Manejo ambulatorio del síndrome diarreico agudo en adultos

Abstract

Diarrhea continues to be an epidemiological problem due to the emergence of bacterial resistance and the recognition of new agents for this syndrome. Most cases will evolve in a self-limited manner requiring only dietary advise, analgesic and/or simple antidiarrheal indications. Data collected from randomized studies support the use and benefit of loperamide as an antidiarrheal agent. Oral rehydration therapy is useful in adults affected by cholera. Patients affected by prolonged diarrhea, dysentery, a cholera-like syndrome as well as those immunocompromised or that need admission will require an etiological study including fecal leukocytes, stool culture, detection of parasites and if required, special studies such as search for Campylobacter spp, Vibrio spp and diarrheogenic variants of Escherichia coli. Current evidence only sustain antimicrobial use during diarrhea associated to Shigella spp, Vibrio cholerae, V. parahaemolyticus, Entamoeba histolytica, Giardia lamblia infection or traveler's diarrhea. Antibiotic treatment for Campylobacter - associated diarrhea or non-typhoidal Salmonella enteritidis has not been beneficial. Quinolones can be applied as an initial empiric therapy or after pathogen identification. Several alternatives are available for treating protozoan-associated diarrhea and include either metronidazole as well as single-dose of tinidazole.