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Guidelines for Using Banatrol Plus for the Management of Diarrhea from C diff.

Banatrol Plus can be used safely and quickly promote more formed stools without inhibiting gut motility for individuals with loose stools or diarrhea, including those with suspected or have tested positive for Clostridium difficile Infection.

Clostridium difficile Infection (CDI) is a common cause of antibiotic-associated diarrhea (AAD) in hospital and nursing home facilities which can occur after the antibiotic therapy upsets the balance of good and bad bacteria in the intestinal tract. Frequent stools or large volumes of loose stools, such as in individuals with CDI, AAD or tube feeding related diarrhea, can be difficult to manage and increase the spread of CDI if present. Additionally, diarrhea can contribute to risk of skin breakdown, urinary tract infection and malnutrition.

However, the use of anti-peristatic medications are not recommended with CDI, as they may obscure symptoms of CDI and precipitate toxic megacolon. The ASPEN 2016 Guidelines recommend the use of a prebiotic (fermentable) soluble fiber supplement for critically ill patients who develop diarrhea. Probiotics are not currently recommended. Fiber maybe contraindicated in some patients such as those with “overflow diarrhea” which is watery diarrhea related to a bowel impaction. Banatrol Plus is a  fermentable soluble fiber supplement which does not inhibit GI motility, allowing for its safe use for C. Diff diarrhea which can be started while awaiting stool test results for suspected C. diff infection.

Banana flakes have been shown more effective than anti-diarrhea medications in reducing diarrhea in tube fed critically ill patients, even in those subjects with C. Diff infection. Subsequently, for individuals with loose stools or diarrhea, fiber intervention is started first with Banatrol Plus (banana flakes and trans-galactooligosaccharide) to safely and quickly promote more formed stools. Once stools consistently become more formed (Bristol Stool score Type 4 or 5).

Implementing Banatrol Plus

Recommendations for implementing Banatrol Plus will be assessed by the bowel management team and/or the nurse and dietitian and reviewed with the Physician.

For oral use, Banatrol Plus will be ordered by the Physician, Nurse Practitioner or Dietitian according to the procedure for Banatrol Plus.

For tube feeding use: As part of the initial tube feeding orders, the physician will include an order for “Banatrol Plus 1 pack via tube q 6-8 hours during tube feeding prn for diarrhea (3 or more loose stools in a 24 hour period)”. The nurse and dietitian will collaborate on monitoring the patients response to the intervention and need for Banatrol Plus dose adjustment.

Procedure for Banatrol Plus

Indications: Indicated for loose stools (Bristol StoolType 6 or 7) or diarrhea (3 or more loose stools per day) related to, but not limited to, medications, tube feeding, antibiotic associated diarrhea or C. diff infection.

Banatrol Plus can be initiated as soon as loose stools or diarrhea occur while awaiting stool test results for suspected CDI and along with antibiotic treatment for CDI.

Cautions: Avoid with allergy to bananas, very strict low potassium diets (Banatrol Plus contains 120 mg or 3.1 mEq of potassium per pack), bowel impaction, ileus and in individuals in which fiber is contraindicated. NOT for parenteral use.

  1. Oral dosing and administration:
    1. Banatrol Plus 1 pack 3 times a day with meals. Can be mixed in 4-8oz of thin or thickened liquid or moist food such as applesauce, yogurt or pudding.
  2. Tube feeding dosing and administration:
    1. Banatrol Plus 1 pack every 6 to 8 hours during tube feeding.
    2. For 14 French sized tubes or larger:
      1. Mix 1 pack of Banatrol Plus with at least 120 mls of warm water. Administer via syringe immediately after mixing.
      2. Flush tube with 30 mls water before and after administration.
  • DO NOT MIX Banatrol Plus with enteral feeding.
  1. For smaller sized feeding tubes:
    1. Mix ½ pack of Banatrol Plus with at least 120 mls of warm water. Infuse via syringe immediately after mixing. Flush tube with 30 mls of water.
    2. Mix remaining ½ pack of Banatrol Plus in at least 120mls warm water. Infuse via syringe immediately after mixing.
  • Flush tube with 30 mls water before and after administration. DO NOT MIX Banatrol Plus with enteral feeding.
  1. Response to Banatrol Plus generally occurs in 5-7 days, depending on the type and severity of diarrhea, the dose and the individual’s response. After 5-7 days, evaluate the person’s response to treatment and adjust the dose of Banatrol Plus up or down 1 pack per day – Increase up to a total of 6 packs of Banatrol Plus per day.
  2. When stools become more formed on a consistent basis (Bristol Stool score Type 4 or 5), wean off of Banatrol Pus.

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