Traveler's diarrhea: Difference between revisions

Revision as of 03:19, 26 June 2014

dysentery if stool bloody, fvr or wbc in stool- invasive inflamm enteropathy
has abrupt onset, metastatic lesions, reactive arthopathies, or campylobacter assoc guillain barre- maybe flouroquinolone resis esp in SE Asia
amoebic dysentery insidious and can get amoebic liver abscess
if do not find infc cause of dysentery, eval pt for IBD or CA
prolonged diarrhea and malabsorption- giardia or tropical sprue- does not respond to removal of gluten from diet- tx with tetra and folate
also consider postinfectious disaccharidase deficiency or irritable bowel dz
if diarrhea starts >1 mo after travel- not caused by travel

Antibiotic
- Ciprofloxacin 750mg PO BID x 1-3 days OR
- Levofloxacin 500mg PO q24h x 1-3 days OR
- Ofloxacin 300mg PO BID x 3 days OR
- Rifaximin 200mg PO TID x 3 days OR
- Azithromyxin 1000mg PO x 1 OR 500mg PO q24h x 3 days
Antimotility agent
- Only for nonpregnant adults with no fever or blood in stool
- Loperamide 4mg PO after each loose stool (Max: 16mg/day)

@@ Line 19: / Line 19: @@
 # if diarrhea starts >1 mo after travel- not caused by travel
-==Treatment==
+==Treatment<ref>Sanford 2014</ref>==
-# regular travelers diarrhea with fluids, antimotility agents, abx- fluoro or macrolide
+*Antibiotic
-# invasive enteropathy- bloody/ fvr- same but no antimotility agents
+**[[Ciprofloxacin]] 750mg PO BID x 1-3 days OR
-# if bloody stool but no fvr, consider enterhemorrhagic E coli- do not give abx since will get hemolytic uremic syndrome in kids
+**[[Levofloxacin]] 500mg PO q24h x 1-3 days OR
-#examine stool if diarrhea invasive, persistent, unresponsive to standard tx or immune compromised
+**[[Ofloxacin]] 300mg PO BID x 3 days OR
-# if persistent diarrhea, give empiric flouro or macrolide or consid metronidazole for giardia- most common parasite
+**[[Rifaximin]] 200mg PO TID x 3 days OR
-# try lactose free diet
+**[[Azithromyxin]] 1000mg PO x 1 OR 500mg PO q24h x 3 days
-# chronic diarrhea usually self limited within 1 yr
+*Antimotility agent
+**Only for nonpregnant adults with no fever or blood in stool
+**[[Loperamide]] 4mg PO after each loose stool (Max: 16mg/day)
+===Pediatrics<ref>Sanford 2014</ref>===
+*[[Azithromycin]] 10mg/kg/day once daily x 3 days OR
+*[[Ceftriaxone]] 50mg/kg/day once daily x 3 days
+*Avoid [[fluroquinolones]]
 ==See Also==