Diarrhea (cont.)
When should antibiotics be used for diarrhea?Most episodes of diarrhea are acute and of short duration and do not require
antibiotics. Antibiotics are not even necessary for the most common bacterial
infections that cause diarrhea. Antibiotics, however, often are used when (1)
patients have more severe and persistent diarrhea, (2) patients have additional
debilitating diseases such as heart failure, lung disease, and AIDS, (3) stool
examination and testing discloses parasites, more serious bacterial infections
(for example, Shigella), or C. difficile, and 4) traveler's diarrhea.
Diarrhea At A Glance
- Diarrhea is an increase in the frequency of bowel
movements, an increase in the looseness of stool or both.
- Diarrhea is caused by increased secretion of fluid
into the intestine, reduced absorption of fluid from the intestine or rapid
passage of stool through the intestine.
- Diarrhea can be defined absolutely or relatively.
Absolute diarrhea is defined as more than five bowel movements a day or liquid
stools. Relative diarrhea is defined as an increase in the number of bowel
movements per day or an increase in the looseness of stools compared with an
individual's usual bowel habit.
- Diarrhea may be either acute or chronic, and each has
different causes and treatments.
- Complications of diarrhea include dehydration,
electrolytes (mineral) abnormalities, and irritation of the anus.
- Dehydration can be treated with oral
rehydration solutions and, if necessary, with intravenous fluids.
- Tests that are useful in the evaluation of acute
diarrhea include examination of stool for white blood cells and parasites,
cultures of stool for bacteria, testing of stool for the toxin of C. difficile
and blood tests for electrolyte abnormalities.
- Tests that are useful in the evaluation of chronic
diarrhea include examination of stool for parasites, upper gastrointestinal
X-rays (UGI series), barium enema, esophago-gastro-duodenoscopy (EGD) with
biopsies, colonoscopy with biopsies, hydrogen breath testing, and measurement
of fat in the stool.
- Diarrhea may be treated with absorbents,
anti-motility medications, and bismuth compounds.
- Antibiotics should not be used in treating diarrhea unless
there is a culture-proven bacterial infection that requires antibiotics,
severe diarrhea that is likely to be infectious in origin, or when an
individual has serious underlying diseases.
Last Editorial Review: 2/24/2009
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