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Old 01-22-2011
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Question Bloody Diarrhea and the use of Antibiotics!

Hi, in Kaplan notes, as well as in the videos, they say that if we have a case of bloody diarrhea + severe disease (Fever + Blood + Pain + Hypotension/Increased pulse), then in that case the BEST NEXT STEP is to give Fluroquinolones ....

How come we can do that if EHEC is a possibility?!?!!? Shouldn't antibiotics not be given until we have the stool culture?

( I read on UpToDate that antibiotics in EHEC would increase the incidence of HUS, meaning, that even if the patient do not present with HUS, then still, in the case of EHEC, we CANT GIVE Abs.

This is very confusing, would like to hear your opinion. Thanks
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Old 01-22-2011
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The overall incidence of HUS is estimated to be approximately 2.1 cases per 100,000 persons per year, with a peak incidence in children who are younger than 5 years (6.1 cases per 100,000 per year). The lowest rate is in adults aged 50-59 years (0.5 cases per 100,000 per year).
Incidence tends to parallel the seasonal fluctuation of E coli O157:H7 infection, which peaks between June and September.
Incidence of D- HUS in children is approximately 2 cases per year per 100,000 total population.

On the other hand Bacterial gastroenteritis is a very common problem in primary care and emergency department settings, especially for children younger than 5 years. Diarrhea accounts for as many as 5% of pediatric office visits and 10% of hospitalizations in this age group. Very often, gastroenteritis is under-reported in the adult population.

Each year, gastroenteritis affects adults and accounts for 8 million doctor visits and 250,000 hospitalizations.

(Source: emedicine)

My opinion is that it is better to cure thousands of cases of gastroenteritis and worsen 1 HUS than the other way around...

Hope this helps!
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Thank you so much, I will do the same as well (if they give me a question like that on the exam)
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Old 01-22-2011
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Quote:
Originally Posted by docoftheworld View Post
Thank you so much, I will do the same as well (if they give me a question like that on the exam)
I believe that on the exam they will make the question pretty straightforward like: A child with bloody diarrhea, which presents with petechiae, confusion, oliguria and elevated BUN/Cr.
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