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Treatment usually consists of replacement of fluids and electrolytes and, very rarely, management of hypovolemic shock and respiratory compromise. In mild diarrhea, increasing ingestion of juices and clear soups is adequate. In more severe cases of dehydration (postural lightheadedness, decreased urination), oral glucose-based rehydration solutions can be used (Ceralyte, Pedialyte). In general, most cases of acute gastroenteritis are self-limited and do not require therapy other than supportive measures. When symptoms persist beyond 3�4 days, initial presentation is accompanied by fever or bloody diarrhea, or the patient is immunocompromised, cultures of stool are usually obtained. Symptoms have often resolved by the time cultures are completed. In this case, even if a pathogen is isolated, therapy is not needed (except for Shigella, since the infecting dose is so small that therapy to eradicate organisms from the stool is indicated for epidemiologic reasons). If symptoms persist and a pathogen is isolated, it is reasonable to institute specific treatment even though therapy has not been conclusively shown to alter the natural history of disease for most pathogens. Exceptions include infection with Shigella where antibiotic therapy has been shown to shorten the duration of symptoms by 2�3 days, infections with E coli O157:H7 (antibiotic therapy does not ameliorate symptoms and may increase the risk of developing hemolytic-uremic syndrome), and Campylobacter infections (early therapy, within 4 days of onset of symptoms, shortens the course of disease). Uncomplicated gastroenteritis due to Salmonella does not require therapy because the disease is usually self-limited and therapy may prolong carriage and perhaps increase relapses. Because bacteremia with complications can occur in high-risk patients, some experts have recommended therapy for Salmonella in patients over the age of 50, in organ transplant recipients, in those with HIV, in patients taking corticosteroids, in those with lymphoproliferative diseases, and in those with vascular grafts. Ciprofloxacin, 500 mg every 12 hours for 5 days, is effective in shortening the course of illness compared with placebo in patients presenting with diarrhea, whether a pathogen is isolated or not. However, because of concerns about selecting for resistant organisms (especially Campylobacter, where increasing resistance to fluoroquinolones has been documented and erythromycin is the drug of choice) coupled with the fact that most infectious diarrhea is self-limited, routine use of antibiotics for all patients with diarrhea is not recommended. Antibiotics should be considered in patients with evidence of invasive disease (white cells in stool, dysentery), with symptoms 3�4 days or more in duration, with multiple stools (eight to ten or more per day), and in those with impaired immune responses. Antimotility drugs may relieve cramping and decrease diarrhea in mild cases. Their use should be limited to patients without fever and without dysentery (bloody stools), and they should be used in low doses because of the risk of producing toxic megacolon.

投稿者 Vivaradrag : 2009年07月31日 07:31

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投稿者 sacbqjvor : 2013年01月26日 02:29

亡霊の呟き

心せよ　亡霊を装いて戯れなば　汝　亡霊となるべし

2005年06月24日

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