GASTROINTESTINAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 254

tions only to control severe cramps or in circumstances where frequent bowel movements
wouldbehazardousorsubstantiallyinconvenientanduncomfortable.Certainlytheneedto
leave a tent in an ice and snow environment five to ten times a night would justify the use
of a medication to lessen the frequency of bowel movements.
Paregoric (tincture of opium), codeine, and diphenoxylate (Lomotil®) are effective
agentsbutarepotentiallyhabituatingandavailableonlybyprescription.Loperamide(Imo-
dium®) has similar actions, and tablets are available without a prescription. These drugs
vary in their effectiveness for different individuals. The drug most effective for each spe-
cific individual should be administered. If the initial drug is not effective, one of the others
may be tried.
Individuals with severe diarrhea (more than ten stools per day) that has persisted for
more that a few days, particularly if chills and fever are present and stools contain blood,
mucus, or pus, should seek a physician for diagnostic studies and treatment. Such infec-
tions are probably caused by invasive organisms. If such care is unavailable, many author-
ities recommend treating such prolonged or severe traveler's diarrhea with an antidiarrheal
agent such as loperamide for two days and an antibiotic such as ciprofloxacin (Cipro®)
or trimethoprim-sulfamethoxazole (TMPSMX; trade names Bactrim DS or Septra DS®),
every twelve hours for five to seven days.
The amount of rest required varies widely. Few are able to continue vigorous activities.
Most must restrict physical activity until symptoms improve or resolve.
Clostridium difficile (Pseudomembranous) Colitis
Persons taking antibiotics for infections not involving the gastrointestinal tract should be
awarethatdiarrheaoftenisasideeffectofsuchtherapy.Itshouldresolveadayortwoafter
the medication is stopped, but if diarrhea persists or worsens and abdominal cramps, fever,
weakness,andmalaisedevelop,colonicinfectionwithorganismssuchas Clostridium diffi-
cile may be the cause. Individuals with such infections are severely ill. Testing for the tox-
in is the optimum guide for therapy, but facilities are not available in the wilderness. The
antibioticshouldbestopped.(Iftheconditionforwhichtheantibioticisbeingtakeniscon-
sidered life threatening, the antibiotic should be changed.) Metronidazole (Flagyl®) may
be administered four times a day until a sophisticated medical facility can be reached. Al-
coholic beverages can cause severe vomiting for individuals receiving metronidazole and
should be avoided while taking the drug and for three days afterward.