Treatments for Diarrheagenic Escherichia coli
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Book Excerpts: Treatment of Diarrheagenic Escherichia coli
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Diarrhea - Acute:
Treatment
(In a Page: Signs and Symptoms)
-
Treatment is generally supportive
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Fluid resuscitation (oral, if possible, or IV)
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Antimotility agents: Opiates (e.g., loperamide) and parasympathetic inhibitors (e.g., diphenoxylate plus atropine); former concerns that these agents may slow the clearance of pathogens have been disproved
- Antibiotic therapy is reserved for severe disease
–Most authorities recommend empiric treatment with a fluoroquinolone or trimethoprin-sulfamethoxasole in patients with severe or bloody diarrhea, fever, or fecal leukocytes
–If Giardia, C. difficile, or E. histolytica is suspected, treat empirically with metronidazole
–Antibiotic therapy increases the risk of hemolytic-uremic syndrome in children with E. coli O157:H7
–There is no good evidence that antibiotics prolong the carrier state in Salmonella infections
- Advise patient to hydrate with glucose-containing, caffeine-free beverages, and to avoid lactose, sorbitol-containing gum, and raw fruit until symptoms subside
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Diarrhea - Chronic:
Treatment
(In a Page: Signs and Symptoms)
-
Fluid resuscitation: Oral, if possible, or IV (e.g., normal saline or lactated Ringer's)
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Nonspecific antidiarrheal agents (e.g., loperamide, codeine, tincture of opium) and fiber supplementation may be attempted initially
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Diabetic neuropathy: Control blood sugar, metoclopramide may be used
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Irritable bowel syndrome: High-fiber diet, anticholinergics
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Inflammatory bowel disease is treated with steroids for acute exacerbations and daily prophylactic therapy with 5-aminosalicyclic agents
–Bowel resection may be necessary
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Lactose intolerance: Lactose-free diet
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Diseases of malabsorption: Gluten-free diet, long-term antibiotics
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Intestinal neoplasm: Consultation with gastroenterology, oncology, and/or surgery
>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Diarrhea – Chronic, No Blood or Weight Loss:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Treatment is directed at cause
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Chronic nonspecific diarrhea
–Restriction of fluid intake to <90 mL/kg/day
–Reduction of fruit juices (<8 ounces/day)
–Elimination of sorbitol-containing juices
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Carbohydrate malabsorption
–Trial elimination or reduction of offending sugar
–Lactase (Lactaid) for lactose intolerance
–Sucrase (Sucraid) for sucrase-isomaltase deficiency
-
Small intestine bacterial overgrowth
–Antibiotic therapy with metronidazole alone or in combination with ampicillin or Bactrim
–Surgery for partial small bowel obstruction
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Low-fat diet: Increase fat intake to approximately 40% of total daily calorie intake
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Irritable bowel syndrome
–Anticholinergic therapy or antidepressants
-
Acrodermatitis enteropathica: Zinc supplements
>>>>> >>
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Diarrhea – Chronic, with Weight Loss:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Correct malnourished states
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IBD: Anti-inflammatories (e.g., steroids, 6MP, 5ASA)
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CD: Lifelong gluten-free diet
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CF: Pancreatic enzyme and nutritional supplements including fat-soluble vitamins (ADEK)
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Allergy: Food antigen avoidance
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Sucrase-isomaltase deficiency: “Sucraid” enzyme
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Neural crest tumors: Surgical resections
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VIPoma: Somatostatin
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Gastrinoma: Proton pump inhibitors
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Whipple disease: Trimethoprim-sulfamethoxazole
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Abetalipoprotenemia: No specific treatment
–Supplements of fat-soluble vitamins and MCT oil
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Acrodermatitis enteropathica: Zinc supplements
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Giardiasis: Metronidazole or nitazoxamide
-
Hyperalimentation: Parenteral nutrition may be needed for familial enteropathies
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Diarrhea – Acute:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Mainstay of treatment is rehydration to correct fluid and electrolyte deficits
–Oral route is best in mildly to moderately dehydrated
children who can tolerate PO fluid
–IV fluids: Useful in severe to moderate dehydration
–Estimate fluid deficit using % of weight loss, and add
this to maintenance requirement and ongoing losses
– Correct over 24–48 hours
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Antibiotics
–Not necessary in most cases, can precipitate HUS
–Indicated for V. cholerae, Shigella, and G. lamblia
–Indicated in selected circumstances: Salmonella in very young infant, if febrile, or positive blood culture
–Metronidazole for C. difficile (if antibiotic elimination doesn’t help)
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Refeeding: No benefit to withholding milk, incidence of lactose intolerance overstated
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Probiotics: Lactobacillus rhamnosus for rotavirus
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Escherichia coli and other Enterobacteriaceae infections:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment consists of correction of fluid and electrolyte imbalances; for an infant or immunocompromised patient, I.V. antibiotics based on the organism's drug sensitivity; and salicylates or opium tincture for cramping and diarrhea.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Diarrhea:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient’s diarrhea is profuse, check for signs of shock—tachycardia, hypotension, and cool, pale, clammy skin. If you detect these signs, place the patient in the supine position and elevate his legs 20 degrees. Insert an I.V. line for fluid replacement. Monitor the patient for electrolyte imbalances, and look for an irregular pulse, muscle weakness, anorexia, and nausea and vomiting. Keep emergency resuscitation equipment handy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Diarrhea:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Administer an analgesic for pain and an opioid to decrease intestinal motility, unless the patient has a possible or confirmed stool infection. Ensure the patient’s privacy during defecation, and empty bedpans promptly. Clean the perineum thoroughly, and apply ointment to prevent skin breakdown.
ALERT: Excessive diarrhea may cause skin breakdown and excoriation. To decrease excoriation and facilitate drainage measurement, insert a rectal tube or large indwelling catheter.
Help the patient maintain adequate hydration, administering I.V. fluid replacements. Measure liquid stools, and weigh the patient daily. Monitor electrolyte levels and hematocrit.
Quantify the amount of liquid stool and carefully observe intake and output.
Patient teaching
Explain the purpose of diagnostic tests to the patient. These tests may include blood studies, stool cultures, X-rays, and endoscopy.
Advise the patient to avoid spicy or high-fiber foods (such as fruits), caffeine, high-fat foods, and milk. Suggest smaller, more frequent meals if he has had GI surgery or disease. If appropriate, teach the patient stress-reducing exercises, such as guided imagery and deep-breathing techniques, or recommend counseling.
Stress the need for medical follow-up to patients with inflammatory bowel disease (particularly ulcerative colitis), who have an increased risk of developing colon cancer.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Diarrhea:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient’s diarrhea is profuse, check for signs of shock, including tachycardia, hypotension, and cool, pale, clammy skin. If you detect these signs, place the patient in the supine position and elevate his legs 20 degrees. Insert an I.V. line for fluid replacement. Monitor patient for electrolyte imbalances, and look for an irregular pulse, muscle weakness, anorexia, and nausea and vomiting. Keep emergency resuscitation equipment handy.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Diarrhea:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Administer an analgesic for pain and an opiate to decrease intestinal motility, unless the patient has a possible or confirmed stool infection.
▪ Ensure the patient's privacy during defecation, and empty bedpans promptly.
▪ Clean the perineum thoroughly, and apply ointment to prevent skin breakdown.
▪ Note the amount and characteristics of the patient's stool.
▪ Monitor intake and output.
▪ Obtain serum samples for electrolytes and treat imbalances.
▪ Provide fluid replacement orally or I.V., as appropriate.
Patient teaching
▪ Stress the need for medical follow-up to patients with inflammatory bowel disease (particularly ulcerative colitis) who have an increased risk of developing colon cancer.
▪ Emphasize the importance of maintaining adequate hydration.
▪ Explain food or fluids that should be avoided.
▪ Discuss stress reduction techniques.
▪ Explain the diagnosis and treatment plan.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Fecal incontinence:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Maintain proper hygienic care, including control of foul odors.
▪ Provide meticulous skin care.
▪ For the neurologically capable patient with chronic incontinence, provide bowel retraining.
▪ Take measures to allay the patient's embarrassment.
▪ Provide emotional support for the patient.
Patient teaching
▪ Teach the patient to perform Kegel exercises to strengthen abdominal and perirectal muscles.
▪ Discuss how to maintain proper hygiene.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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