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Chapter 040. Diarrhea and Constipation (Part 7)

ACUTE DIARRHEA: TREATMENT Fluid and electrolyte replacement are of central importance to all forms of acute diarrhea. Fluid replacement alone may suffice for mild cases. Oral sugarelectrolyte solutions (sport drinks or designed formulations) should be instituted promptly with severe diarrhea to limit dehydration, which is the major cause of death. Profoundly dehydrated patients, especially infants and the elderly, require IV rehydration. In moderately severe nonfebrile and nonbloody diarrhea, antimotility and antisecretory agents such as loperamide can be useful adjuncts to control symptoms. Such agents should be avoided with febrile dysentery, which may be exacerbated or prolonged by them. Bismuth subsalicylate may. | Chapter 040. Diarrhea and Constipation Part 7 ACUTE DIARRHEA TREATMENT Fluid and electrolyte replacement are of central importance to all forms of acute diarrhea. Fluid replacement alone may suffice for mild cases. Oral sugar-electrolyte solutions sport drinks or designed formulations should be instituted promptly with severe diarrhea to limit dehydration which is the major cause of death. Profoundly dehydrated patients especially infants and the elderly require IV rehydration. In moderately severe nonfebrile and nonbloody diarrhea antimotility and antisecretory agents such as loperamide can be useful adjuncts to control symptoms. Such agents should be avoided with febrile dysentery which may be exacerbated or prolonged by them. Bismuth subsalicylate may reduce symptoms of vomiting and diarrhea but should not be used to treat immunocompromised patients or those with renal impairment because of the risk of bismuth encephalopathy. Judicious use of antibiotics is appropriate in selected instances of acute diarrhea and may reduce its severity and duration Fig. 40-2 . Many physicians treat moderately to severely ill patients with febrile dysentery empirically without diagnostic evaluation using a quinolone such as ciprofloxacin 500 mg bid for 35 d . Empirical treatment can also be considered for suspected giardiasis with metronidazole 250 mg qid for 7 d . Selection of antibiotics and dosage regimens are otherwise dictated by specific pathogens geographic patterns of resistance and conditions found Chaps. 122 143 146 147 148 149 150 151 and 152 . Antibiotic coverage is indicated whether or not a causative organism is discovered in patients who are immunocompromised have mechanical heart valves or recent vascular grafts or are elderly. Antibiotic prophylaxis is indicated for certain patients traveling to high-risk countries in whom the likelihood or seriousness of acquired diarrhea would be especially high including those with immunocompromise IBD hemochromatosis or .