no Rx or loperamide 4mg stat then 2mg after each loose stool to max. 16mg/day (do not use in children under 2 years)
moderate symptoms (3 or more stools /day):
loperamide as above
if persistent > 2 days, start 3 day course of oral antibiotics such as norfloxacin 400mg bd, co-trimoxazole, or azithromycin 10mg/kg up to 500mg once daily
if symptoms distressing, consider initial dose double the usual dose
incapacitating symptoms, fever or bloody diarrhoea:
avoid loperamide if dysenteric symptoms (fever, bloody diarrhoea)
double dose antibiotic Rx as above initially then usual dose
persistent symptoms despite above:
stool culture
consider parasitic or drug resistant cause
suspected invasive Salmonella enteritis
patients with persistent fevers who have not been to typhoid-prone areas should be considered for invasive Salmonella enteridis infection
these patients should have stool culture, 2 sets of blood cultures
ciprofloxacin is the preferred antibiotic NOT norfloxacin which is really only useful for non-invasive enteritis
delayed onset diarrhoea > 1 month after return
amoebiasis may result in mild diarrhoea 6-12 weeks after infection but may then develop a hepatic abscess with raised LFTs and inflammatory markers