see also:

• travel medicine
• the febrile returned traveller
• gastroenteritis

• 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

• 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

• 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