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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
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.
For Entamoeba histolytica: Metronidazole 500mg PO TID for 7 days
For Giardia lamblia: Metronidazole 250mg thrice a day for 5 days or Tinidazole 2g
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.
Antibiotics for possible bacterial overgrowth or Metronidazole for Giardia,
cholesteramine for bile acid malabsorption or
Non specific therapy with constipating agents such as loperamide, diphenoxylate
and in more severe cases codeine or long acting somatostatin analogue.
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.