GENERAL MEASURES :
β’ Replacement of lost fl uid and electrolytes
β’ Clear liquids such as tea, broth, carbonated beverages (without caffeine) and rehydration fl uids (e.g., Gatorade) to replace lost fluid
β’ Packets of rehydration salts (one packet to be diluted in one quart of water); drink until thirst is quenched; will help in replacing lost electrolytes. Treatment of choice for pediatric patients.
DIET :
β’ During periods of active diarrhea, avoid coffee, alcohol, dairy products, most fruits, vegetables, red meats, and heavily seasoned foods
β’ After 12 hours with no diarrhea, begin by eating clear soup, salted crackers, dry toast or bread, and sherbet
β’ As stooling rate decreases, slowly add to diet, rice, baked potato, and chicken soup with rice or noodles
β’ As stool begins to retain shape, add to diet baked fish, poultry, applesauce, and bananas
DRUG(S) OF CHOICE
. Loperamide, 4 mg followed by 2 mg capsule after each unformed stool, or bismuth subsalicylate, 30 mL every half hour until 8 doses, may be helpful in mild diarrhea
. If diarrhea persists and a bacterial or parasitic organism is identifi ed, antibiotic therapy should be started:
. Giardia: metronidazole 250 mg tid for 5 days
. E. histolytica: metronidazole 750 mg tid for 10 days
. Shigella: trimethoprim-sulfamethoxazole 160 mg and 800 mg, respectively, bid for fi ve days, or ciprofl oxacin
(Cipro) 500 mg bid for 3 days
. Campylobacter: erythromycin 500 mg qid for 5 days or ciprofloxacin (Cipro) 500 mg bid for 3 days
. C. difficile: metronidazole 500 mg tid for 10-14 days
. Travelers diarrhea: Ciprofloxacin (Cipro) 750 mg one dose or if severe, 500 mg divided PO bid for 3 days
ALTERNATIVE DRUGS :
β’ Doxycycline 100 mg bid for 3 days
β’ Diphenoxylate-atropine in nonpregnant adults
β’ Tinidazole or secnidazole for E. histolytica
β’ Vancomycin for C. difficile infections
β’ Alosetron in IBS
PATIENT MONITORING : If diarrhea continues for three to fi ve days with or without blood or mucus then consult physician
PREVENTION/AVOIDANCE :
β’ Frequent oversights during foreign travel include brushing teeth with contaminated water, ingesting ice cubes, or eating cold salads or meats
β’ Avoid uncooked or undercooked seafood or meat, buffet meals left out for several hours, or food served
by street vendors
β’ Antibiotic use is associated with diarrhea (and possibly pseudomembranous colitis)
POSSIBLE COMPLICATIONS:
β’ Dehydration
β’ Sepsis
β’ Shock
β’ Anemia
EXPECTED COURSE/PROGNOSIS ; A common problem that is rarely life-threatening if attention is given to maintaining adequate hydration