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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 40, Gastrointestinal Infections.

KEY CONCEPTS

KEY CONCEPTS

  • image Infectious 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.

  • image Two 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.

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

  • image The 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.

  • image Loperamide 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.

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

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

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

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

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

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

Watch the CDC expert commentary entitled, Dying From C. diff: Who is most vulnerable?, available from: http://tinyurl.com/yxthsmyk. This 6-minute video provides background information on risk factors, transmission, and prevention of Clostridium difficile infection.

INTRODUCTION

Gastrointestinal (GI) infections and enterotoxigenic poisonings encompass a wide variety of medical conditions characterized by inflammation of the GI tract. Inflammation-induced vomiting and diarrhea are responsible for much of the morbidity and mortality of these conditions. Diarrhea is defined as a decrease in consistency of bowel movements (ie, unformed stool) and an increase in frequency of stools to three or more per day.1,2 Acute diarrheal disease is commonly associated with diarrhea lasting less than 7 days, prolonged diarrhea lasts 7 to 13 days, persistent diarrhea lasts 14 to 29 days, and chronic diarrhea lasts 30 days or longer.

This chapter focuses on infectious etiologies of acute GI infections and enterotoxigenic poisonings. A wide variety of viral, bacterial, and parasitic pathogens are responsible for ...

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