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  #1  
Old 05-25-2012
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GIT Antibiotics for Acute Diarrhea; Give or Not?

A 38-year-old woman is seeing you for a 5-day history of nonbloody diarrhea. She denies any recent travel and has not been on any antibiotics for the last 3 months. She is not immunocompromised and works fixing electrical lines for Commonwealth Edison. On examination she has a temperature of 37.7C (99.9F), her pulse is 90 beats/min and regular and her BP is 128/85 mm Hg. She does not appear in any distress. Her mucous membranes are moist, her abdomen is scaphoid, and bowel sounds are hyperactive. There is tenderness without rebound in all quadrants, but especially the left lower quadrant. No guarding is present. What is the most appropriate management of this patient?

A. Empiric quinolone antibiotic while awaiting results from stool culture.
B. Fluid and dietary advice only
C. Stool culture and empiric quinolone antibiotic while awaiting culture result, and fluid and dietary advice.
D. Stool culture and stool assay for Clostridium difficile toxin, with fluid and dietary advice
E. Stool culture and stool for ova and parasites only


need good expln in this...btw..what are criteria for starting antibitoics? as far i know, its severe diarrhea [hypotension,abdomen pain, hematochezia,fever]...
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Old 05-25-2012
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Consider empiric therapy with an oral fluoroquinolone after obtaining samples for initial diagnostic tests if the patient has any of the following (mnemonic: “BaD ****”):
• Bloody stools
• Duration >7 days (u might also find sources that say 5
• Hypovolemia or frequency >8 stools/day (hypotension / tachycardia)
• Immunosuppression
• Temperature >38.5C or mild to moderate Traveller's diarrhea + abdominal pain

Also test for ova and parasites with three separate specimens on consecutive days in the following situations :
• Waterborne Outbreak in community
• Persistent diarrhea (may be meant for weeks)
Travel (recent)
Immunosuppgression
• Bloody diarrhea with negative fecal leukocytes !?

Initial test are:
• Fecal leukocyte
• Fecal occult blood
If fecal leukocyte (+) obtain C+S

I Hate Diarrhea Question
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  #3  
Old 05-25-2012
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comeon it just a mnemonic Bad s H I T
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Quote:
Originally Posted by bisho View Post
comeon it just a mnemonic Bad s H I T
so whats the ans?
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Quote:
Originally Posted by tyagee View Post
A 38-year-old woman is seeing you for a 5-day history of nonbloody diarrhea. She denies any recent travel and has not been on any antibiotics for the last 3 months. She is not immunocompromised and works fixing electrical lines for Commonwealth Edison. On examination she has a temperature of 37.7C (99.9F), her pulse is 90 beats/min and regular and her BP is 128/85 mm Hg. She does not appear in any distress. Her mucous membranes are moist, her abdomen is scaphoid, and bowel sounds are hyperactive. There is tenderness without rebound in all quadrants, but especially the left lower quadrant. No guarding is present. What is the most appropriate management of this patient?

A. Empiric quinolone antibiotic while awaiting results from stool culture.
B. Fluid and dietary advice only
C. Stool culture and empiric quinolone antibiotic while awaiting culture result, and fluid and dietary advice.
D. Stool culture and stool assay for Clostridium difficile toxin, with fluid and dietary advice
E. Stool culture and stool for ova and parasites only


need good expln in this...btw..what are criteria for starting antibitoics? as far i know, its severe diarrhea [hypotension,abdomen pain, hematochezia,fever]...
A & C are out since there is no indication for ABs.
B is out since she is having this for 5 days and has increased tenderness in left Q.
D is out since she has not had any Abs for 3 months.

E is the answer since you have to send stool cultures and left Q tenderness is more in favor of a parasitic infestation.
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Quote:
Originally Posted by bisho View Post
comeon it just a mnemonic Bad s H I T
There is a lot of BAD s HIT flying around when you work with electrical lines for Commonwealth Edison
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Quote:
Originally Posted by Novobiocin View Post
A & C are out since there is no indication for ABs.
B is out since she is having this for 5 days and has increased tenderness in left Q.
D is out since she has not had any Abs for 3 months.

E is the answer since you have to send stool cultures and left Q tenderness is more in favor of a parasitic infestation.
ans is B fluid:co nfused:
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Old 05-26-2012
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Yes it should be B, though i quote ur question but i dont know why did'nt appear
Look at criteria for empiric abx , pt doesn't fulfill any of them and there's no travel hx which is the main factor in addition to duration of diarrhea, on which we screen for O&P
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Quote:
Originally Posted by tyagee View Post
ans is B fluid:co nfused:
Yeah.....I forgot the golden rules:
1. Findings have more weight than history
2. Specific history has more weight than non-specific findings.

It specifically mentions "She denies any recent travel" which rules out E as a choice.
I made the classical mistake of going for non-specific findings and got it wrong.
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