K3 in the treatment of acute abdominal pain[J].
Youjiang Medicine, 2009, 37(3): 299- 300.
[5] Liu Guilan, Gao Fang.
Irrational phenomena in the application of microecological preparations in pediatrics and intervention countermeasures[J].
Primary Medical Forum: Version B, 2006, 10(11): 1049-1050.
[6] Zou Yuexin .
The clinical application of microecological preparations in the treatment of pediatric digestive diseases[J].
Clinical Medical Research and Practice, 2018, 3(26):85-86.
[7] Si Jigang, Li Aijie.
Reasonable specification of montmorillonite powder Use[J].
Journal of Pediatric Pharmacy, 2018, 24(8): 62-64.
[8] Yang Jin, Yin Lifen.
Comparison of in vitro adsorption of 6 drugs by montmorillonite[J].
Chinese Journal of New Drugs and Clinical Medicine, 1999 , 21(3): 162.
[9] Li Jing.
Adverse reactions and interactions of quinolones [J].
Pharmaceutical Research, 2009, 4(9): 121-122.
[10]Zhao Zhigang.
Analysis of 500 cases of clinically safe and rational drug use [M].
Beijing: People's Medical Publishing House, 2009: 329-332.