Use of antibiotics prudently

Even in normal sanitary conditions it’s one of the most common medical concerns, and the large area inundated with polluted water will only increase the number of cases. The logical advice is to avoid ingesting infected water or food.

Acute diarrhoea involves a significant increase in the frequency of bowel movements and/or less solid stools. Viruses, bacteria or parasites invade and inflame the lining of the small intestine, increasing secretion of fluids. A toxin produced by bacteria can result in a similar effect. The patient is often nauseous, vomiting, feverish and suffering abdominal cramps. When diarrhoea is severe or lasts a few days, with persistent vomiting, there are also  signs of dehydration.

Of the many types of micro-organisms causing acute diarrhoea, the most common is viral gastroenteritis. The illness lasts three days at most, but there is no blood or pus in the stool. Diarrhoea induced by viruses requires no antibiotics. 

Bacteria – most commonly campylobacter, shigella (responsible for bloody dysentery) and salmonella (some strains causing typhoid fever) – can also cause acute diarrhoea by invading the small intestine and colon, leading to bacterial enterocolitis. In these cases, the diarrhoea begins suddenly and can last up to seven days. In the more severe instances, blood or pus is present in very loose or watery stools, indicating the aggressive nature of the bacteria. Fever is often present and signs of dehydration can rapidly appear. 

Other bacteria such as strains of E Coli, which usually lives harmlessly in the intestine, can also cause serious illness, either by invading the intestine or producing diarrhoea-inducing toxins. Toxins produced by bacteria are the cause of most short-term food poisoning.

Less frequently, parasites are responsible for acute diarrhoea. Giardia lamblia induces no complications, whereas amoebic dysentery often leads to bloody diarrhoea with severe abdominal pain. Parasitic infections need to be treated with specific medicine and often require the identification of the responsible parasite. 

Acute diarrhoea can lead to two types of complications. The first is the infection itself, which can spread beyond the lining of the intestine and reach other organs. Subsequent blood infection (septicaemia) and/or abscesses in various tissues are life-threatening. 

Second is the dehydration that results directly from the diarrhoea-induced loss of water and mineral electrolytes. Patients with mild dehydration might experience only thirst and dry mouth. Moderate to severe dehydration can cause hypotension, with fainting, severe weakness, shock, kidney failure, confusion and coma. 

Despite the chance of numerous complications, most episodes of acute diarrhoea are short-lived and require no antibiotics. Antibiotics, however, might be needed in the more severe cases, or among patients with pre-existing medical conditions. Signs of dehydration should always be treated with oral solution or by IV when there is persistent vomiting. 

In situations like we have at present, when medical access is temporarily limited, antibiotic prescriptions should remain under medical supervision and “self-use” should be discouraged. A study conducted at a Thai medical school revealed a high rate of overuse of antibiotics for acute diarrhoea. 

With an expected large number of affected patients in the weeks to come, it’s essential to rationalise the use of antibiotics to minimise the risk of developing multi-resistant types of bacteria. 

 

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].