Monday, June 11, 2007

Diarrhea

How does your stools looks like?
According to Wikipedia, Type 1 and Type 2 indicates constipation, 3 and 4 are the easiest to pass and types 5-6 are the more symptomatic of diarrhea, while type 7 may be a sign of cholera, food poisoning, etc.

If you are having type 7 stools?
Sign and symptoms
Loose liquid stools +/- blood or mucus, fever, abdominal pain and distension, headache, anorexia, malaise, vomiting, myalgia, cramping.

Treatment
Oral Rehydration Salt: The main treatment.
Loperamide: 4mg followed by 2mg capsule after each unformed stool
Diphenoxylate/Atropine: 2.5mg/25ug every 4 hours until symptoms resolved.

If the pathogens identified (after consulting your doctor or pharmacist)
Giardia: Metronidazole 250mg tds for 5 days.
E.histolytica: Metronidazole 750mg tds for 10 days.
Shigella: Trimethoprim-sulfamethoxazole 160mg and 800mg 2bd for 5 days, or Ciprofloxacin 500mg bid for 3 days.
C.difficile (associated with antibiotic uses): Metronidazole 500mg tds for 10-14days.
Travellers diarrhea: Ciprofloxacin 750mg one dose or, if severe 500mg bid for 3 days.

Ask the pharmacist!
1)If you are given antibiotic by your doctor, make sure you ask for what type of antibiotic you are taking.
2)If you are given antibiotics others than above, maybe you can ask what is your actual diagnosis.
3)Photosensitivity is the common side effect when taking above antibiotics, so you may need to reduce your sun exposure during treatment.
4)Let the pharmacist know what other medication you are taking, eg. Ciprofloxacin increase theophylline levels and cost toxicity.
5)There is no evidence that bowel rest speeds recovery, and food may enhance the efficacy of oral rehydration therapy. I would encourage you to follow your normal diet or this (dry toast or bread, baked potato, chicken soup with rice or noodles, poultry, bananas) but you still need to avoid coffee, alcohol, diary products, most fruits, vegetables, red meats, and heavily seasoned foods.
6) Taking probiotics can reduce the duration of acute infectious diarrhea (Systemic review of 23 randomized trials of probiotics in 1,917 patients with acute diarrhea; probiotics reduced risk of diarrhea at 3 days(15 trials) and mean duration of diarrhea by 30.5 hours (12 trials)
7) Taking zinc supplementation at 3x RDA reduce duration of diarrhea (Pediatrics 2002 May;109(5):898), reduced diarrheal duration and volume (J Paediatr Gastroenteral Nutr), and reduce morbidity and mortality(BMJ 2002 Nov 9;325(7372):1059)

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