Diarrhea is considered when patients have more than 3 loose bowel movements in a day. Small volume stools indicate large intestine involvement whereas large volume stool indicates small intestine involvement. Acute diarrhea is considered when symptoms are less than 15 days while chronic diarrhea symptoms more than 30 days.
Medications:
Consider bacterial infection if diarrhea is associated with vomiting, abdominal cramps, blood and mucus in stools with fever
- Adult – Tab. Levoflox 750 (Levofloxacin 750 mg) 1 tablet once a day for 5 days.
- Children – Dry syrup Elfi CV 100 mg/62.5 mg (Cefixime 100 mg, Clavulanic acid 62.5 mg) – 4 mg/kg orally twice daily for 7 days.
- Pregnancy – Tab. Zifi-CV 200 (Cefixime 200 mg, Clavulanic acid 125 mg) – 1 tablet twice a day for 7 days.
Or
- Adult – Tab. Azee-500 (Azithromycin 500 mg) 1 tablet once a day for 5 days.
- Children – Dry syrup Azee 200 (Azithromycin 200 mg/5ml) – 10 mg/kg/day orally once a day for 5 days (maximum daily dose – 500 mg/day).
Consider amoebic infection if there is no improvement for 48 hours after above treatment or if diarrhea present with blood and mucus in stool with no fever
- Adults – Tab. Flagyl 400 (Metronidazole 400 mg) 1 tablet thrice a day for 7 days.
- Children – Syrup Flagyl (Metronidazole 200 mg/5ml) – 7.5 mg/kg thrice a day for 7 days.
- Pregnancy – Avoid Metronidazole in first trimester.
Follow Flagyl treatment with:
- Tab. Amicline (Diloxanide 500 mg) 1 tablet thrice a day for 10 days.
- Children less than 12 years – Tab. Amicline (Diloxanide 500 mg) 20 mg/kg/day orally in 3 divided doses for 10 days.
- Pregnancy: Avoid Diloxanide in pregnancy.
Consider Cholera in case of profuse diarrhea (rice water stools) with vomiting
- Adults – Tab. Azee-500 (Azithromycin 500 mg) 1 tablet once a day for 5 days.
- Children – Dry syrup Azee 200 (Azithromycin 200 mg/5ml) 10 mg/kg/day once a day for 5 days (maximum daily dose – 500 mg).
- Pregnancy – Tab. Zifi CV 200 (Cefixime 200 mg, Clavulanic acid 125 mg) – 1 tablet twice a day for 7 days.
Consider food poisoning if diarrhea present with excessive vomiting (especially if more than one member of the household or group is affected)
- Adults – Tab. Azee-500 (Azithromycin 500 mg) 1 tablet once a day for 5 days.
- Children – Dry syrup Azee 200 (Azithromycin 200 mg/5ml) – 10 mg/kg/day once a day for 5 days (maximum daily dose – 500 mg).
- Pregnancy – Tab. Zifi CV 200 (Cefixime 200 mg, Clavulanic acid 125 mg) – 1 tablet twice a day for 7 days.
Supportive treatments:
- Syrup Zincovit (Zinc and multivitamin) 10 mls once a day.
- Tab. Stemetil 5 (Prochlorperazine 5 mg) 1 tablet thrice a day to reduce nausea.
Patients with bacterial dysentery are at a high risk of dehydration. Please assess patients for level of dehydration and treat as below:
No obvious dehydration
- Patient can be treated at home with ORS (oral rehydration solution). Give as much fluid as patient can tolerate. Patient should continue to eat soft bland diet.
- Ages less than 2 yrs – give 500 ml or more ORS + 50 – 100 ml ORS for every extra stool passed.
- Age 2 to 10 yrs – give 1000 ml or more ORS + 100 – 200 ml ORS for every extra stool passed.
- Age more than 10 yrs – give 2000 ml or more ORS + 100 – 200 ml ORS for every extra stool passed.
Mild to moderate dehydration
- Give as much fluid as patient wants. Patient should continue to eat soft diet.
- Patient weighing less than 6 kg – less than 400 ml ORS
- Patient weighing 6 kg to 10 kg – 400 to 700 ml ORS
- Patient weighing 10 kg to 12 kg – 700 to 900 ml ORS
- Patient weighing 12 kg to 19 kg – 900 to 1400 ml ORS
Reassess dehydration after 4 hours and treat symptoms as suggested above.
Severe dehydration
For ages less than 12 months – give i.v. fluids as suggested below
- First hour – 30 ml/kg of 0.9% Sodium chloride
- Next 5 hours – 70 ml/kg of 0.9% Sodium chloride
- Correct any electrolyte abnormality as needed
- Give ORS if patient can tolerate oral fluids
- Repeat same again if patient condition doesn’t improve.
Age more than 12 months less than 5 years – give i.v. fluids as below
- First 30 minutes – 30 ml/kg of 0.9% Sodium chloride
- Over next 2 & 1/2 hours – 70 ml/kg of 0.9% Sodium chloride
- Correct any electrolyte abnormality as needed.
- Give ORS if patient can tolerate oral fluids
- Repeat same again if patient condition doesn’t improve
Investigations:
- Faecal leukocytes – suggests infective diarrhoea.
- Stool routine – to rule out amoebic cysts.
- Complete Blood Count – to look for systemic infection.
Referral:
Consider referral to gastroenterologist if patient fails to respond or presents with complications.