Neobook — clinical reference

Infection	Infectious diarrhoea
Brief outline/clinical setting	Acute diarrhoea loose stools 3 or more /24hrs, watery or bloody (dysentery)
Aetiologies/organisms	Bacteria: Aeromonas spp, Bacillus cereus, Campylobacter spp, Clostridium difficile, Clostridium perfringens, Escherichia coli (EHEC, STEC, EIEC, EPEC), Listeria monocytogenes, Pleisiomonas shigelloides, Salmonella spp, Shigella spp, Staphylococcus aureus, Vibrio spp, Yersinia enterocolitica and Yersinia pseudotuberculosis* Viruses: Rotavirus, Adenovirus, Astrovirus, Human calicivirus, Norovirus, Sapovirus Parasites: Entamoeba histolytica, Giardia lamblia, Trichurius, Strongyloides, Schistosomiasis, Cryptosporidium, Cyclospora cayetanensis, Dientamoeba fragilis, Balantidium coli, Blastocystis spp, Cytoisospora belli, Hymenolepis nana/diminuta, Diphyllobothrium latum/nihonkaiense, Taenia solium, Taenia saginata/asiatica, Clonorchis sinensis/Opisthorchis spp./Metorchis spp, Fasciola hepatica/gigantica, Schistosoma mansoni, Schistosoma spp, Ancylostoma duodenale, Necator americanus, Ascaris lumbricoides/suum, Enterobius vermicularis, Strongyloides stercoralis, Trichuris spp., Enerocytozoon bieneusi, Encephalitozoon spp
Optimal antimicrobial selection	Majority of acute diarrheal illness will not require antibiotic therapy Indications to consider empiric antibiotic therapy Inflammatory diarrhoea: dysentery (blood stools), leucocytes in the stool Systemic toxicity (invasive diarrhea): fever, tachycardia, hypovolaemic shock. Diarrhea associated with travel (esp. Campylobacter endemic areas, Thailand, South-East Asia.) Outbreaks: e.g. Cholera, Salmonella food borne outbreaks, Clostridoides difficile Ongoing diarrhea with worsening or non-resolving symptoms >72hrs If any of above are present: send stool sample for MCS, as well as Ova and parasites (especially recent travel, immune-compromised) If recent hospitalization, institutionalization or antibiotic history C.difficile testing Azithromycin 1000mg po single dose/ 500mg po daily for 3 days If suspected protozoal infection: add metronidazole 400mg p.o 8hrly for 5 days
Duration	Stat or 3 days
Alternative if allergic/not available	Azithromycin: 1000mg po single dose or 500 mg po daily for 3 days Trimethoprim-sulfamethoxazole (co-trimoxazole): 800/160mg po 12-hrly (one double strength tablet BD) If patient cannot tolerate orally: Ceftriaxone 1-2g i.v. for 5-days
Rationale	Local epidemiology
Level of evidence	High

Infectious Diarrhoea

Drugs mentioned