Table 2.

Treatment-related diarrhea

Clinical situation	Intention	Intervention	SoR	QoE	Reference	Comments
Treatment-associated diarrhea	Primary prevention	Octeotride LAR	D	I	[47, 48]	No sufficient evidence to recommend the use of octreotide LAR for secondary prevention
		Glutamine	D	I	[49, 50]
Late-onset diarrhea after irinotecan therapy	Cure	Treatment with loperamide po plus				Stop treatment, if no response after 72 h
		Budesonide 3 mg tid po until resolution of symptoms or	B	IIu	[24]
		Acetorphan 100 mg tid po for 48 h	B	IIu	[25]
Late-onset diarrhea after irinotecan therapy	Primary prevention	Prophylaxis with budesonide 3 mg tid po or	D	I	[52]
		Neomycin 500 mg bid po	D	I	[53]
Treatment-associated diarrhea, 1st line	Cure	Loperamide, initial dose 4 mg, followed by 2 mg po after each unformed bowel movement	A	IIu	[36–39]	-Only in persisting and severe cases of diarrhea and after exclusion of infectious diarrhea -Careful risk-benefit assessment in neutropenic patients -No further benefit after 16 mg qd -Administer 30 min. before eating for maximum efficacy
Treatment-associated diarrhea, 2nd line	Cure	Octreotide 100 μg tid sc; increase to 500 μg qd if no improvement after 24 h	B	IIu	[40–44]	-Only in cases of persisting and severe diarrhea and after exclusion of infectious diarrhea -Titration to higher dosages may be considered if no response to 500 μg qd sc -Careful risk-benefit assessment in neutropenic patients -iv administration at 25–50 μg/h possible
	Cure	Psyllium seeds	B	IIt	[45, 46]	-Only in persisting and severe cases of diarrhea and after exclusion of infectious diarrhea
		Alternatives: Diphenoxylate plus atropine, paregoric tincture of opium, codeine or morphine	B	III		-Only in cases of persisting and severe diarrhea and after exclusion of infectious diarrhea -Careful risk-benefit assessment in neutropenic patients
Chemotherapy-associated lactose intolerance	Prevention	Dietary restriction of milk products	B	IIu	[34, 35]	Only if clinical signs and symptoms are present
Antibiotic-associated diarrhea	Prevention	Probiotics	C	IIt,r	[59]	No sufficient safety data in immunocompromised patients available

SoR strength of recommendation, QoE quality of evidence