Loperamide red flags — GPhC CRA MCQ
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Correct answer: A — Decline loperamide and arrange urgent assessment of febrile bloody diarrhoea
Decline loperamide and arrange urgent assessment of febrile bloody diarrhoea: Dysentery features suggest invasive infection; slowing intestinal transit may worsen illness or obscure severity and antimicrobial assessment may be needed. Supply maximum-dose loperamide and review symptoms after 48 hours: Bloody febrile diarrhoea is a contraindication to unsupervised antimotility treatment. Combine loperamide with a previously prescribed travel antibiotic course: Leftover antimicrobials may be ineffective or harmful and do not replace assessment. Withhold fluids until visible blood has cleared from the stool: Fluid replacement is important and fasting does not treat invasive infection. Offer oral rehydration alone and review if fever persists for seven days: Fever and blood increase concern for invasive bacterial disease and warrant prompt assessment.
Reference: BNF: loperamide hydrochloride: https://bnf.nice.org.uk/drugs/loperamide-hydrochloride/