GASTROINTESTINAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 259

psylliumhuskfiber(Metamucil®),maybeuseful.Ifdiarrheaisthepredominantsymptom,
loperamide may be helpful.
Other types of drug therapy, all of which must be administered by a physician, include
Librax®, which includes a benzodiazepine, Bentyl®, and cholestyramine. Other psycho-
active drugs, such as Elavil® and Prozac®, have been used. Treatment is directed at the
control of symptoms since no cure for this condition is known. All interventions may be
ineffectual. Fortunately, the condition is mainly a nuisance and not life threatening.
SEVERE DIARRHEAS
Severe acute diarrhea and subacute diarrhea are mostly of bacterial origin and, like less
severe diarrhea, are most frequently transmitted by fecal contamination of drinking water.
In areas where these diseases exist, all water must be carefully disinfected. Other precau-
tions are described in the discussion of traveler's diarrhea.
Experienced physicians have difficulty distinguishing different invasive bacterial
diarrheas in the wilderness. Nonphysicians in this situation cannot expect to be able to
make correct diagnoses. Individuals in any of the following categories who are considered
tohaveaninvasivegastrointestinal bacterial infectionshouldcontactamedicalcenterwith
a bacteriologic laboratory as soon as possible:
Childrenunderthreeyearsofageandadultsoversixty-five,particularlythosewithoth-
er significant illnesses
Individuals who are pregnant
Anyone with severe diarrhea lasting more than forty-eight to seventy-two hours that is
associated with any of the following:
Stools that contain blood or easily detected pus
Pronounced abdominal tenderness
Fever (morning temperature over99°F or37.2°C; evening temperature over 100°F or
37.8°C)
Dehydration (loss of more than 5 percent of usual body weight)
If timely evacuation is impossible, appropriate antimicrobial drugs should be admin-
istered. Under these circumstances, pregnant women present a special problem since some
of the drugs normally used may harm the developing child. Loperamide (Imodium®) is
safe. TMP-SMX is relatively safe for the first eight months but should be avoided at term.
The safety of ciprofloxacin (Cipro®) during pregnancy and the first eighteen years of life
has not been established, but the drug is extremely effective.
Precautions are necessary to avoid spread of the infection. An individual with one of
these diseases should be isolated as much as possible. Attendants should be limited to one
or two individuals who are scrupulous about cleanliness.
The attendants must scrub their hands vigorously, preferably with an antibacterial soap
suchasPhisoHex®orsoapcontainingBetadine®;wearprotectiverubberorplasticgloves,