Question of the Week # 233

233 )  A 36 year old man is evaluated in the emergency room for nausea, vomiting and diarrhea. He also reports fever of one day duration. He denies any rash. He has had 4 to 5 watery bowel movements in the last 24 hours. The diarrhea started 3 days ago and is progressively worse. He feels extremely weak.  His last sexual activity was 6 months ago and he always uses condoms. He denies any fever or  using any recent medications. He works in tourism industry and returned from a business trip to Mexico one week ago.  On examination, temperature is 101F, blood pressure 90/50 mm hg, his oral mucosa are dry. Abdominal examination is benign. The patient has been adequately hydrated and feels better now though, he continues to have diarrhea. Which of the following is the most appropriate next step in management?

A) Observation

B) Rifaximin

C) Amoxicillin

D) Trimethoprim-Sulfamethoxazole

E) Metronidazole

9 Responses

  1. e

  2. meant “e”…

  3. A

  4. Ans A. (from CDC website)
    TD usually is a self-limited disorder and often resolves without specific treatment; however, oral rehydration is often beneficial to replace lost fluids and electrolytes. Clear liquids are routinely recommended for adults. Travelers who develop three or more loose stools in an 8-hour period—especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools—may benefit from antimicrobial therapy. Antibiotics usually are given for 3-5 days. Currently, fluoroquinolones are the drugs of choice. Commonly prescribed regimens are 500 mg of ciprofloxacin twice a day or 400 mg of norfloxacin twice a day for 3-5 days. Trimethoprim-sulfamethoxazole and doxycycline are no longer recommended because of the high level of resistance to these agents.

  5. A) Observation

  6. Rifaximin is recommended for water diarrhea by CDC.

  7. Rifaximin is recommended for watery diarrhea by CDC.

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