OTC Cases: Stomach Infections

CASE 1: Heartburn

Q: DN, a 45-year-old man, feels a burning sensation in his stomach. He has taken OTC omeprazole (Prilosec) for 3 months with no relief. The sensation
wakes him every night. Initially, the omeprazole relieved the pain. Over time, the burning sensation worsened and he has found little relief with omeprazole. DN has no other pain or symptoms and takes no other medications. He wants to try a stronger OTC medicine. What should the pharmacist recommend?

A: Because DN has been taking OTC treatment for more than 14 days and has been waking up each night, he should contact his primary care physician for evaluation. Patients taking OTC proton pump inhibitors such as esomeprazole (Nexium), lansoprazole (Prevacid), or omeprazole should be referred to a physician if symptoms worsen.¹ Patients taking omeprazole also should seek medical attention if they have been taking the medication for more than 14 days; they experience diarrhea, joint pain, or a rash; or they need more than 1 course or 14 days of treatment every 4 months.²

CASE 2: Pinworm Infection

Q: LF is a 22-year-old nurse who is complaining about having itching for a few weeks in her perianal area. She initially thought she had hemorrhoids. She went to the doctor and received a diagnosis of pinworm infection. The doctor told her to try OTC pyrantel pamoate, but LF is not sure an OTC medication will be effective. She is healthy and has no other medical conditions. LF takes a daily calcium supplement and a multivitamin. What recommendation should the pharmacist make?

A: Pyrantel pamoate is the only FDA-approved nonprescription medication for treatment of pinworm infection. Pyrantel pamoate is indicated for patients 2 years and older based on a weight-based dosing chart. The pharmacist should advise LF that pyrantel pamoate is more than 90% effective at managing pinworms, and she should consider trying the medication before requesting a prescription product. The pharmacist should first determine that LF does not have liver disease and is not pregnant. Adverse effects from taking pyrantel pamoate may include abdominal cramps, diarrhea, dizziness, headaches, nausea, and vomiting. Although dosing can be repeated, LF should consult
her physician before taking the medication again.³

CASE 3: Probiotics

Q: KU is a 35-year-old woman with an upper respiratory infection who has a prescription for an antibiotic. She typically avoids antibiotics because she has had cramping and diarrhea while taking them. KU wants to know the pharmacist’s thoughts on antibiotic-associated diarrhea (AAD). She is healthy and has no other medical conditions. What should the pharmacist recommend?

A: Diarrhea is a common adverse effect of taking antibiotics, but KU may be able to prevent AAD by taking probiotics. Many variations are available over the counter. The most common contain Lactobacillus or Bifidobacterium bacteria. Probiotics help the body’s immune response manage the normal flora of bacteria in the gut to prevent AAD.⁴

CASE 4: Food Poisoning

Q: DI is looking for something to treat vomiting for his wife, RI, who is 40 years old and has been vomiting for the past 24 hours. They had dinner at a restaurant the night before with friends, who also have symptoms of food poisoning. RI is healthy with no medical conditions and is not pregnant. What recommendation should the pharmacist make?

A: Food poisoning symptoms typically resolve on their own. DI should buy an oral rehydration solution to prevent RI from experiencing dehydration. Oral rehydration solutions such as Pedialyte are preferable to sports drinks such as Gatorade and Powerade, which contain large amounts of sugar that can cause additional diarrhea. Patients with food poisoning should seek medical attention if they experience diarrhea with blood in their stool, dehydration, or a high fever. If RI does not improve within 3 days, she should contact her health care provider.⁵ Patients who would be at higher risk and should consider seeking immediate medical attention for food poisoning include children younger than 5 years, individuals older than 65 years, patients who are immunocompromised, and pregnant women.⁶

About The Authors

Rupal Patel Mansukhani, PharmD, FAPhA, NCTTP, is a clinical associate professor at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey in Piscataway, and a transitions-of-care clinical pharmacist at Morristown Medical Center in New Jersey.

Ammie J. Patel, PharmD, BCACP, BCPS, is a clinical assistant professor
of pharmacy practice and administration at Ernest Mario School of Pharmacy
at Rutgers, The State University of New Jersey in Piscataway, and an ambulatory care specialist at RWJBarnabas Health Primary Care in Shrewsbury and Eatontown, New Jersey.

References

1. Over-the-counter (OTC) heartburn treatment. FDA. March 12, 2021. Accessed April 6, 2022. https://www.fda.gov/drugs/ information-consumers-and-patients-drugs/over-counter-otc-heartburn-treatment

2. Prilosec OTC. Procter & Gamble. Accessed April 2, 2022. https://prilosecotc.com/en-us/product/prilosec-otc-tablets

3. Reese’s Pinworm Medicine. Reese Pharmaceutical Company. Accessed April 5, 2022. https://reesespinworm.com/reeses-pin- worm-medicine/#

4. Probiotics: what you need to know. National Center for Complementary and Integrative Health. Updated August 2019. Accessed April 4, 2022 https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know

5. Food poisoning symptoms. CDC. March 9, 2021. Accessed April 4, 2022. https://www.cdc.gov/foodsafety/symptoms.html

6. Food poisoning. FoodSafety.gov. Updated August 20, 2020. Accessed April 4, 2022. https://www.foodsafety.gov/food-poisoning