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travel_diarrhoea

traveller's diarrhoea

introduction

causes of traveller's diarrhoea

  • 80% bacterial eg. enterotoxigenic Escherichia coli (ETEC), Salmonella, Campylobacter, etc.
  • up to 20% are parasitic eg. giardiasis, Cryptosporidium, Cyclospora, amoebiasis
  • remainder are viral eg. rotavirus, adenovirus, calicivirus

self management

  • oral rehydration solutions
  • mild symptoms (< 3 loose stools/day):
    • no Rx or loperamide 4mg stat then 2mg after each loose stool to max. 16mg/day (do not use in children under 2 years)
  • moderate symptoms (3 or more stools /day):
    • loperamide as above
    • if persistent > 2 days, start 3 day course of oral antibiotics such as norfloxacin 400mg bd, co-trimoxazole, or azithromycin 10mg/kg up to 500mg once daily
      • if symptoms distressing, consider initial dose double the usual dose
  • incapacitating symptoms, fever or bloody diarrhoea:
    • avoid loperamide if dysenteric symptoms (fever, bloody diarrhoea)
    • double dose antibiotic Rx as above initially then usual dose
  • persistent symptoms despite above:
    • stool culture
    • consider parasitic or drug resistant cause

suspected invasive Salmonella enteritis

  • patients with persistent fevers who have not been to typhoid-prone areas should be considered for invasive Salmonella enteridis infection
  • these patients should have stool culture, 2 sets of blood cultures
  • ciprofloxacin is the preferred antibiotic NOT norfloxacin which is really only useful for non-invasive enteritis
travel_diarrhoea.txt · Last modified: 2016/01/14 03:55 by gary1