ACUTE INFECTIONS DIARRHEA CLINICAL

SYNDROMES: WATERY vs DYSENTRIC

WATERY DYSENTRIC
(enterotoxigenic) (invasive)

STOOL Watery Bloody

Apperarance Increased Increased
Volume Less than 10 Greater than 10
Number per day Negative Positive
Occult blood Absent or few many
Fecal
polymorphonucle
ar cells

MECHANISMS Toxins Mucosal

Decreased invasion
absorption

COMPLICATIO Could be severe Mild

NS Acidosis, shock, Tenesmus,
Dehydration elecrolyte rectal prolapse,
others imbalance seizures

ETIOLOGY Rotavirus Shigella

Enterotoxigenic Camphylobacte
E.coli, Vibrio r
cholerae Salmonella
 enteritidis

DEHYDRATION BASED ON PERCENTAGE BODY

WEIGHT LOSS IN CHILDREN
MILD (3-5%) MODERATE SEVERE
(6-9%) (>10%)

ORT 50 mL/kg ORT 100 mL/kg Ringer lactate 40

over 2–4 h over 2–4 h mL/kg in 15–30
min, then 20–40
Replace ongoing Replace ongoing mL/kg if skin
losses with low- losses with low- turgor, alertness,
sodium sodium and pulse have
ORT (40–60 ORT (40–60 not returned to
mEq/L Na+) at mEq/L Na+) at normal
10 mL/kg/stool or 10 mL/kg per
emesis stool or emesis OR

Ringer lactate or
NS 20 mL/kg,
repeat if
necessary, and
then replace
water and
 electrolyte
deficits over 1–2
days Followed by
ORT 100 mL/kg
over 4 h.

Replace ongoing
losses with low-
sodium ORT
(40–60mEq/L
Na+) at 10 mL/kg
per stool or
emesis

RECOMMENDATIONS FOR ANTI-MICROBIAL

THERAPY
PATHOGEN: FIRST-LINE ALTERNATIVE
Enterotoxigen AGENTS AGENTS
ic (cholera-
like) diarrhea

Vibrio • Doxycycline • Chloramphenicol

cholerae O1 or 300 mg oral 50 mg/kg IV
O139 single dose; every 6 hours,
 • tetracycline • erythromycin
500 mg 250–500
orally QID× mg orally every 6–8
3 days; or hours (QID-TDS),
• Septrin DS and furazolidone
tablet BD× 3
days;
• norfloxacin
400 mg
orally BD× 3
days; or
• ciprofloxacin
500 mg
orally BD× 3
days or 1 g
orally single
dose

Enterotoxigeni • Norfloxacin Septrin DS tablet BD

c Escherichia 400 mg or
Coli ciprofloxacin
500 mg
orally BD× 3
days

Clostridium Metronidazole • Vancomycin 125

difficile 250 mg QID to mg orally QID×
500 mg TDS× 10 10 days;
 days • Bacitracin
20,000–25,000
units QID × 7–
10 days

PATHOGEN FIRST-LINE ALTERNATIVE

: Invasive AGENTS AGENTS
(dysentery-
like) diarrhea

Shigella • Septrin DS • Ofloxacin 300

species BD× 3–5 days mg,
• norfloxacin
400 mg, or
• ciprofloxacin
500 mg BD× 3
days, or
• nalidixic acid
1 g/day × 5
days;
 • azithromycin
500
mg orally × 1, then
250 mg orally daily
× 4 days
Salmonella • Septrin DS BD; • Azithromycin
Non typhoidal • ofloxacin 300 1,000 mg
mg, orally × 1 day,
• Norfloxacin followed by
400 mg, or 500 mg orally
• ciprofloxacin once daily × 6 days
500 mg BD × 5
days; or
• Ceftriaxone 2 g
IV daily or
• cefotaxime 2 g
IV TDS × 5
days
•
Salmonella Ciprofloxacin 500 • Azithromycin
Enteric fever mg orally BD× 3–14 1,000 mg
days (ofloxacin orally × 1 day,
equally efficacious) followed by
500 mg daily ×
5days; or
• cefixime,
cefotaxime,
and
 cefuroxime; or
chloramphenic
ol
500 mg QID orally
or IV × 14 days

Campylobacte • Erythromycin • Ciprofloxacin

r 500 mg orally 500 mg or
BD× 5 days; • norfloxacin
• azithromycin 400 mg orally
1,000 mg BD× 5 days
orally × 1 day,
followed by 500 mg
daily× 5 days or
• clarithromycin
500 mg orally
BD

Yersinia A combination
species therapy with
doxycycline,
aminoglycosides,
septrin, or
fluoroquinolones
PATHOGEN: FIRST-LINE ALTERNATIVE
Traveler’s AGENTS AGENTS
diarrhea

Prophylaxis • Norfloxacin • Rifaximin

400 mg or 200 mg one
• ciprofloxacin to TDS × 2
500 mg orally weeks
daily
• Septrin DS
tablet orally
daily

Treatment • Norfloxacin • Rifaximin

400 mg or 200 mg TDS
• ciprofloxacin or 400 mg
500 mg orally BD × 3 days
BD × 3 days,
or
• Septrin DS
tablet orally
BD × 3 days
or
• azithromycin
500 mg orally
OD× 3 days