Sandbox:Reddy

OUT Patient

Dysenteric Diarrhea Frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping. Patient may be febrile and toxic.	Shigella Salmonella Campylobacter Yersinia E. coli 0157:H7 'C.difficile'	Ciprofloxacin 500 mg PO BID OR Ciprofloxacin 750 mg daily x 3 days (avoid in cases of E. coli O157:H7 as it may increase the risk of hemolytic-uremic syndrome) Recent antibiotic exposure: consider C. difficile Antimotility drugs should not be used in C.difficile. C. difficile - Metronidazole 500 mg PO TID x 10-14 days. If no response at 5 days, switch to Vancomycin 125mg PO QID x10-14 days. See inpatient guidelines for severe or recurrent C. difficile infection and/or policy on C. difficile management.	Empiric therapy is generally indicated if patient is toxic appearing, elderly or immunocompromised.  If empiric therapy is given, obtain culture and give fluoroquinolone x 3 days while awaiting cultures Azithromycin should be used for pregnancy and suspected quinolone resistant Campylobacter. Antimotility drugs improve symptoms and can be used if patient is not toxic.   Antimicrobial treatment may worsen outcomes in patients with E. coli0157:H7 E. histolytica - Metronidazole 750 mg PO TID x 7-10 days then Iodoquinol 650 mg PO TID x 20 days or Paromomycin5 25-35 mg/kg/day in 3 divided doses x 7 days
Nondysenteric Diarrhea Large volume, nonbloody, watery diarrhea. Patient may have nausea, vomiting, and abdominal cramping but fever often absent.	Viruses Giardia Enterotoxigenic E. coli Enterotoxin-producing bacteria	General Care: Observation Oral rehydration Antimotility agents Giardia – especially if patient describes recent history of travel and/or ingestion of unfiltered water (e.g., camping), consider – Metronidazole 250 mg PO TID x 5 days.	Generally, empiric therapy and stool cultures are not indicated. Most disease is self-limiting and can be treated with antimotility agents If patient fails to improve, cultures (-), and symptoms persist, consider stool for O & P. Metronidazole resistance seen in 20% giardia cases. Check C. difficile toxin if recent history of antibiotic use or hospitalization.
Traveler’s diarrhea Empiric treatment while abroad	Toxigenic E. coli Salmonella Shigella Campylobacter Amebiasis	Ciprofloxacin 500 mg PO BID x 1-3 days Pregnancy or fluoroquinolone-resistant campylobacter: Azithromycin 1 g x 1 dose EITHER WITH or WITHOUT: Loperamide 4 mg PO x 1; then 2 mg after each loose stool, MAX 16 mg/day	Mild, self-limited cases can be treated with fluid and electrolyte repletion and bismuth subsalicylate. Prophylaxis generally not recommended.