Acute Diarrhea

• History：
• Travel: E. coli, parasites
• 生海鮮：Vibrio sp.
• 不熟的絞肉（漢堡）：E. coli O157:H7
• 生豬肉：Campylobacter, Salmonella
• Abx: C. difficile
  
• Work up首先看有無：
• severe dehydration
• fever
• 持續>5天
• mucus, pus, blood
• abdominal pain
• 最近用抗生素
• 若無以上情形，觀察並補充水份即可
• 若有以上任一情形，則需做進一步work up
• stool pus cell, OB
• C. diff toxin (if recent abx)
• 血或濃 -> 考慮 enteroinvasive infection
• stool culture
• E. coli O157:H7 不可用抗生素
• Empirical treatment：
• mild
• bismuth subsalicylate & loperamide PRN
• moderate-severe, fever, blood, pus:
  
• fluoroquinolone x 1-5 day (without suspicion of E. coli O157 or fluoroquinolone-resistance Campylobacter)
  
• Clostridium difficile:
• Stool ELISA
• D/C abx
• Metronidazole 10-14 day(if keep ori abx, keep MNZ > 7d after cessation)
• Vancomycin 10-14 day(may select for VRE)
• Severe diarrhea/colitis, Pregnancy, < 10y,  no response to MNZ