Answer: Ciprofloxacin, 500 mg twice daily for 5 days (or one of the other fluoroquinolones) Bismuth subsalicyate (Pepto-Bismol), 2 tablets with every meal and at bedtime for 5 days Bactrim DS, one tablet twice daily for 3 days (Note: Many organisms are now resistant to Bactrim.) Reference: Sleisenger MH, Fordtran JS (eds): Gastrointestinal Disease: Pathophysiology, [...]

Answer: Enterotoxigenic E. coli Shigella sp. Campylobacter jejuni Plesiomonas sp. Rotavirus Cryptosporidium sp. Enteroaggregative E. coli Salmonella sp. Aeromonas sp. Norwalk virus Giardia sp. Cyclospora sp. Reference: Lichetenstein GR, Wu GD (eds): The Requisites in Gastroenterology: Vol 2: Small and Large Intestines. St. Louis, Mosby, 2003

Answer: Travelers should carefully select, handle and prepare food and dairy products. Everything should be washed thoroughly and freshly cooked. Commercially bottled water, carbonated beverages, and beer are safe-but ice is not! Reference:  Lichetenstein GR, Wu GD (eds): The Requisites in Gastroenterology: Vol 2: Small and Large Intestines. St. Louis, Mosby, 2003

Answer: Traveler’s diarrhea is a common term given to the onset of diarrhea in patients who have traveled to other countries, usually in the third world, where the enteric flora are different. Eighty percent of cases are caused by bacteria that can be transmitted via a fecal-oral route. Viruses account for 10% of cases, and [...]

Answer: The term dysentery refers to a diarrheal stool that contains inflammatory exudate (pus) and blood. Bacillary dysentery refers to infectious diarrhea caused by invasive pathogens, most commonly, Shigella, Salmonella, Campylobacter, and enteroinvasive or enterohemorrhagic Escherichia coli. Reference:  Sleisenger MH, Fordtran JS (eds): Gastrointestinal Disease: Pathophysiology, Diagnosis, and Management, 7th ed. Philadelphia, W.B. Saunders, 2003

Answer: The stool osmolar gap is < 50 mOsm/kg in secretory diarrhea but is > 50 mOsm/kg in osmotic diarrhea. Secretory diarrhea is typically unrelated to ingested foods or solutes and persists during a 24-72-hour fast, whereas osmotic diarreha stops when ingestion of the offending solute ends. Patients with a pure secretory diarrhea do not [...]

Answer: Osmotic diarrhea is caused by ingestion of excessive amounts of a poorly absorbable but osmotically active solute. Commonly implicated substances include mannitol or sorbitol (seen in patients chewing large quantities of sugar-free gum), magnesium sulfate (Epsom salt), and some magnesium-containing antacids. Carbohydrate malabsorption also may cause osmotic diarrhea through the action of unabsorbed sugars [...]