Bacterial gastroenteritis: Difference between revisions

Revision as of 00:34, 31 May 2017

See Acute gastroenteritis (peds) for pediatric patients

Noninvasive AGE
Species	Onset	Symptoms	Transmisison	Preformed Toxin
Viral (norovirus, adenovirus, rotavirus)	11-72 hrs	Nausea, vomiting, watery diarrhea Mild abdominal cramps, myalgia	Fecal-oral Contaminated food or water	No
Staph	1-6 hrs	Nausea, severe vomiting, diarrhea, Mild abdominal cramping	Previously cooked foods (mayonaise, ham, salads)	Yes
B. cereus	1-6 hrs	Abrupt onset of nausea, vomiting, mild diarrhea	Previously cooked foods (rice, vegetables, dried fruits, meat)	Yes
C. perfringens	8-24 hrs	Nausea, minimal vomiting, watery diarrhea Abd cramps	Previously cooked or reheated meats and poultry	Yes
V. cholerae	11-72 hrs	Explosive rice-water diarrhea Vomiting, abdominal cramps Fever	Fecal-oral Contaminated food or water	No
Giardia	1-4 wks	Flatus, bloating Foul-smelling and fatty stools (steatorrhea)	Fecal-oral Contaminated water	No

Invasive AGE
Species	Onset	Symptoms	Transmission
Salmonella	6-72 hours	Fever, relative bradycardia Abdominal pain Bloody diarrhea Headache Osteomyelitis in sickle cell	Eggs Poultry Water Reptiles
Shigella	1-3 days	Fever Abdominal pain Bloody diarrhea Headache 1-5 years old Seizures in children	Food Fecal-Oral
Yersinia	1-5 days	Appendicitis mimic, RLQ pain Fever Vomiting Kids and Young Adults	Water Milk Pork Wild Animals Fecal-Oral
Campylobacter	1-7 days	Low grade fever Abdominal pain Kids and Young Adults Guillain-Barre	Water Poultry Pets/Animals
C. Diff	1-11 Weeks	Copious FOUL diarrhea	Antibiotic use: PCN, Clinda, Cephalosporins
Entamoeba	1-11 weeks	Appendicitis Mimic Abdominal pain, nausea/vomiting, diarrhea	Water Sanitation Travel

Rehydration (PO preferred)
- 30mL(1oz)/kg/hr
- Reduced-osmolarity oral rehydration solution
Antiemetic
- Ondansetron 0.15mg/kg/dose IV/PO
Antibiotics
- Only consider in patients with invasive infection
  - Shigella, campylobacter, E. coli, yersinia, vibrio
  - Bloody stool with mucus and fever
- NOT indicated for E. coli O157:H7
- NOT routinely indicated for salmonella
  - Exceptions: SCD, IBD, <3mo
- Azithromycin (able to tolerate PO)
- OR ciprofloxacin
- OR TMP-SMX
- Ceftriaxone (parenteral)

Most can be discharged
Admit
- Unable to tolerate PO
- Hemodynamic instability
- Significant comorbidities

Authors:

@@ Line 160: / Line 160: @@
 #**Exceptions: SCD, [[IBD]], <3mo
 #*[[Azithromycin]] (able to tolerate PO)
-#*OR [[ciprofloxacin]]
+#*'''OR''' [[ciprofloxacin]]
-#*OR [[TMP-SMX]]
+#*'''OR''' [[TMP-SMX]]
 #*[[Ceftriaxone]] (parenteral)
 ==Disposition==