Pharm Approach for GE

Question 1

Diarrhea definition

Answer 1

3 or more loose stools per day

Stool that conforms to the shape of its container

Question 2

How to tell between secretory and malabsorptive diarrhea

Answer 2

Secretory = even if you stop eating, it will not go away
Malabsorptive = will go away with no intake

Question 3

Watery diarrhea characteristics

Answer 3

Low or absent fever, nausea, profuse diarrhea
Ex: norovirus, rotavirs, choolera, ETEC, giardia, cryptosporidium
Usual site of infection is small intestine

Question 4

Inflammatory diarrhea characteristics

Answer 4

Abdominal pain, fever, blood or pus in stools, tenesmus, prostration
Ex: Salmonella, shigella, campylobacter, E histolytica, C diff
Usual site of infection is colon

Question 5

Who should get empiric treatment?

Answer 5

Traveler’s diarrhea
Bloody diarrhea only if < 3 mo, severely ill adult with fever, or recent exposure to shigella
Watery diarrhea only in young infants and immunocompromised
C diff if worried its severe

Question 6

Travellers’ diarrhea empiric tx (general and SE Asia)

Answer 6

Generally: Ciprofloxacin 500 mg po

SE Asia: Azithromycin 1000 mg single dose

Question 7

4 pathogens that should be considered for definitive treatment if the patient is still symptomatic

Answer 7

Shigella
Campylobacter
E histolytica
C difficile

Question 8

3 pathogens that should not be treated

Answer 8

EHEC O157:H7
Non-O157 STEC
Salmonella in a healthy host

Question 9

What is the best anti emetic to use in acute GE?

Answer 9

Ondansetron (a 5-HT3 antagonist)