Treatment:
Adequate fluid and electrolyte replacement and maintenance are essential to the management of diarrheal illness Rehydration.None to moderate hypovolemia — can be effectively treated with oral rehydration solution (ORS). An improved, reduced osmolarity. ORS solution, containing 75 mEq/L of sodium and 75 mmol/L of glucose.
Severe hypovolemia- should receive intravenous fluids. Ringer’s lactate is preferred, but normal saline can also be used.( Normal saline is less preferable because it does not contain potassium to replace losses nor a base to correct acidosis).
- Antimicrobial therapy is not typically indicated for the treatment of acute watery diarrhea in adults. An important exception is the treatment of severe cholera in outbreak settings, for which antibiotics can decrease the duration of illness and the volume of fluid losses.
- The use of probiotics or prebiotics for the treatment of acute diarrhea in adults is not recommended, except in cases of postantibiotic-associated illness.
- In patients receiving antibiotics for traveler’s diarrhea, adjunctive loperamide therapy can be administered to decrease duration of diarrhea and increase chance for a cure [7]. Loperamide should be avoided in dysentery.
- In contrast to the treatment of watery diarrhea, adults with bloody diarrhea should be treated promptly with an antimicrobial that is effective against Shigella. Antibiotics reduced the duration of diarrhea and fever in infections caused by Shigella, which is the most common cause of dysentery in resource-limited settings and can otherwise be associated with severe complications.
- Stool microscopy and cultures has to be sent routinely in dysentery syndromes and antibiotics should be selected based on the microscopy and sensitivity testing.
Antibiotic Treatment for Diarrhea
| Suspected Cause | Antibiotic |
|---|---|
V. Cholerae |
Doxycycline (Not recommended in children and pregnant women) 300mg once |
Shigella |
Ciprofloxacin 500 mg b.d for 3days |
Amoebiasis |
Metronidazole 500 mg t.i.d for 5 days |
Giardiasis |
Metronidazole 250 mg t.i.d for 5 days |
Campylobacter |
Azithromycin 500 mg for 3days |
Aeromonas |
Ciprofloxacin 500 mg b.i.d for 3days |
*The antibiotic of choice is Flouroquinolones or Azithromycin. Ampicillin or TMP-SMX are no longer drugs of choice in India in view of high resistance. As the resistance of shigella to Azithromycin and cefixime is nearing 20 percent.