0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40
828 Infectious Diarrheas
discontinue inciting antibiotic(s), if possible
avoid antimotility agents
metronidazole (first line) or oral vancomycin
for severe disease or unable to take po:
metronidazole IV
vancomycin (NG, enema, intracecal)
Vibrio cholerae
rehydration
doxycycline, tetracycline, or fluoroquinolones
Vibrio parahaemolyticus
antibiotics do not shorten course
Yersinia enterocolitica
antibiotics usually not needed
if severe: doxycycline+aminoglycoside (in combination),
trimethoprim-sulfamethoxazole, or fluoroquinolones
follow-up
n/a
complications and prognosis
■most cases resolve spontaneously or with appropriate antimicrobial
treatment
■toxic megacolon, intestinal perforation
➣Shigella
➣rarely: Shiga toxin-producing E. coli,C. difficile,Campylobacter,
Yersinia, Salmonella
■hemolytic-uremic syndrome, thrombotic thrombocytopenic pur-
pura
➣Shiga toxin-producing E. coli (10%, with 5–10% mortality among
afflicted), Shigella, rarely Campylobacter
■reactive arthritis
➣Shigella, Salmonella, Yersinia, Campylobacter
■metastatic infection
➣Salmonella
➣rarely:Yersinia, Campylobacter
■malnutrition, weight loss
➣Giardia
■Guillain-Barr ́e syndrome
➣rarely:C. jejuni
■relapses (not antibiotic resistance)
➣C. difficilediarrhea and colitis: reinfection with same strain, 1 wk
(usual) to 2 months (less common) after stopping treatment