Modern approaches to the treatment of acute gastroenteritis in children

Indications

Smecta is used in cases where the body seeks to overcome the consequences of a toxic influence on it. This can happen under various circumstances, but our body already has a prepared program for removing toxic substances or eliminating the clinical picture. If they were caused by the following pathologies and conditions of the body, then the doctor has the right to prescribe an appropriate course of treatment. The drug is used in the presence of the following types of diarrhea:

• allergic reactions,
• medicinal origin,
• result of non-compliance with dietary intake,
• eating low quality and unusual food,
• intestinal infections.

In addition, Smecta is prescribed for:

• food intoxication,
• intestinal colic,
• eliminating the clinical picture of heartburn, gas incontinence, abdominal pain and other signs of dyspepsia.

The manufacturer states that, although the medicine helps in many cases where the patient suffers from diarrhea, there are a huge number of conditions when you should consult a doctor before prescribing therapeutic actions on your own. In this case, only a doctor will provide assistance:

• the presence of loose stools and high fever, chills, incessant vomiting,
• stool is accompanied by bloody discharge and exhaustion of the body,
• the patient is at risk: damage to the heart valves, therapy that disrupts the protective function of the immune system,
• elderly people,
• even after 2 days of taking the drug, your health remains at a poor level,
• increased thirst, fatigue and severe dehydration,
• diarrhea may reappear after short periods of time or may systematically replace constipation.

Smecta instructions for use

How to dilute and take the drug in accordance with the smecta instructions for use in adults and children?

The powder mass is diluted in 100 ml of water until it becomes a suspension solution. This procedure is carried out shortly before taking the medication. No need to do this in advance! According to the standard, it is recommended to take the drug before meals or during a pause between them. There is no need to combine it with other medications. If the doctor determines that a person suffers from esophagitis or heartburn, the drug is taken immediately before meals.

The effect that the drug has appears in the presence of loose stools after a period of time from six to twelve hours, in case of intoxication - after a couple of hours, and in case of esophagitis - after half an hour.

The regimen and dose are interconnected with the diagnosed pathology, the degree of its progression and the age category of the patient. The daily dose is divided into 2-3 doses.

smecta instructions for use

Buy Diosmectite powder 3g No. 10 in pharmacies

Instructions for use Diosmectite Buy Diosmectite for application. suspensions for oral administration 3g

Diosmectite Instructions for medical use - RU No. LSR-000247/08

Dosage form

Powder for the preparation of suspension for oral administration. Compound

Active substance:

Dioctahedral smectite - 3 g;

Excipients:

Glucose (dextrose) - 0.749 g, vanillin - 0.004 g, soluble saccharin (sodium saccharinate) - 0.007 g. Description of the dosage form

Powder from yellowish or grayish-white to grayish or brownish-yellow with the smell of vanillin. Pharmacological group

Antidiarrheal agent. Pharmacodynamics

The drug is of natural origin and has an adsorbing effect. Stabilizes the mucous barrier, forms polyvalent bonds with mucus glycoproteins, increases the amount of mucus, improves its gastroprotective properties (with respect to the negative effects of hydrogen ions HCl, bile salts, microorganisms and their toxins). It has selective sorption properties, which are explained by its discoid-crystalline structure; adsorbs bacteria and viruses located in the lumen of the gastrointestinal tract (GIT). In therapeutic doses it does not affect intestinal motility. Pharmacokinetics

It is not absorbed and is excreted unchanged from the body. Indications

Diarrhea (allergic, drug origin; violation of diet and quality of food), gastritis, peptic ulcer of the stomach and duodenum, colitis; diarrhea of ​​infectious origin - as part of complex therapy.

Symptomatic treatment of heartburn, flatulence and abdominal discomfort in gastrointestinal diseases. Contraindications

Hypersensitivity, intestinal obstruction. Use during pregnancy and breastfeeding

It is possible to use the drug Diosmectite during pregnancy and lactation according to indications.

Experimental studies have shown that the drug does not have a teratogenic effect. Directions for use and doses

Adults are prescribed 3 packets per day for at least 3 days. For acute diarrhea, at the beginning of treatment the daily dose can be doubled.

Before use, dissolve the contents of 1 packet in half a glass of water. To obtain a homogeneous suspension, gradually pour the powder into the liquid, stirring it evenly. For esophagitis, it is preferable to take the drug after meals, in other cases - between meals.

Children under one year of age are prescribed 1 packet per day; from 1 to 2 years - 2 packages per day; over 2 years old - 2-3 packets per day. The course of treatment is at least 3 days. The contents of the package are dissolved in a baby bottle for 50 ml of water and distributed into several doses throughout the day, or thoroughly mixed with some semi-liquid product: soup, porridge, compote, puree, baby food. Side effects

Constipation, allergic reactions. Interaction

Reduces the rate and degree of absorption of simultaneously taken medications. special instructions

The patient should consult a doctor if symptoms do not improve within 3 days after taking the drug, as well as in cases where abdominal pain is accompanied by fever or vomiting.

Should not be prescribed simultaneously with other drugs. It is recommended to take any other medicine 1–1.5 hours before taking Diosmectite. Release form

Powder for the preparation of suspension for oral administration 3 g.

3.76 g of the drug (3 g of active substance) in heat-sealable bags.

5, 10, 20 or 30 bags with instructions for use in a cardboard pack. Storage conditions

At a temperature not higher than 25 °C.

Keep out of the reach of children. Best before date

4 years.

After the expiration date indicated on the package, do not use the drug. Conditions for dispensing from pharmacies

Over the counter.

For acute diarrhea

Let's take a closer look at the instructions for using smecta in bags :

• Children under one year: two sachets per day for three days. After another couple of days, one sachet.
• Children from one year to twelve years: 4 packs per day for 3 days. After a couple more days, 2 sachets per day.
• Teenagers over twelve years of age and adults: 6 packs per day for three days. After a couple more days, 3 sachets every 24 hours.

The duration of the treatment session varies from three days to one week. This depends on the disease itself, on the progress made in eliminating the disease, on the characteristics of the human body who is taking Smecta. Thus, those who have hard stools should take the drug with extreme caution and only until the clinical picture is eliminated. If after 7 days the clinical picture remains unchanged, pain in the abdominal cavity appears from time to time, and temperature increases, then taking Smecta is suspended. In this situation, you need to consult a doctor.

In the presence of acute diarrhea, it is also necessary to carry out rehydration treatment aimed at restoring the balance of fluid and salt in the body. In a pharmacy you can purchase one of the products that was specially developed for these purposes: Regidron, Trisol, Disol, Hydrovit, Reosolan, Citraglucosolan, etc. The fluid balance in the body is calculated in accordance with the clinical picture, the age category of the patient and the severity of diarrhea. The average is 0.5 liters of fluid for each episode of diarrhea. You need to consume liquid in small sips so as not to cause vomiting.

Modern approaches to the treatment of acute gastroenteritis in children

M.K.
BEKHTEREVA , Ph.D.,
V.V.
IVANOVA , Doctor of Medical Sciences, Prof.,
A.M.
KOMAROVA ,
S.G.
SEMENOVA ,
Federal Medical and Biological Agency of Russia, St. Petersburg
Medical clays are not just natural raw materials,

used as part of a medicinal product,

and, in fact, represent the medicine itself.

Jean Marie Triat

Acute intestinal infections (AI) currently occupy second place in the structure of infectious morbidity in children after acute respiratory infections and are a serious health problem. The incidence of infectious diarrhea in the Russian Federation varies widely: for example, in St. Petersburg, the incidence rate of rotavirus gastroenteritis in children under 14 years of age is more than 700 per 100 thousand of the corresponding age, and the incidence of norovirus gastroenteritis in 2014 reached 110 per 100 thousand children under 14 years of age (Rospotrebnadzor in St. Petersburg). In Europe, between 0.5 and 1.9 episodes of infectious diarrhea are reported annually in children under 3 years of age [1, 2].

It is known that in children, 70% of intestinal infections at any time of the year are caused by viral agents, and in the cold season, viral gastroenteritis accounts for up to 90% of cases of infectious diarrhea in children [1, 3]. We analyzed the etiological structure of acute intestinal infections in 6,728 hospitalized children in 2009–2014. in the clinic of intestinal infections of the Federal State Budgetary Institution Research Institute of Intestinal Diseases of the Federal Medical and Biological Agency of Russia (St. Petersburg) using polymerase chain reaction (PCR). Of these, 45.29% (3047) of patients had confirmed viral gastroenteritis, with the share of rotavirus infection being 23.88%, norovirus infection - 13.28%, viral-viral associations - 4.72%, mixed viral-bacterial ACI - 4.67%.

It must be emphasized that the diagnosis of ACI is a clinical and not a laboratory diagnosis and is based primarily on clinical and epidemiological data. Of great importance is the collection of an epidemiological history (cases of the disease in the team and family, nutritional factors, travel, swimming in open water, etc.) and taking into account the age of the sick. Approaches to diagnosing acute intestinal infections currently tend to be unified. Thus, according to the World Health Organization (WHO), a case of acute gastroenteritis (AGE) is an episode of loose stool (more than 3 bowel movements per day) in combination with or without fever, as well as with or without vomiting. Before starting treatment, it is necessary to establish the pathogenetic type of diarrhea (invasive, secretory, osmotic or mixed), determine the syndrome of damage to the gastrointestinal tract (GIT) (gastritis, gastroenteritis, enteritis, gastroenterocolitis, enterocolitis, colitis, distal colitis), in addition, it is important to diagnose existing complications of acute intestinal infections (dehydration syndrome, hypovolemic shock, infectious-toxic shock, hemolytic-uremic syndrome, etc.) [4].

Children with infectious diarrhea can receive medical care in both outpatient and inpatient settings. At present, in Russia, unified approaches to the indications for hospitalization for OGE are not clearly formulated. The World Gastroenterological Association (2012) clearly formulated the indications for hospitalization for infectious diarrhea in children: clinical dehydration; change in mental state; early patient age (<6 months or <8 kg body weight); burdened premorbid background (prematurity, chronic diseases, etc.); fever > 38 °C for children <3 months or > 39 °C for children from 3 to 36 months; visible blood in the stool; severe diarrhea syndrome (frequent and large stools); persistent (repeated) vomiting; lack of effect from oral rehydration; insufficient effect of outpatient treatment within 48 hours; clinical symptom complex of a severe infectious disease with hemodynamic disorder, organ failure; epidemiological indications (children from “closed” institutions with round-the-clock stays, from large families, etc.); inability to provide adequate care at home (social or technical problems) [5].

The treatment algorithm for acute intestinal infections in children involves a targeted effect, first of all, on the macroorganism, causing the correction of water and electrolyte disorders that have arisen and the elimination of the pathogen. For OGE, WHO considers the effectiveness of only two therapeutic measures to be absolutely proven: rehydration and diet therapy (2006) [1]. In accordance with the 2014 ESPGHAN consensus (The European Society of Paediatric Gastroenterology, Hepatology and Nutrition), enterosorbents (diosmectite) and probiotics (Lactobacillus rhamnosus GG, Saccharomyces boulardii, heat-treated Lactobacillus acidophilus)

LB) [6].

It should be noted that many experts classify enterosorption not only as pathogenetic therapy, but also as etiotropic [7].

The basis of treatment for OHE is rehydration [1, 6]. Indications for oral rehydration (OR) are diarrheal diseases of any etiology, accompanied by dehydration syndrome of I and I-II degrees. The basic principles of OR are: fractional administration of fluid, oral rehydration (carried out in two stages):

Stage I - the first 6 hours after the patient’s admission eliminates the water-salt deficiency that arose before the start of treatment. The amount of liquid for primary rehydration at stage I is 40-50 ml per kg of body weight in 6 hours for dehydration syndrome of stage I; for degree II dehydration syndrome - 80-90 ml per kg of body weight in 6 hours;

Stage II - maintenance rehydration, which is carried out throughout the subsequent period of treatment, taking into account the child’s daily need for liquid and salts and ongoing losses. For each subsequent 6-hour period of time, the child must drink as much solution as he lost fluid through feces and vomit over the previous 6 hours. The second stage of rehydration is continued until diarrhea stops. The approximate volume of solution for maintenance rehydration is from 80 to 100 ml/kg body weight per day.

The effectiveness of glucose-salt solutions for oral rehydration is due to the fact that when they are used, lost salts are replaced; the presence of glucose serves not only to replenish the energy losses of the macroorganism, but, in addition, glucose ensures the transport of sodium and potassium through the mucous membrane of the small intestine, which contributes to more rapid restoration of water-salt homeostasis [8].

Classic solutions for oral rehydration had an osmolarity of 311-282 mOsm/l, low-osmolar rehydration solutions were recommended by WHO and UNICEF for widespread use in 2006. Requirements for solutions with reduced osmolarity: sodium-glucose ratio - 60/90 mmol/l, osmolarity 200- 240 mOsmol/l and energy value up to 100 kcal. According to WHO and ESPGHAN, only when treated with solutions with reduced osmolarity does the absorption of water and electrolytes in the intestine improve, and the volume and duration of diarrhea are reduced [8, 9]. By eliminating electrolyte imbalance, rehydrating solutions do not reduce stool frequency or shorten the duration of the disease.

The effectiveness of oral rehydration is assessed by reducing the volume of fluid loss; disappearance of clinical signs of dehydration; normalization of diuresis; improving the general condition of the child. It has been proven that in the treatment of gastroenteritis in children, oral rehydration is highly effective in most children, is not inferior in effectiveness, and in some respects is superior to parenteral rehydration therapy [9].

Contraindications for oral rehydration are: infectious-toxic (septic) and hypovolemic shock; dehydration syndrome II-III degree, uncontrollable vomiting; oligoanuria as a manifestation of acute renal failure; diabetes; impaired glucose absorption.

Diet therapy for acute infectious diarrhea in children has the following goals: prevention of catabolism; preventing the development of atrophy of the intestinal mucosa; providing sufficient fats and carbohydrates in readily available forms as energy sources; supply of the required amount of protein; in this case, it is necessary to correct the existing malabsorption syndrome (in 90% of cases, secondary lactase deficiency); At the same time, it is desirable to influence the immunoresistance of the macroorganism and, if possible, reduce the frequency of nosocomial infection of patients. Adequate diet therapy for a child with ACI is the key to a smooth course of the disease and the absence of disturbances in trophic status in the period of late convalescence [1, 4, 5].

Enterosorption is a method based on the binding and removal from the gastrointestinal tract for therapeutic and prophylactic purposes of exogenous and endogenous toxins, pathogenic microorganisms and their metabolic products. Enterosorption is the only non-invasive method of detoxification; enterosorbents bind and remove pathogenic agents: viruses, bacteria and their toxins, undigested carbohydrates and bile acids; promotes restoration of the intestinal mucosa [10].

Currently, a large number of enterosorbents have been developed and recommended for use for medical purposes, the choice of which for the treatment of patients with a specific disease is carried out depending on a clear understanding of the characteristics of the action of the sorbent in various parts of the gastrointestinal tract, taking into account the nature of the disturbance of the processes of digestion and absorption.

In our country, for the treatment of acute intestinal infections, activated carbon is widely used as an enterosorbent, both as prescribed by a doctor and without seeking medical help, which has high surface activity and low price. However, its use is undesirable due to the effect of reversible sorption, which does not guarantee complete removal of toxins from the body, as well as the ability to cause microtrauma to the gastrointestinal mucosa. It is more advisable to use enterosorbents with cytomucoprotective properties and a gastroprotective effect, the effect of which will be both etiotropic and pathogenetic [10].

In 1985, Edelman R. formulated the characteristics of an ideal antisecretory compound for the treatment of infectious diarrhea: suppression of fluid secretion or stimulation of fluid absorption by the intestinal mucosa, development of effect within a few minutes, limited constipation effect, high therapeutic index, no action that interferes with the restoration of local function intestines, minimal impact on the central nervous system, low likelihood of drug abuse, affordable price [11].

A high degree of evidence and safety for OGE in children and adults is available only for one sorbent - dioctahedral smectite (B) [6]. Diosmectite generally meets all the requirements for effectiveness and safety.

Diosmectite is a naturally occurring substance, an aluminum silicate clay, with a lamellar, non-fibrous crystalline structure, consisting of double aluminum and magnesium silicates and giving it strong absorbent properties. Diosmectite is not absorbed in the intestine and is capable of binding water in an amount 8 times greater than its own weight, thereby reducing the content of free water in feces. The drug absorbs toxins (including C. difficile toxins A, B, C and C. perfringens enterotoxin

), bacteria, preventing their adhesion to epithelial cells. In vitro, it has been proven that diosmectite binds and removes up to 90% of rotavirus particles [12, 13].

Unlike antidiarrheal agents that affect intestinal motility, diosmectite does not inhibit the motility of the gastrointestinal tract (GIT), shortening the residence time of the infectious agent in the intestine; its use does not lead to the development of constipation and megacolon. Diosmectite has a cytoprotective effect, helping to restore the intestinal mucosal barrier, since it is able to penetrate the mucin layer of the intestinal mucosa and increase mucus production by interacting with its glycocalyx, and also reduces the loss of electrolytes in feces [13, 14].

Nevertheless, the sorption characteristics of diosmectite can affect the absorption rates of other substances, which must be taken into account when prescribing several drugs together. The interval between the time of taking diosmectite and other medications should be at least 60 minutes.

Diosmectite is widely used in clinical practice for the treatment of infectious and non-infectious diarrhea in both children and adults. The clinical effect of the drug has been proven for functional diarrhea, post-radiation and AIDS-associated chronic idiopathic diarrhea [15-18].

Nine randomized clinical trials on the effectiveness of diosmectite for OGE in children were analyzed in a meta-analysis by Szajewska H. et al. in 2006 [19]. It was found that the inclusion of diosmectite in the treatment algorithm reduced the duration of diarrhea by an average of 23 hours.

Two parallel double-blind, placebo-controlled studies of the effectiveness of a double dose of diosmectite during OGE in reducing stool weight in children aged 1 to 36 months were conducted under the leadership of Dupont K. in 2006-2007. in Peru (n = 300) and Malaysia (n = 302) [20]. This study established a significant effect of diosmectite on stool weight as well as on the duration of diarrhea in children. It was proven that the average stool weight over 72 hours was lower in the diosmectite group (94.5 ± 74.4 g/kg) than in the placebo group (104.1 ± 94.2 g/kg) (p = 0.002) , and the effect was more pronounced in patients with rotavirus gastroenteritis. In addition, diosmectite has been shown to reduce the duration of diarrhea: in the diosmectite group, the duration of diarrhea was significantly shorter (median 25.1 hours; 95% CI 20.50-29.00 hours) than in the placebo group (median 32.6 hours ; 95% CI 27.5–39.3 h) (p < 0.001) [20].

As our experience has shown, unfortunately, parents and children have low adherence to taking enterosorbents, including diosmectite for OGE. Only 72% of patients treated in a hospital and receiving diosmectite as part of the therapy adhered to the recommendations of the attending physician regarding the frequency and rules for taking diosmectite.

Thus, the use of diosmectite for acute gastroenteritis in children and adults leads to a decrease in the duration of diarrhea, a decrease in stool weight, an improvement in the well-being of patients and relief of signs of inflammation, a decrease in pain, and a decrease in bloating, which is accompanied by the restoration of the integrity and permeability of the intestinal mucous membranes. The clinical effect of diosmectite depends on the timeliness of its administration: the earlier the drug is prescribed, the higher the sorption coefficient [25, 26].

The use of probiotics is of no small importance in the treatment of infectious diarrhea. The choice of probiotic used in the treatment of infectious diarrhea is based on strain specificity. It is known that different probiotic strains differ in their clinical effects; not all probiotic strains have convincingly demonstrated their effectiveness in clinical practice.

A memorandum from the ESPGHAN working group in 2014, having reviewed data on the effectiveness of various strains of probiotics for acute intestinal infections in children, based on an analysis of published systematic reviews and the results of randomized clinical trials, including placebo-controlled ones, concluded that at the present stage all probiotic strains can be divided into three groups [6]:

1. Probiotics with a positive recommendation ( Lactobacillus GG, Saccharomyces boulardii, Lactobacillus reuteri

strain DSM 17938 (original strain ATCC 55730), heat-treated
Lactobacillus acidophilus LB
).

2. Probiotics with negative recommendation Enterococcus faecium SF-68.

3. Probiotics with insufficient evidence of their effectiveness ( E. coli Nissle 1917, L. acidophilus, L. acidophilus rhamnosus, L. paracasei ST11, L. acidophilus, L. rhamnosus, B. longum, B. lactis Bb12 and Str. thermophiles TH3; Bacillus clausii

(O/C84, N/R84, T84, SIN84), etc.

Thus, the basis for the treatment of infectious diarrhea of ​​any type is adequate and timely rehydration, diet therapy, enterosorption using sorbents with proven effectiveness.

Literature

1. Guarino A, Albano F, Ashkenazi S, Gendrel D, Hoekstra JH, Shamir R, Szajewska H. European Society for Paediatric Gastroenterology, Hepatology, and Nutrition / European Society for Paediatric Infectious Diseases Evidence-based Guidelines for the Management of Acute Gastroenteritis in Children in Europe. J Pediat Gastroenterol Nutr, 2008, 46(2): 81-122. 2. Casburn-Jones AC, Farthing MJG. Management of infectious diarrhea. Gut., 2004, 53(2): 296–305. 3. Hatchette TF, Farina D. Infectious diarrhea: when to test and when to treat. CMAJ, 2011, 183: 339-344. 4. Gorelov A.V., Milyutina L.N., Usenko D.V. Clinical guidelines for the diagnosis and treatment of acute intestinal infections in children. A manual for doctors. M., 2006: 109. 5. Acute diarrhea in adults and children: a global perspective. World Gastroenterology Organization Global Guidelines. February 2012. 6. Szajewska H, ​​Guarino A, Hojsak I, Indrio F, Kolacek S, Shamir R, Vandenplas Y, Weizman Z. Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics . J Pediatr Gastroenterol Nutr 2014, 58(4): 531-539. 7. Acute intestinal infections in children. Educational and methodological manual. Edited by Uchaikin V.F. Moscow, State Educational Institution of Higher Professional Education RGMU, 2005: 116. 8. Bellemare S, Hartling L, Wiebe N et al. Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomized controlled trials. BMC Medicine, 2004, 2: 11. 9. Fonseca BK, Holdgate A, Craig JC. Enteral vs intravenous rehydration therapy for children with gastroenteritis: a meta-analysis of randomized controlled trials. Arch Pediatr Adolesc Med, 2004, 158(5): 483-90. 10. Gorelov A.V. Usenko D.V. Rotavirus infection in children. Issues of modern pediatrics, 2008, 7(6): 78-84. 11. Edelman R. Prevention and treatment of infectious diarrhea. Speculations on the next 10 years. Am J Med 1985, 78: 99 –106. 12. Clark KJ, Sarr AB, Grant PG et al. In vitro studies on the use of clay, clay mineral sandcharcoalto adsorb bovine rotavirus and bovine coronavirus. Vet Microbiol, 1998, 63(2-4): 137-46. 13. Fioramonti J, Fargeas M, Bueno L. Action of T-2 toxin on gastrointestinal transit in mice: protective effect of an argillaceous compound. Toxicol. Lett., 1987, 36 (3): 227–232. 14. Mahraoui L, Heyman M, Plique O et al. Apical effect of diosmectite on damage to the intestinal barrier induced by basal tumor necrosis factor-α. Gut., 1997, 40 (3): 339–343. 15. Chang F, Lu C, Chen C et al. Effcacy of dioctahedral smectite in treating patients of diarrheapredominant irritable bowel syndrome. J. Gastroenterol. Hepatol., 2007, 22 (12): 2266– 2272. 16. Yao-Zong Y, Shi-Rong L, Delvaux M. Comparative effcacy of dioctahedral smectite (Smecta) and a probiotic preparation in chronic functional diarrhea. Digestive and Liver Disease, 2004, 36 (12): 824–828. 17. Hombrick J. Prevention of radiation-induced diarrhea by smectite. Results of a double-blind randomized, placebocontrolled multicenter study. Strahlenther. Onkol., 2000, 176: 173–179. 18. Mastroianni A, Cancellieri C, Coronado O et al. Smectite in AIDS-associated chronic idiopathic diarrhea. Minerva Gastroenterol. Dietol., 1998, 44 (4): 231–234. 19. Szajewska H, ​​Dziechciarz P, Mrukowicz J. Meta-analysis: smectite in the treatment of acute infectious diarrhoea in children. Aliment Pharmacol Ther 2006, 23: 217–227. 20. Dupont C, Foo J, Garnier P et al. Oral diosmectite reduces stool output and diarrhea duration in children with acute watery diarrhea. Clin. Gastroenterol. Hepatol., 2009, 7 (4): 456–462. 21. Leber W. A new suspension form of smectite (Liquid Diasorb) for the treatment of acute diarrhoea: a randomized comparative study. Pharmatherapeutics, 1987, 5(4):256–260. 22. DuPont H, Ericsson C, DuPont M et al. A randomized, open-label comparison of nonprescription loperamide and attapulgite in the symptomatic treatment of acute diarrhea. Am. J Med 1990, 88(6):20–23. 23. De Sola Pool N, Loehle K, Radzik A et al. A comparison of nonsystemic and systemic antidiarrheal agents in the treatment of acute nonspecifc diarrhea in adults. Today's Therapeutic Trends, 1987, 5(2): 31–38. 24. Van Maercke Y, Mallend M. Comparative clinical trial of Diasorb and loperamide in acute diarrhea in adults. Tijdschrift Voor Gastro-Enterologie 1987, 17: 367–371. 25. Khediri F, Ilhem Mrad A, Azzouz M et al. Efficacy of diosmectite (Smecta) in the treatment of acute watery diarrhea in adults: A multicentre, randomized, double-blind, placebo-controlled, parallel group study. Gastroenterol. Res. Pract., 2011, : 1–8. 26. Dupont C, Vernisse B. Anti-Diarrheal Effects of Diosmectite in the Treatment of Acute Diarrhea in Children A Review. Pediatr Drugs, 2009, 11 (2): 89-99.

Source:

Medical Council, No. 6, 2015