Diarrhea: Preventable and Treatable

Although diarrheal disease Is preventable and treatable, it affects billions of individuals annually.

Patients who experience diarrhea are depleted of body fluids, resulting in profound dehydration and possible death.¹ With nearly 1.7 billion cases of diarrheal disease diagnosed annually, pharmacists can play an important role in the battle against this disease.²

Background

Diarrhea is defined by the World Health Organization as “the passage of 3 or more loose or liquid stools per day, or more frequently than normal for the individual.”² This disease is associated with several symptoms, including abdominal cramps, fever, nausea, vomiting, fatigue, and urgency.³ Further classification of diarrhea into subgroups—acute, persistent, and chronic—are based on the amount of time patients experience the disease (Table 1³).

Although this disease is both preventable and treatable, it remains the second leading worldwide cause of death of children younger than 5 years.² Annual cases worldwide have been reported in the billions; however, this number may be grossly underestimated due to a large amount of individuals who do not visit a health care provider for management of the disease.

Etiology

Each case of diarrhea has either an infectious or noninfectious etiology. Infectious causes include the transmission of viral, bacterial, or parasitic pathogens (Table 2¹). In addition, nearly 90% of diarrhea-associated deaths can be attributed to unsafe water, inadequate sanitation, and insufficient hygiene.¹ The microorganisms associated with the development of infectious diarrhea are often spread via the fecal-oral route and can be found in food, water, or on the surface of various objects.

Noninfectious causes of diarrhea include food allergies, inflammatory bowel disease, irritable bowel syndrome, alcohol ingestion, and medications⁴ (Online Table 3⁵). Diarrhea is a frequent drug adverse effect (AE), with antimicrobials accounting for approximately 25% of all drug-induced diarrhea cases.⁶

Table 3: Drug-Induced Diarrhea Medication

Antibiotics (eg, erythromycin, amoxicillin-clavulanate,)

Chemotherapy (eg, irinotecan, 5-FU, capecitabine)

Antibiotics (eg, erythromycin, amoxicillin-clavulanate)

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