Guideline for the management of acute diarrhea in adults

Manatsathit, Sathaporn; DuPont, Herbert L.; Farthing, M. J. G.; Kositchaiwat, Chomsri; Leelakusolvong, Somchai; Ramakrishna, B. S.; Sabrá, Aderbal; Speelman, Peter; Surangsrirat, Surapol

doi:10.1046/j.1440-1746.17.s1.11.x

Cited by 72 publications

(48 citation statements)

References 95 publications

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“…This is compatible with what Manatsathit et al mentioned in their paper. 10 Hence, stool culture has a limited value for the acute management of most patients presenting with diarrhoea.…”

Section: Discussionmentioning

confidence: 99%

“…Different guidelines have been raised due to differences in epidemiology. In general, bloody diarrhoea, fever, dehydration, diarrhoea that does not subside after a few days, 7,[10][11][12] outbreaks of gastroenteritis or food poisoning, 13 recent travel to high risk areas, and immunocompromised states 14 are commonly quoted indications for doing stool culture. There is no clear guideline in Hong Kong currently as to under what circumstances should stool culture be sent.…”

Section: Discussionmentioning

confidence: 99%

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What Have We Learnt from Bacterial Stool Culture Results? a Retrospective Study of Hospitalised Gastroenteritis Cases in a Regional Hospital in Hong Kong

Wong¹,

Que

2010

Hong Kong j. emerg. med.

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Background: Stool culture is one of the common investigations done for patients with gastroenteritis, and fluoroquinolones have been used frequently for suspected bacterial gastroenteritis. Objective: To study the yield of bacterial pathogens in stool culture in a local regional hospital for in-patients with gastroenteritis and the individual pathogens identified. Also, the value of stool culture and the prescription of fluoroquinolones as empirical antibiotics were reviewed. Methods: This was a retrospective study. All inpatients with the principal diagnosis of "gastroenteritis" in the year 2007 were reviewed. We excluded pregnant patients and patients under 18 years of age. Patients were divided into two age groups and data were analysed including demographics, clinical findings, admission time and culture results. Antibiotics prescription behaviour was also analysed. Results: A total of 837 adult patients fulfilled the criteria. Among them, 562 cases had their stool saved and sent for bacterial culture. Eighty-nine cases were found to have their stool cultures positive for bacteria. The identified pathogens were namely Vibrio parahaemolyticus (38.2%), Salmonella species (34.8%), Campylobacter species (11.2%), Plesiomonas species (10.1%) and Aeromonas species (3.4%) respectively. The yield of positive stool culture was 15.8%. Conclusion: Vibrio parahaemolyticus and Salmonella species were still the most common pathogens for bacterial gastroenteritis among hospitalized patients in Hong Kong, especially in the young and middle aged. Their occurrence followed a seasonal pattern. Physicians had a tendency to prescribe fluoroquinolones for cases with fever and travel history. Also, the problem of antibiotic resistance did exist. It is important for practitioners to follow local guidelines before ordering microbiological investigations on stool and prescribing empirical antibiotic treatment.

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“…This is compatible with what Manatsathit et al mentioned in their paper. 10 Hence, stool culture has a limited value for the acute management of most patients presenting with diarrhoea.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

What Have We Learnt from Bacterial Stool Culture Results? a Retrospective Study of Hospitalised Gastroenteritis Cases in a Regional Hospital in Hong Kong

Wong¹,

Que

2010

Hong Kong j. emerg. med.

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“…infectious disease, gastrointestinal disease etc.) [11][12][13] or who take any drugs that frequently cause diarrhea (ex. antibiotics, anticancer drugs, non-steroidal antiinflammatory drugs etc.)…”

Section: Methodsmentioning

confidence: 99%

The Evaluation of Risk Factors Associated with Adverse Drug Reactions by Metformin in Type 2 Diabetes Mellitus

Okayasu

Kitaichi

Hori

et al. 2012

Biological & Pharmaceutical Bulletin

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Metformin is a drug to improve glycemic control by reducing insulin resistance and is currently considered to be one of the first-choice drugs for type 2 diabetes mellitus (T2DM). However, during metformin use, adverse drug reactions (ADRs) including gastrointestinal adverse events were frequently observed. Thus, in the present study, we investigated the incidence of ADRs induced by metformin and further analyzed risk factors for ADRs in Japanese patients with type 2 diabetes mellitus who initially administered metformin (500-750 mg). One hundred and one hospitalized patients receiving metformin during September 1, 2009 and August 31, 2010 were studied. The incidence of ADRs and changes in laboratory data including hemoglobin A1c (HbA1c) were monitored retrospectively. The anti-glycemic effect of metformin was successfully observed as indicated by decreased HbA1c. Among ADRs, diarrhea was most frequently occurred during metformin use (26.7% of patients) although the symptom of diarrhea was mild in most cases and disappeared within 3 d after the initial use. A logistic regression analysis showed the existence of six risk factors, including initial dose (750 mg), female, age (≦65), body mass index (≧25), aspartate aminotransferase (≧30 IU/L) and alkaline phosphatase (≧270 IU/L). The incidence of diarrhea increased linearly as the number of risk factors increased. In conclusion, in order to avoid ADRs, especially diarrhea, subsequently improving the quality of life during metformin use, the optimization of the dose of metformin by considering risk factors would be beneficial for patients with T2DM.

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“…Etest MICs for metronidazole were lower than agar dilution MICs (P < 0.01) but without difference in susceptible-intermediate-resistant categorization. No particular PCR ribotype was associated with clindamycin or fusidic acid resistance.Clostridium difficile-associated diarrhea (CDAD) is common in hospitals (2,3,11,14,21,22,27,29) and usually treated with metronidazole or vancomycin, which have comparable response rates (80% to 90%) and relapse rates (5% to 25%) (13,23). Metronidazole is currently the first choice agent due to its lower potential for selecting vancomycin-resistant enterococci and for economical reasons, and fusidic acid has been suggested as an alternative drug (17, 30).…”

mentioning

confidence: 99%

Antimicrobial Susceptibility Pattern of Clostridium difficile and Its Relation to PCR Ribotypes in a Swedish University Hospital

Aspevall

Lundberg

Burman

et al. 2006

Antimicrob Agents Chemother

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All 238 Clostridium difficile isolates were susceptible to metronidazole and vancomycin, whereas 84% and 1% were resistant to clindamycin and fusidic acid. Etest MICs for metronidazole were lower than agar dilution MICs (P < 0.01) but without difference in susceptible-intermediate-resistant categorization. No particular PCR ribotype was associated with clindamycin or fusidic acid resistance.Clostridium difficile-associated diarrhea (CDAD) is common in hospitals (2,3,11,14,21,22,27,29) and usually treated with metronidazole or vancomycin, which have comparable response rates (80% to 90%) and relapse rates (5% to 25%) (13,23). Metronidazole is currently the first choice agent due to its lower potential for selecting vancomycin-resistant enterococci and for economical reasons, and fusidic acid has been suggested as an alternative drug (17, 30).As several studies have reported full susceptibility of C. difficile isolates for metronidazole and vancomycin, clinical laboratories do not routinely perform culture and susceptibility testing of the organism (5,8,10,12). However, resistance to metronidazole in up to 9% of isolates (1,4,6,18), intermediate resistance to vancomycin in 3% of isolates (1), and "relatively poor" outcome of metronidazole therapy in CDAD (15,19,28) was recently reported. This emphasizes the need for periodic monitoring of any emergence of drug resistance in C. difficile. The aim of the present study was to investigate its susceptibility to metronidazole, vancomycin, fusidic acid, and clindamycin in a Swedish tertiary care hospital by using the Etest.The first C. difficile isolate from each of 238 consecutive CDAD patients at Huddinge University Hospital, Stockholm, Sweden, from 10 February 2000 through 10 February 2001, were studied. The definition of CDAD, culture method, and epidemiological data for these patients were recently described (25). All C. difficile isolates were also subject to PCR ribotyping according to the method of Stubbs et al. (24) but with an improved method previously correlated with serotypes (25). Isolates were subcultured three times on horse blood agar prior to susceptibility testing to ensure purity. Bacteria were suspended in tryptic soy broth to a McFarland standard of 1 to 1.5 for testing against clindamycin, fusidic acid, metronidazole, and vancomycin by Etest on Brucella blood agar according to the manufacturer's instructions (AB-Biodisk, Solna, Sweden). Plates were scored after anaerobic incubation at 36°C for 48 h.A random subset of 34 isolates was also tested using agar dilution to determine metronidazole MICs for comparison with Etest data. Agar dilution was performed on Wilkins-Chalgren agar (1) incubated as described above. Eubacterium lentum ATCC 43055 and Clostridium perfringens ATCC 13124 were used for quality control.MICs for the drugs tested are shown in Table 1. Using the pharmacological breakpoints (Table 1) recommended by the Swedish Reference Group for Antibiotics (SRGA) (http://www .srga.org), all isolates were susceptible to metronidazole and vancom...

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Guideline for the management of acute diarrhea in adults

Cited by 72 publications

References 95 publications

What Have We Learnt from Bacterial Stool Culture Results? a Retrospective Study of Hospitalised Gastroenteritis Cases in a Regional Hospital in Hong Kong

What Have We Learnt from Bacterial Stool Culture Results? a Retrospective Study of Hospitalised Gastroenteritis Cases in a Regional Hospital in Hong Kong

The Evaluation of Risk Factors Associated with Adverse Drug Reactions by Metformin in Type 2 Diabetes Mellitus

Antimicrobial Susceptibility Pattern of Clostridium difficile and Its Relation to PCR Ribotypes in a Swedish University Hospital

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