Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning (Part 9)

Loperamide should not be used by patients with fever or dysentery; its usemay prolong diarrhea in patients with infection due to Shigella or other invasive organisms.bThe recommended antibacterial drugs are as follows: Travel to high-riskcountry other than Thailand: Adults: (1) A fluoroquinolone such as ciprofloxacin, 750 mg as a single dose or 500 mg bid for 3 days; levofloxacin, 500 mg as a single dose or 500 mg qd for 3 days; or norfloxacin, 800 mg as a single dose or 400 mg bid for 3 days. (2) Azithromycin, 1000 mg as a single dose or 500 mg qd...
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Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning (Part 9) Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning (Part 9) a Loperamide should not be used by patients with fever or dysentery; its usemay prolong diarrhea in patients with infection due to Shigella or other invasiveorganisms. b The recommended antibacterial drugs are as follows: Travel to high-riskcountry other than Thailand: Adults: (1) A fluoroquinolone such as ciprofloxacin,750 mg as a single dose or 500 mg bid for 3 days; levofloxacin, 500 mg as a singledose or 500 mg qd for 3 days; or norfloxacin, 800 mg as a single dose or 400 mgbid for 3 days. (2) Azithromycin, 1000 mg as a single dose or 500 mg qd for 3days. (3) Rifaximin, 200 mg tid or 400 mg bid for 3 days (not recommended foruse in dysentery). Children: Azithromycin, 10 mg/kg on day 1, 5 mg/kg on days 2and 3 if diarrhea persists. Alternative agent: furazolidone, 7.5 mg/kg per day infour divided doses for 5 days. Travel to Thailand (with risk of fluoroquinolone-resistant Campylobacter): Adults: Azithromycin (at above dose for adults).Alternative agent: a fluoroquinolone (at above doses for adults). Children: Sameas for children traveling to other areas (see above). All patients should take oral fluids (Pedialyte, Lytren, or flavored mineralwater) plus saltine crackers. If diarrhea becomes moderate or severe, if feverpersists, or if bloody stools or dehydration develops, the patient should seekmedical attention. Source: After Dupont. The mainstay of treatment is adequate rehydration. The treatment of choleraand other dehydrating diarrheal diseases was revolutionized by the promotion oforal rehydration solutions, the efficacy of which depends on the fact that glucose-facilitated absorption of sodium and water in the small intestine remains intact inthe presence of cholera toxin. The use of oral rehydration solutions has reducedmortality due to cholera from >50% (in untreated cases) to Although most secretory forms of travelers diarrhea—usually due toenterotoxigenic and enteroaggregative E. coli—can be treated effectively withrehydration, bismuth subsalicylate, or antiperistaltic agents, antimicrobial agentscan shorten the duration of illness from 3–4 days to 24–36 h. Changes in diet havenot been shown to have an impact on the duration of illness, while the efficacy ofprobiotics continues to be debated. Antibiotic treatment for children who present with bloody diarrhea raisesspecial concerns. Laboratory studies of enterohemorrhagic E. coli strains havedemonstrated that a number of antibiotics induce replication of Shiga toxin–producing lambdoid bacteriophages, significantly increasing toxin production bythese strains. Clinical studies have supported these laboratory results, andantibiotics are not recommended for the treatment of enterohemorrhagic E. coliinfections in children. Prophylaxis Improvements in hygiene to limit fecal-oral spread of enteric pathogenswill be necessary if the prevalence of diarrheal diseases is to be significantlyreduced in developing countries. Travelers can reduce their risk of diarrhea byeating only hot, freshly cooked food; by avoiding raw vegetables, salads, andunpeeled fruit; and by drinking only boiled or treated water and avoiding ice.Historically, few travelers to tourist destinations adhere to these dietaryrestrictions. However, an intensive hygienic effort in Jamaica involvinggovernment, hotel, and tourism agencies led to a decrease in the incidence oftravelers diarrhea by 72% from 1996 to 2002. Bismuth subsalicylate is an inexpensive agent for the prophylaxis oftravelers diarrhea; it is taken at a dosage of 2 tablets (525 mg) four times a day.Treatment appears to be effective and safe for up to 3 weeks. Prophylacticantimicrobial agents, although effective, are not generally recommended for theprevention of travelers diarrhea, except when travelers are immunosuppressed orhave other underlying illnesses that place them at high risk for morbidity fromgastrointestinal infection. The risk of side effects and the possibility of developingan infection with a drug-resistant organism or with more harmful, invasivebacteria make it more reasonable to institute an empirical short course of treatmentif symptoms develop. The recent availability of effective nonabsorbed antibioticssuch as rifaximin may lead to new prophylactic options. The possibility of exerting a major impact on the worldwide morbidity andmortality associated with diarrheal diseases has led to intense efforts to developeffective vaccines against the common bacterial and viral enteric pathogens.Recent research ha ...