Page 239 - ATP-P 11th Ed

GASTROENTERITIS PROTOCOL

SPECIAL CONSIDERATIONS
1. Etiology of acute diarrhea is often viral, but bacterial or parasitic infections are
common in the deployed environment.
2. Emerging fluoroquinolone resistance among enteropathogenic E. coli and Campy-
lobacter makes azithromycin the new primary agent for therapy.
3. Consider antibiotic-related diarrhea if on antibiotics at onset.
4. Consider parasitic infection if symptoms persist for 3 or more days. SECTION 2
5. Must rule out malaria if fever and GI symptoms exist in a malarious area.

Signs and Symptoms
1. Acute onset of nausea, vomiting, and diarrhea.
2. Fever may or may not be present.
Management
1. Loperamide (Imodium ) 4mg PO initially, then 2mg PO after every loose bowel
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movement with a maximum dose of 16mg per day.
2. Do not use loperamide (Imodium ) in the presence of fever or bloody stools.
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3. Azithromycin (Zithromax ) 500mg PO daily for 3 days OR moxifloxacin (Avelox )
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400mg PO daily for 3 days
4. Treat per Nausea and Vomiting Protocol.
5. Treat per Dehydration Protocol.
6. If diarrhea persists after 3 days of therapy, or diarrhea develops while already on
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antibiotics, give metronidazole (Flagyl ) 500mg PO tid for 10 days.
Disposition
1. Urgent evacuation if grossly bloody stools or circulatory compromise.
2. Priority evacuation if dehydration occurs despite above therapy.
3. Routine evacuation if diarrhea develops while already on antibiotics.

228 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 229