Diarrhea is loosely defined as passage of abnormally liquid or unformed Stool at an increased frequency. For adults on a typically western Diet, stool weight exceeding 200g/d Can generally be considered diarrheal.
Empiric antibiotic therapy is often also logically used for more severely ill patients while awaiting bacterial culture results. Adachi JA, Zeichner LO, DuPont HL, Ericsson CD: Empirical antimicrobial therapy for traveler's diarrhea. Clin Infect Dis 31:1079, 2000.
Ciprofluxacine 500 mg Q12h ( 3 days) Or Azythromycin 1000 mg single dose
Experts also advise against empiric treatment of salmonellosis unless enteric fever is present. Sirinavin S, Garner P: Antibiotics for treating salmonella gut infections. Cochrane Database Syst Rev 30:CD001167, 2000.
Nonspecific antidiarrheal agents can reduce stool frequency and stool weight and can reduce coexisting symptoms, such as abdominal cramps
Opiates, such as loperamide, or diphenoxylate with atropine frequently are employed. Schiller LR: Review article: Anti-diarrhoeal pharmacology and therapeutics. Aliment Pharmacol Ther 9:87, 1995.
Intraluminal agents, such as bismuth subsalicylate and adsorbents (e.g., kaolin) also may help reduce the fluidity of bowel movements. Schiller LR: Review article: Anti-diarrhoeal pharmacology and therapeutics. Aliment Pharmacol Ther 9:87, 1995.
Empiric Therapy of Chronic Diarrhea is used in three situations: (1) Initial treatment before diagnostic testing; (2) After diagnostic testing has failed to confirm a diagnosis (3) When a diagnosis has been made but no specific treatment is available or specific treatment has failed to produce a cure.
Generally, empiric antibiotic therapy is less useful in chronic diarrhea than in acute diarrhea.
In chronic diarrhea an empiric course of metronidazole or a fluoroquinolone before extensive diagnostic testing, before extensive diagnostic testing, is not recommended.
Bcause travelers' diarrhea is contracted by the ingestion of fecally contaminated food or water.
The first line of defense for the traveler is care in selecting food and beverages.
► ► The first approach is chemoprophylaxis using either antibiotics or bismuth to prevent diarrhea.
The most widely used approach to travelers' diarrhea is probably the provision of antibiotics to be used by the traveler, if and when diarrhea strikes.
Antibiotic prophylaxis is indicated for travelers (to high risk countries), with 1. Gastric achlorhydria 2. IBD 3. Immunocompromise
A reasonable current recommendation is to provide a three-day course of a quinolone for travelers to most developing countries.
The patient is told to begin the antibiotic when diarrhea starts and to continue treatment for 3 days.
A quinolone represents the drug of choice for travelers if antibiotic prophylaxis is used or for the treatment of travelers' diarrhea.
A single daily dose of ciprofloxacin (500 mg) had a protective efficacy of 94%.
. Norfloxacin in a daily dose of 400 mg had a protective efficacy of 93%.
► ► Chemoprophylaxis with bismuth is moderately effective (approximately 65%) in preventing diarrhea.
► ► Two bismuth tablets(240mg x 2) taken four times daily.
self-treatment regimens are not appropriate for the traveler with It needs to be emphasized before travel that self-treatment regimens are not appropriate for the traveler with bloody diarrhea, severe abdominal pain, high fever
The disadvantages relate to the possibility of 1-side effects 2-selection of antibiotic-resistant organisms.
The advantage of prophylactic antibiotics is their high efficacy in preventing disease.
Finally, the most important component of self-treatment is the replacement of the fluid and electrolytes lost during diarrhea.
Watery diarrhea that occurs later after return or that persists longer than 10 days despite antibiotic therapy is most commonly Giardia lamblia infection.
If the diarrhea fails to respond to metronidazole, a gastrointestinal evaluation should be performed.
The diagnostic & therapeutic considerations differ somewhat for bloody diarrhea, and the pace of the workup should be accelerated.
Indications of antibiotic coverage wether or not a causative organism is discovered in acute diarrhea 3 1. Immunecompromised patient. 2. Mechanical heart valves or recent vascular graft. 3. Elderly.