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Transcript
Internal Medicine
1. Rehydration
•
In patients with massive diarrhea and vomiting with hypotension intravenous fluids
like Ringer’s lactate or Normal saline should be given in adequate amount.
•
For patients without hypotension oral fluid containing sodium, glucose, potassium and
chloride ions (ORS) are preferred.
2. Antimicrobial therapy
Antibiotics:
•
Most acute infectious diarrheal diseases do not require antibiotic therapy because
majority of them are self limited and viral in nature.
•
Of the non invasive bacterial diarrhea, antibiotics decrease the volume of diarrhea
only in cholera. Doxycycline 300mg single dose is the drug of choice.
•
For invasive bacterial diarrhea caused by E. coli and Shigella (bacillary dysentery)
Ciprofloxacin 500 mg or Norfloxacin 400mg twice a day for 3-5 days is indicated.
Anti-protozoal:
•
For Entamoeba histolytica: Metronidazole 500mg PO TID for 7 days
•
For Giardia lamblia: Metronidazole 250mg thrice a day for 5 days or Tinidazole 2g
once.
•
For Isospora belli: Co- trimoxazole 960mg four times a day for 10 days then 960mg
twice a day for additional three wks . In immunocompromized patients continue
maintenance dose of the same drug three times a week.
•
When no specific therapy is available or no cause is identified it’s appropriate to give
empirical therapy E.g.
o
Antibiotics for possible bacterial overgrowth or Metronidazole for Giardia,
cholesteramine for bile acid malabsorption or
o
Non specific therapy with constipating agents such as loperamide, diphenoxylate
and in more severe cases codeine or long acting somatostatin analogue.
References:
1) Kasper L., Braunwald E., Harrison’s principles of Internal medicine, 16th Edition, Diarrhea,
pages 225-229.
2) Myers R. Allen, National Medical Series for independent Study (NMS) 3rd edition Medicine,
Diarrhea, 210-224.
388