Diarrhoea

Treatment: The priority in treatment is correcting dehydration. Mild and moderate dehydration can be corrected with ORS (50-100 ml/kg 4 hourly) taken in frequent small drinks. Severe dehydration requires intravenous fluids. If hypotension, resuscitate with saline. In adults regulate fluids according to pulse, BP and urine output. See paediatric section for amount and assessment of hydration.

Gastroenteritis: watery diarrhea often with vomiting and low grade fever. Hydration is the only treatment. Antibiotics should not be used.

Giardia: May cause a more chronic malabsorption. Treat with metronidazole 2g OD for 3 days or 400mg TDS for 5-7 days, or tinidazole 2 gm stat

Cholera: Profuse, watery diarrhoea, often litres per day. The main priority is to maintain hydration, keeping up with stool losses by ORS or IV fluids. When vomiting subsides, give doxycycline 300mg single dose, or cotrimoxazole 2 tabs BD for 3 days.

Amoebiasis: Bloody diarrhea, no fever, Entamoeba histolitica trophozoites in stool microscopy. Treat with metronidazole 600-800mg (15mg/kg) TDS for 10 days. Cysts can be present in asymptomatic individuals and are not sensitive to metronidazole. Amoebic liver abscess presents with a tender hepatic mass.

Bacterial Dysentery: Small amounts of frequent, bloody stool, pain and tenesmus, often fever. Stool microscopy will show RBC’s and WBC’s in mild cases treatment with antibiotics is not indicated and may complicate cases of salmonella or E.coli. In severe cases, treat with ciprofloxacin 500mg BD for 5 days as first line. Alternatives are nalidixic acid 1g (15mg/kg) QDS for 5 days, or gentamicin 240mg IV OD if vomiting. In adults (not children) loperamide 2mg QID can be added to decrease duration and severity of symptoms.

Chronic diarrhoea: Often a presentation of HIV. Other possibilities are giardia for which a trial of treatment may be given. Consider also non-infectious causes, like Crohn’s disease or ulcerative colitis.

GLOSSARY

BD= TWICE A DAY

TDS= 3 TIMES A DAY

QID= 4 TIMES A DAY

Br Beppe