Chapter 1: Clinical Overview
Choosing a diarrhoea treatment
Two points guide every recommendation:
1. Oral rehydration comes first for every customer, at every age.
2. Stopping the bowel is not always helpful. Diarrhoea is partly the body clearing the infection. Medicines that slow the bowel are mainly for situations where reaching a toilet is difficult.
Select the (+) in each section to review the available options.
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Examples: Hydralyte or Gastrolyte
Oral rehydration salts replace the water and salts lost through diarrhoea. They are the first-line treatment for everyone and are suitable from infancy and during pregnancy.
Use clean water and the measuring cup supplied. Do not add cordial, juice, sugar or anything else. Once prepared, keep the solution in the fridge and use it within 24 hours.
What to say: “This is the important one. It puts back the fluid and salts you are losing. Make it up with plain water, nothing added, and keep sipping it until the diarrhoea settles.”
Do not promise: that it will stop the diarrhoea.
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Example: Imodium or Gastro-Stop
Loperamide is a Pharmacy Medicine (Schedule 2). It slows the bowel and reduces trips to the toilet.
It is for adults and children over 12 years only, for short-term symptom control when a toilet cannot be reached easily.
Do not supply if there is:
blood or mucus in the stool
fever
a recent course of antibiotics
pregnancy or breastfeeding
Possible side effects include cramping, nausea and constipation.
What to say: “This slows things down for a short time, but you still need rehydration alongside it.”
Do not promise: that it treats the infection or can be used for days on end.
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This medicine works in a similar way to loperamide but is more likely to cause drowsiness, dizziness and confusion.
It is a Pharmacist Only Medicine (Schedule 3).
Do not counsel on this product yourself.
What to say: “That one needs to come from our pharmacist. Let me get them for you.”
Key safety questions
Before supplying any medicine, ask:
Who is it for, and how old are they?
How long has it been going on, and how many times a day?
Is there any blood or mucus?
Is there fever or severe tummy pain?
Is there vomiting, and can they keep fluids down?
How much are they drinking, and how often are they passing urine?
Have they travelled recently?
Have they taken antibiotics or started a new medicine recently?
Are they pregnant or breastfeeding?
Do they take regular medicines or have other health conditions?
Have they tried anything already?
When must the pharmacist be involved?
Involve the pharmacist when:
any referral sign from Part 4 is present
there is any blood in the stool
there is any sign of dehydration
a medicine to stop diarrhoea is requested for a child under 12
the customer is pregnant or breastfeeding
the customer is older or has a long-term condition
the customer has a weakened immune system
antibiotics were taken recently
diphenoxylate with atropine is requested
vomiting stops them keeping fluids down
you are unsure whether the request is within your role