Page 119 - PJ MED OPS Handbook 8th Ed
P. 119
Gastroenteritis
SPECIAL CONSIDERATIONS:
1. Etiology of acute diarrhea is often viral, but bacterial or parasitic infections are common
in the deployed environment.
2. Consider antibiotic-related diarrhea if on antibiotics at onset.
3. Consider parasitic infection if symptoms persist for 3 or more days.
4. Must rule out malaria if fever and GI symptoms exist in a malaria 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 movement
with a maximum dose of 16mg qd
2. Do not use loperamide in the presence of fever or bloody stools
3. Moxifloxacin (Avelox) 400mg PO daily for 3 days
4. Treat nausea/vomiting, and hydrate as indicated
5. If diarrhea persists after 3 days of therapy, or diarrhea develops while already on antibiot-
ics, give metronidazole (Flagyl) 500mg PO tid for 10 days if available
DISPOSITION:
1. Urgent evacuation if grossly bloody stools or hypotension.
2. Priority evacuation if dehydration occurs despite above therapy.
3. Routine evacuation if diarrhea develops while already on antibiotics.
Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 117
