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KEY CONCEPTS

KEY CONCEPTS

  • imageInfectious diarrhea is a disease that causes significant morbidity and mortality worldwide. Its etiology includes various bacteria, viruses, and protozoans, with viral causes being most predominant globally.

  • imageTwo types of infectious diarrhea include watery or enterotoxigenic diarrhea and dysentery or bloody diarrhea. Common pathogens responsible for watery diarrhea are viruses and enterotoxigenic Escherichia coli. Common pathogens responsible for dysentery diarrhea are Shigella spp., Campylobacter jejuni, nontyphoid Salmonella, and enterohemorrhagic E. coli.

  • imageFluid and electrolyte replacement is the cornerstone of therapy for diarrheal illnesses. Oral rehydration therapy is preferred in most cases of mild and moderate diarrhea.

  • imageThe use of antibacterial therapy for infectious diarrhea is not commonly indicated due to the mild and self-limited nature of the infection, or viral etiology. Antibiotic therapy is recommended in cases of severe diarrhea, moderate-to-severe cases of traveler’s diarrhea, most cases of febrile dysenteric diarrhea, and culture-proven bacterial diarrhea in high-risk patients.

  • imageLoperamide and diphenoxylate/atropine may offer symptomatic relief in patients with moderate watery diarrhea; however, use of antimotility agents should be avoided in patients with watery and dysentery diarrhea.

  • imageDiarrheal illness can be largely prevented by procedures to prevent contaminated food or water supplies and with appropriate personal hygiene.

  • imageOral vancomycin or fidaxomicin are recommended as the initial therapy for patients with Clostridium difficile infection.

  • imageCommon traveler’s diarrheal pathogens include enterotoxigenic E. coli, Shigella spp., Campylobacter spp., Salmonella spp., and viruses.

  • imagePatient education on prevention strategies and appropriate self-treatment of traveler’s diarrhea is preferred, and prophylaxis with antibacterials is not recommended.

  • imagePathogens commonly responsible for food poisoning include Staphylococcus spp., Salmonella spp., Shigella spp., and Clostridium spp.

PATIENT CARE PROCESS

Patient Care Process for Clostridioides difficile Infections (CDI)

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Collect

  • Patient characteristics (eg, age, sex)

  • Patient medical history (personal and family), including any previous episodes of CDI

  • Social history (eg, tobacco/ethanol use) and dietary habits

  • Current medications including OTC, herbal products, dietary supplements, acid suppressive medication, and previous antibiotic use (within the past 3 months)

  • Characteristics of diarrhea including onset, number of episodes per day, and presence of blood

  • Objective data

    • Blood pressure (BP), heart rate (HR), respiratory rate (RR), height, weight, O2-saturation

    • Labs including white blood cell count (WBC) and serum creatinine (SCr)

    • Stool sample to be tested for Clostridim difficile toxins

    • Radiographic abdominal imaging if concern for ileus or megacolon

Assess

  • Hemodynamic stability (eg, systolic BP <90 mm Hg, HR >110 bpm, O2-sat <90% [0.90], RR)

  • Radiographic studies for the presence of ileus, megacolon, or perforation

  • Presence of CDI risk factors (age, antibiotic use, recent healthcare exposure, chemotherapy, GI surgery, tube feeding, acid suppressive medications)

  • Ability to stop offending antibiotic agent if applicable

  • Ability/willingness to pay for first-line treatment options

  • Ability/willingness to try investigational therapies such as fecal microbiota transplant (if applicable for recurrent disease)

  • Ability/willingness to pay for adjunctive therapy with bezlotoxumab

Plan*

  • Drug therapy regimen including specific antibiotic dose, route, frequency, and ...

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