Term
| What is the most important treatment for diarrhea? |
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Definition
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Term
| Why is soda, gatorade, broth, or juice not recommended for rehydration? |
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Definition
| It's too osmolar. You end up getting more fluid in the lower GI, which causes more diarrhea. |
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Term
| When are antimobility agents contraindicated |
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Definition
| When the diarrhea is bloody, lasts more than 48 hours, or is accompanied by a fever |
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Term
| What is the most common agent for infectious diarrhea? |
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Definition
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Term
| What is required to get C Diff infection? |
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Definition
| You must be colonized by C Diff and take antibiotics in sufficient amount as to alter the normal intestinal flora. |
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Term
| What antibiotics are most associated with C Diff? |
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Definition
Clindamycin (most)
Pennicillins
Cephalosporins
Fluoroquinolones |
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Term
| What common OTC drug class can increase risk of C Diff infection? |
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Definition
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Term
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Definition
It attracts neutrophils and monocytes, produces enterotoxin, and causes inflammation and fluid buildup
Think A = attraction |
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Term
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Definition
It degrades colonic epithelial cells.
Think B = beast |
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Term
| What is used to diagnose C diff? |
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Definition
| Toxin in fecal sample or endoscopy? |
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Term
| When should you suspect C Diff? |
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Definition
| When a patient has diarrhea shortly after a course of antibiotics. |
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Term
| What are the first line treatments for C Diff? |
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Definition
Nonsevere: Metronidazole 500mg PO TID 10-14 days
Severe: Vancomycin 125 mg PO QID x 10-14 days |
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Term
| What is considered a severe C Diff infection? |
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Definition
| Elevated white count AND a change in serum creatinine. |
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Term
| How do you treat C Diff recurrence? |
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Definition
First time: Treat it the same way.
Second time: use Vancomycin |
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Term
| If you can't go PO, what can you do to treat C Diff? |
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Definition
| You can use metronidazole IV, or you can use a vanc enema. You can NOT use Vanc IV. |
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Term
| What are 4 alternative treatments for C Diff? |
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Definition
Fidaxomycin
Rifaxamin (usually added as a chaser to prevent recurrence)
Nitazoxazole (used when patients can't tolerate vanc and flagyl)
Stool transfer |
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Term
| What are two adjunctive treatments for C Diff? |
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Definition
Anion exchange resins (Cholestryamine or Colestipol)
Probiotics |
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Term
| What are five features that are important about Vibrio Cholerae? |
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Definition
Illness caused by enterotoxin
50% asymptomatic
Death can occur in 24 hours
Seen in travelers drinking contaminated water
Diarrhea has the electrolyte concentrations similar to plasma |
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Term
| What two types of treatment should you give cholera patients? |
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Definition
Rice-based oral replacement of fluids
Lactated ringers |
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Term
| What are the three treatments for cholera? |
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Definition
Doxycycline 300mg (single dose)
Tetracycline 12.5 mg/kg QID x 3 days
Peds: erythromycin liquid 12.5 mg/kg QID x 3 days |
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Term
| What form(s) of E coli do we worry about? |
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Definition
Entertoxigenic E coli (ETEC)
Enterohemorrhagic E coli (EHEC) |
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Term
| What is the most common cause of traveler's diarrhea? |
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Definition
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Term
| Is ETEC usually associated with bloody stool or pus? |
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Definition
| No. It usually resolves within 24-48 hours and only needs fluid or electrolyte replacement. |
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Term
| What are the antibiotics of choice for ETEC? |
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Definition
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Term
| What separates ETEC from EHEC? |
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Definition
| EHEC produces shiga-like toxins. |
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Term
| Is EHEC commonly seen with bloody stool or pus? |
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Definition
| Yes. It also comes with nausea and vomiting. |
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Term
| What's the general presentation of Shigellosis? |
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Definition
Frequent watery stools
Fever --> decreased fever, but severe abdominal pain --> bloody diarrhea |
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Term
| What's one really weird fact that distinguishes Shigellosis? |
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Definition
| Diarrhea is often green and contains leukocytes. |
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Term
| How do you treat Shigellosis? |
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Definition
Usually? You don't. You only treat the elderly, immunocompromised, children in daycare, malnourished children, and healthcare workers.
Treatment:
US: Bactrim
Outside US: FQs or Azith |
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Term
| Which pets cause salmonellosis? |
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Definition
| Reptiles. LIke my pet turtles! |
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Term
| How big must the inoculum be for salmonellosis? |
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Definition
| At least 1000 organisms. About the amount found in two drops of chicken juice. |
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Term
| How do you treat Salmonellosis? |
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Definition
You don't. You only do it if they are under 6 months old, immunocompromised, severely symtomatic WITH fever AND bloody diarrhea, or pateitns after a splenectomy.
If you treat it, go with FQs or 3rd gen ceph
If it's bacteremia, you double up. Ceftriaxone + Cipro. |
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Term
| What's the treatment for chronic carriers of salmonella? |
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Definition
| Norfoxacin 400mg BID x 28 days |
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Term
| Does campylobacter present with bloody stools? |
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Definition
| Yup. Bloody, foul smelling stools. They are loose to watery. |
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Term
| You got campylobacter! How soon should you get to the doc? |
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Definition
| If you don't start abx within 4 days, they won't help |
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Term
| Who do you treat for camplobacter? |
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Definition
high fever, severe bloody diarrhea, and illness that lasts over a week.
Or pregnant. Or immunocompromised |
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Term
| How do you treat Camplobacter? |
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Definition
| Usually? You don't. If you do, give macrolides. |
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Term
| How do you treat Yersiniosis? |
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Definition
| FQs +/- 3rd gen ceph or AGs. |
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Term
| You just got norovirus! What were you probably doing? |
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Definition
| Cruising. VERY common on cruise ships. |
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Term
| How's the best way to prevent traveler's diarrhea? |
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Definition
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Term
| What's the REALLY dumb, yet common mistake travelers make that lands them with diarrhea? |
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Definition
| They use bottled water, and then they put ice in it. >_< |
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