RISK FACTORS: Under-cooked poultry, meat, raw dairy products, contaminated water, mushrooms - C. jejuni,
Under-cooked pork, other meat and dairy products - Y. enterocolitica, Raw vegetables (especially sprouts), meats tainted fruit and juices
GENERAL MEASURES
• Most are self-limited syndromes and do not require specific therapy
• Oral solutions for rehydration. Sport drinks and diluted fruit juices with broth and crackers suffi cient in mild
cases.
• For moderate cases, consider 8 oz orange or apple juice plus 1/2 teaspoon honey and a pinch of salt followed by 8 oz water with 1/4 teaspoon baking soda
• Intravenous fl uid or oral rehydration solutions containing 50-100 mEq Na/L and electrolyte replacement if
necessary for more severe dehydration (particularly in the elderly)
• For infants, rehydration products (e.g., Pedialyte) provides adequate fl uid and electrolyte replacement.
Don’t use for more than 1 to 2 days without clinical reassessment of nutritional needs.
• For Health Department reporting information see Other Notes
DIET Eliminate contaminated food. Reintroduction of bland or normal age-appropriate diets as soon as
hydrated and able. Generally, no dietary restrictions are broadly recommended.
PATIENT EDUCATION
• Avoidance of raw or under-cooked foods
• Proper food storage and preparation techniques such as refrigeration
• Instruction on prevention if patient traveling to foreign countries
• Avoid antidiarrheal drugs in most cases; they may prolong the carrier state
DRUG(S) OF CHOICE :
• Antibiotic use is controversial and often of limited benefit
• For septicemias and focal infections, systemic antibiotic therapy may be indicated
• Consider antibiotics in prolonged febrile state with fecal blood and/or leukocytes or moderate to severe
traveler’s diarrhea
• Shigella: trimethoprim-sulfamethoxazole 160 mg and 800 mg, respectively, bid for five days, or ciprofloxacin (Cipro) 500 mg bid for 10 days if acquired outside the U.S.
• Campylobacter: erythromycin 250 mg qid for 5 days or ciprofloxacin (Cipro) 500 mg bid for 7 days
• Yersinia: Ceftriaxone 1 g IV qd
• Listeriosis: ampicillin plus aminoglycoside
• Traveler’s diarrhea: trimethoprim-sulfamethoxazole one double strength tablet bid for 3 days or ciprofloxacin
(Cipro) 500 mg bid for 3 days
• Bismuth subsalicylate may have anti-inflammatory and bactericidal activity
PATIENT MONITORING
• Individualized based on degree of dehydration and electrolyte imbalance, or signs of sepsis
• Close medical follow up and evaluation should be considered for persistence of symptoms unabated > 48
hours, and in infants, elderly, and immunocompromised
• Serious disturbances require hospitalization, frequent vital signs, strict recording of input and output with
appropriate fl uid replacement
PREVENTION/AVOIDANCE :
• No ingestion of raw or undercooked seafood, meats, or poultry
• Avoid any unpasteurized dairy products; juices or eggs
• Clean thoroughly any food preparation area in contact with causative items
• Ensure proper cold storage of any prepared foods not immediately consumed
• Wash hands frequently and thoroughly when handling
or preparing foods
• Be wary of frozen fruit products from developing nations
POSSIBLE COMPLICATIONS
• Cardiovascular collapse
• Arrhythmias from electrolyte disturbance
• Septicemias or other metastatic infections
• Hypoglycemic seizures or coma
EXPECTED COURSE/PROGNOSIS
• Resolution of signs and symptoms over a few days in
most cases
• Chronic sequelae include Guillain-Barré syndrome, reactive arthritis