Cholestyramine & Loperamide References
Compiled by Erica Deighton

    The information gathered here is intended to help rabbit caregivers and their vets access some of the current evidence in support of the potentially life-saving use of Cholestyramine [Questran®] for the treatment of enteric disorders in rabbits. This evidence seems quite robust and well-documented in veterinary texts, yet apparently not yet in wide-spread use in clinical practice.

  • "Therapeutic agents used in the treatment of enteric disorders shows Cholestyramine applicability across disorders". [1]

  • "There is evidence that the ion exchange resin Cholestyramine absorbs the enterotoxin and improves survival rate if it is given in the early stages.....This preparation is safe enough to give rabbits in any situations where enterotoxaemia could develop". [1]

  • "Cholestyramine also binds fat soluble and bacterial toxins and is effective in the treatment of enterotoxaemia if it is given in the early stages of the disease. In a study by Rateau et al., (1986), Cholestyramine reduced loss of water and electrolytes from the ileum of rabbits treated with cholera toxin. It was also effective in preventing death from enterotoxaemia in rabbits treated with clindamycin (Lipman et al., 1992) even if the treatment was delayed until 48h after the administration of the antibiotic......"[1]

  • "Cholestyramine ( 2g/20ml water orally once a day for 2 weeks) can be given to absorb exotoxins if Clostridium spirofrome is suspected to be causinf enteritis. Cholestyramine is a[n inert] granular [ion exchange] resin with an affinity to hydrophobic compounds. It does not affect gastrointestinal motility and is not absorbed, but can dehydrate intestinal contents if not given with plenty of liquid." [2]

  • Cholestyramine, an ion-exchange resin capable of binding bacterial toxins, has been used with very good results. [3]

  • Utilization of cholestyramine resin as a preventive treatment for antibiotic (clindamycin) induced enterotoxaemia in the rabbit. [4]

  • "A specific approach to reducing enterotoxaemia relies on gavage feeding cholestyramine at 0.1 g/ml in water. This ion exchange resin binds bacterial toxins and may be useful but should be given early in the development of the disease before significant toxin absorption has occurred."[5]

  • "control enterotoxemia (cholestyramine 2 gm in 20 ml water PO q 8 hr). It is obvious that treatment must be aggressive and initiated early on in the disease process. Even under the best circumstances, the prognosis is guarded." [6]

  • "Severe antibiotic associated colitis may be helped by cholestyramine, a drug used in humans to bind cholestrol, as it also binds the Clostridium toxin that poisons the gut."[7]

  • "Acute outbreaks of diarrhoea with high mortality rates are frequently observed in rabbits. Amongst various aetiological factors Escherichia coli or its toxins have been found to be commonly incriminated. Sulphonamides or antibiotics are used to treat rabbits with bacterial diarrhoea. The result of the antibiotic treatment is moderately successful. We had good results using oral rehydration treatment in combination with loperamide hydrochloride (Immodium) in a colony of rabbits with E. coli diarrhoea."[8]

  • Infants aged 4 to 36 months with acute diarrhea (rotavirus 66%) were treated as outpatients with oral fluids and a rapid return to full feedings. In addition, the infants were randomized to receive for 3 days either cholestyramine 2 g twice daily (N = 10), an equivalent placebo 2 g twice daily (N = 15), or loperamide 0.10 mg/kg divided in three doses (N = 16). The duration of watery diarrhoea from the beginning of treatment was 0.9 +/- 1.0 days in the cholestyramine group, 2.5 +/- 1.3 days in the loperamide group, and 3.3 +/- 1.6 days in the placebo group (p less than 0.001 cholestyramine vs. placebo, p less than 0.005 cholestyramine vs. loperamide). The infants receiving cholestyramine also had a better weight gain than those receiving the placebo, and their metabolic acidosis was corrected sooner. There was no hyperchloraemia associated with the cholestyramine treatment. It is concluded that cholestyramine 2 g twice daily for 3 days can be safely used to shorten the course of acute diarrhoea. The use of loperamide in acute infantile diarrhoea does not appear justified. [9]

  • Loperamide: Rabbit: 0.1 mg/kg BW PO tid for 3 days, then sid for 2 days (Banerjee et al., 1987)[10]


  • If you have any questions or want any more information, please feel free to ask me.

    Erica

    References

  • [1] Harcourt-Brown, Textbook of Rabbit Medicine

  • [2] Barbara Deeb, Digestive System and Disorders. In Flecknell's Manual of Rabbit Medicine and Surgery.

  • [3] Antibiotic-induced Enteritis and Enterotoxemia - Jeffrey R. Jenkins, DVM

  • [4]Cholestyramine [Questran®] for Enterotoxaemia (abstract) - N.S. Lipman et al.

  • [5] Enteritis and Diarrhoea - David Williams, MRCVS

  • [6] Rabbit Gastro-Intestinal Disease - Michael Murray, DVM

  • [7] Acute Gastrointestinal Disturbances in Companion Rabbits - Owen Davies, MRCVS & Linda Dykes

  • [8] Acute diarrhoeal disease in rabbit: bacteriological diagnosis and efficacy of oral rehydration in combination with loperamide hydrochloride. - Banerjee AK, Angulo AF, Dhasmana KM, Kong-A-San J., Lab Anim 1987 Oct;21(4):314-7

  • [9] A comparative trial of cholestyramine and loperamide for acute diarrhoea in infants treated as outpatients. - Vesikari T, Isolauri E., Lab Anim. 1987 Oct;21(4):314-7.

  • [10] Veterinary Clinical Services

 

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